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Pediatric dentists must comprehend children's aesthetic perception because kids are increasingly aware of their own and other children's appearance. Many aesthetic restorations are available on the market, including open-faced stainless-steel crowns, pre-veneered stainless-steel crowns, strip crowns, and polycarbonate crowns, but each has its own drawbacks. Prefabricated zirconia crowns are a new trend among pediatric dentists for restoring carious, damaged, and malformed primary molars and anteriors. Customized zirconia crowns, on the other hand, may be able to overcome the limitations of prefabricated crowns in certain situations, particularly molars, resulting in excellent aesthetics and longevity. Our case series illustrates the use and performance of personalized zirconia crowns in a variety of challenging clinical circumstances.

To find if an association could be established between Human Papilloma Virus (HPV) infection and oropharyngeal cancers (OPCs) in a group of patients known to be regular users of tobacco, and to determine the impact of HPV status on clinical outcomes.Case records of 212 patients with AJCC-7 (The American Joint Committee on Cancer 7th edition) stages II–IVB non metastatic squamous cell carcinoma of the oropharynx treated using radical radiotherapy with or without chemotherapy during the years 2015–2018 were retrieved. Formalin-fixed, paraffin-embedded blocks from oropharyngeal biopsies were available for 177 patients and were evaluated for p16 expression by immunohistochemical (IHC) staining. More than 50% nuclear staining with or without cytoplasmic staining was considered HPV+ . The association between tobacco use and HPV, as well as the influence of HPV status on survival outcomes were assessed. p16 expression was found to be positive in 23(13%) patients. Significant association was found between chewable tobacco usage and HPV positivity (p = 0.051). The median follow up was 20.5 months (range: 3–80). 5-year Overall Survival was 43.4% and 29.8% (p = 0.044) in HPV+ and HPV− patients, respectively. Local control was significantly better in HPV+ patients (38.6% vs. 25.3%, p = 0.049). There was also a trend towards improved Disease-free Survival in HPV+ patients (31 months vs. 15 months, p = 0.078). Though less in prevalence among the Indian population, improved outcomes in HPV+ OPC patients and widely available IHC HPV assays signifies the routine implementation of p16 testing in day-to-day clinical practice.

Purpose The purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR). Methods and Materials A total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound–based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores. Results We found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3–11), which increased to 12 (7–17) at 4 weeks and 9 (5–14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion. Conclusions Single-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.

Objective: Primary fallopian tube carcinoma (PFTC) is a rare entity constituting only 0.2-1.5% of all primary female genital-tract malignancies. Transitional cell carcinoma of fallopian tube is very rare constituting only around 10% of the PFTC and very less literature have been reported worldwide. Case report: A 59-year-old postmenopausal women presented with discharge per vaginum and abdominal distension, and was found to have right adnexal mass on clinical examination. Imaging findings were suggestive of a heterogenous adnexal mass and she underwent staging laparotomy. Post-operative histopathology examination confirmed a primary transitional cell carcinoma of right fallopian tube. FIGO stage was IA, and she received six cycles of adjuvant chemotherapy. The patientis nowalive, after 10-years of initial treatment.

Background: Primary adenoid cystic carcinomas (ACCs) of central trachea-bronchi system are rare and heterogeneous tumors. Definitive radiotherapy (RT) is the recommended treatment in surgically unresectable or incomplete resection or in the presence of severe comorbidities. Objective: To evaluate the clinical features and outcomes of patients with ACC of trachea-bronchi treated with radiotherapy. Methods: Retrospective medical records review was done in all patients with histologically confirmed ACC of trachea-bronchi between January 2010 and December 2019. Patient disease and treatment characteristics and toxicity data were analyzed. Overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were computed using Kaplan-Meier method (log-rank test). Results: Nineteen patients (10 women and 9 men) were included in this analysis with median age of 40 years (range, 14–70). Of these patients, 63.2% (n = 12) presented in stage IV disease. Twelve and three patients received definitive (median dose 67.8 Gy) and adjuvant (median dose 50 Gy) RT, respectively. The median follow-up was 42.5 months (range, 4–120); 15 patients were alive and 4 were dead at that time. Local recurrence or progression was observed in 52.6% and distant metastasis found in 47.3% of patients. The 5-year OS, LRFS, and DMFS for all patients were 81.2%, 52.8%, and 39.6%, respectively. Baseline lymph node involvement showed significant impact on OS (56.3% vs 100%, p = 0.011). Among patients receiving definitive RT, patients with higher RT dose (⩾66 Gy) had significantly better survival outcomes (5-year LRFS: 75% vs 16.7%, p = 0.013). Conclusion: Definitive RT is an exemplary treatment for unresectable disease. Higher dose is recommended to improve long-term outcomes.

Purpose This study aimed to calculate the expansion margins around enlarged pelvic lymph nodes to encompass internal motion and setup errors during intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer. Methods and Materials Four-dimensional computed tomography scans were obtained for 19 patients with cervical cancer, and 32 fluorodeoxyglucose-avid pelvic lymph nodes were delineated in different respiratory phases to calculate respiratory displacement. Setup variations during daily treatments were estimated from on-board imaging. Descriptive statistics were used to quantify the expansion margins using Mc Kenzie and Van Herk formulas separately. An analysis of variance was used to analyze the volumetric impact of the margins. Results Based on the McKenzie formula, an internal margin (internal target volume) of 3 mm and setup margin (planning target volume) of 5 mm was required to adequately encompass respiratory and setup uncertainties, respectively. Although the use of the Van Herk formula necessitated a single 6 mm expansion margin for all uncertainties, which resulted in a significant reduction in boost volume, inherent limitations in our methodology might pose a higher risk of target miss with such smaller margins. Conclusions An isotropic expansion margin of 3 mm for the internal target volume and 5 mm for the planning target volume is necessary for enlarged pelvic lymph nodes while planning intensity modulated radiation therapy with simultaneous integrated boost for cervical cancer.

Objective(s) This study aimed to retrospectively evaluate the toxicity and clinical outcomes in patients of locally advanced cervical cancer treated with three-dimensional conformal radiotherapy (3DCRT) and concurrent chemotherapy. Material and methods Two hundred and ten newly diagnosed patients of locally advanced cervical cancer of FIGO 2009 Stage II-III treated with 3DCRT (46 Gy/23 fractions/4½ weeks) and weekly concurrent Cisplatin (40 mg/m2), from January 2013 to 2015 were analyzed. A planning computed tomography was performed and contouring was done according to published guidelines. External radiotherapy was followed by Intracavitary brachytherapy delivered to a dose of 9 Gy HDR in 2-fractions, given one week apart. The endpoints were treatment related toxicities and clinical outcomes. Local control (LC), overall survival (OS) and disease free survival (DFS) were evaluated and toxicities were documented using the common terminology criteria for adverse events (v3.0) (CTCAE). Results The median follow up time was 37 (range, 19-54) months. The 3 year OS, DFS and LC were 84.2%, 80.6% and 81% respectively. Grade ≥3 acute skin, upper and lower gastrointestinal (GI) and genitourinary (GU) toxicity was observed in 3 (1.4%), 11 (5.2%), 12 (5.7%) and 0 (0%) patients, respectively. Grade ≤2 hematological toxicity was observed in 154 (73.3%) patients. Grade ≥3 late GI and GU toxicity was seen in 9 (4.2%) patients and 2 (0.9%) patients, respectively. Conclusion 3DCRT with concurrent chemotherapy results in good loco-regional control with acceptable normal tissue toxicity. In the background of indeterminate evidence regarding routine practice of intensity modulated radiotherapy in carcinoma of the cervix, 3DCRT may be considered as the treatment of choice.

Due to increasing number of cancer survivors, it is important to assess late side effects of treatment and quality of life (QoL). We evaluated QoL in ovarian cancer survivors (OCS) who survived at least 2 years after the treatment. QoL was measured using European Organisation of Research and Treatment for Cancer (EORTC) QLQ C-30 and QLQ OV-28 instruments. The impact of various factors was analyzed using one-way analysis of variance (Univariate ANOVA). A total of 84 OCS were found suitable for the analysis. The median Global QoL score was 83.3 (IQR: 66.6–100). The highest median score was noted for cognitive, social and role functioning (100 each). A median score of 90 and 91.6 was observed for physical and emotional functioning respectively. In symptom scale, a median score of 0 (i.e. no symptom) was reported for gastrointestinal symptoms, insomnia, and dyspnoea. In EORTC QLQ OV-28 instrument, a median score of 100, 83.3 and 33.3 was obtained for attitude to disease, body image and sexual functions, respectively. In symptom scale on the OV-28 instrument, peripheral neuropathy had the highest median score (22.2). Age, number of chemotherapy cycles, co-morbidities, obesity and stage were the factors affecting various domains of QoL. Side effects of the cancer treatment may have a life-long impact in ovarian cancer survivors. Thus it is vital to evaluate QoL even after treatment completion. Recognition of the factors influencing QoL will help in developing suitable interventions for these patients. CTRI, CTRI/2017/05/008591, Registered 18 May 2017.

Primary Mediastinal Germ Cell Tumor (PMGCT) is a rare and heterogeneous entity. These tumors are typically diagnosed in young adults and carry a poor prognosis. We conducted this study to evaluate the role of radiotherapy on treatment outcomes and prognostic factors in PMGCT that may allow a more adapted treatment strategy to improve survival. Case records of patients who presented with PMGCT over a period of 10-years from January-2009 to December-2019 were retrospectively evaluated. Survival analyses were calculated using Kaplan-Meier (Log-rank) method. Poor prognostic factors for survival were evaluated with Multivariate analysis using Cox-regression method. A total of 46-patients data was analyzed, the majority of the patients were males (95.7%) with a median age of 25-years (range, 17–62). Non-seminomatous histology was predominant (60.9%). Sixteen-patients (34.7%) presented with complications at their initial presentation. Majority of the patients were treated with multimodality approach using chemotherapy, surgery, and/or radiotherapy. At a median follow-up of 40.8 months, the 1, 3, and 5-year overall survival (OS) was 69.6%, 52.2%, and 44.7% respectively. Patients who received radiotherapy in first-line treatment showed significant improvement in 5-year OS (72% vs 30%, p = 0.004) and disease-free survival (70% vs 24%, p = 0.007) in comparison with patients who did not receive. Multivariate analysis revealed that radiotherapy, chemotherapy, surgery, and complications at presentation were independent prognostic factors for OS. PMGCTs are aggressive neoplasms especially in patients presenting with disease-related complications. Dual modality management (radiotherapy as local therapy along with chemotherapy) had shown improvement in survival.

A wide range of adjuvant treatment regimens exist in gastric carcinoma patients which include chemotherapy, radiotherapy, and/or both either sequential or concurrent. The study aimed to assess the benefit of adjuvant sequential chemotherapy followed by radiotherapy for operable gastric cancers and evaluate the prognostic factors associated with clinical outcomes. Patients of stage IB-III gastric carcinoma who underwent radical surgery followed by adjuvant treatment from January 2013 to December 2016 were analyzed retrospectively. Survival was computed using Kaplan-Meier method and prognostic factors were analyzed in multivariate analysis using Cox progression hazard model. A P value

Conservative approaches in muscle-invasive bladder cancer (MIBC) have been evolved to avoid aggressive surgery, but are limited to elderly, frail, and patients medically unfit for surgery. Our study aimed to assess the response rate of neoadjuvant chemotherapy (NACT) before radiotherapy (RT) in MIBC patients.Forty patients with urothelial carcinoma of stage T2-T4a, N0, M0 were enrolled between November 2013 and November 2015, and treated with three cycles of NACT with gemcitabine-cisplatin. Post-NACT response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Patients who achieved complete response (CR) and partial response (PR)50% were treated with radical RT, and those who had PR50%, stable disease (SD), and progressive disease (PD) underwent radical cystectomy (RC). Survival analysis was done with Kaplan-Meier method and point-to-time events were analyzed with Cox-proportional hazards regression model.After NACT, 35 (87.5%) patients achieved either PR50% or CR, and were treated with RT. Five (12.5%) patients who had PR50%, SD, or PD underwent RC. All patients who received radiation showed CR after 6 weeks. Median follow-up was 43 months (range: 10-66 months) and median overall survival (OS) was not reached. Three-year OS, local control, and disease-free survival were 70.1%, 60.9%, 50.6%, respectively, and 50% of patients preserved their functioning bladder. Three-year OS rate was 88.9% in patients who achieved CR to NACT, 73.1% in patients with PR ≥50% and 40% in patients with PR50%.NACT followed by RT provides a high probability of local response with bladder preservation in CR patients. Appropriate use of this treatment regimen in carefully selected patients may omit the need for morbid surgery.

Primary broad ligament carcinoma is a very rare occurrence with 28 reported cases worldwide, to date. The epidemiology, treatment strategy and prognosis are still uncertain because of the scarcity of cases. Currently, all broad ligament carcinomas are managed similar to epithelial ovarian cancer. We report the case of a 43-year-old female with a prolonged complaint of abdominal pain and intermittent urinary retention, requiring frequent catheterization. She was diagnosed with obstructive right hydroureteronephrosis. The abdominal Contrast Enhanced Computed Tomography (CECT) revealed a well-defined heterogeneous lesion of 2.1х3х3.2cm size in the right lateral and posterior wall of the cervix. An ultrasound (USG)-guided Fine Needle Aspiration Cytology (FNAC) of the mass was done and it was suspected to be malignant. The patient underwent total abdominal hysterectomy, right salpingo-oophorectomy, pelvic lymph-nodal sampling, and peritoneal washing. Histological examination depicted an endometrioid adenocarcinoma of the broad ligament. She received adjuvant chemotherapy, followed by hormonal therapy. It has been five years since her surgery, and she is now alive and disease free.

Adenoid cystic carcinoma is a relatively rare tumour arising from salivary glands of head and neck region. Surgery and radiotherapy form standard treatment modalities in the management of this tumor. In this analysis we present results of multimodality treatment in our cohort of patient. This retrospective analysis evaluated results of treatment in forty patients diagnosed with adenoid cystic carcinoma of the head and neck. Evaluation was done to identify prognostic factors affecting the disease free survival. A median disease free survival of 34 ± 2.42 (Median ± SE) versus 10 ± 5.45 months was seen in patients undergoing surgery followed by post operative radiotherapy versus radiotherapy alone (P = 0.01). A radiotherapy dose more than 60 Gy was associated with a better disease free survival compared with patients receiving less than 60 Gy (P = 0.01). Positive surgical margins and perineural invasion were associated with a poor treatment outcome (P = 0.02) Patients with c-kit positive status showed a poor local control rate (P = 0.05).

Intuition into the molecular pathways of glioblastoma multiforme (GBM) has changed the diagnostic, prognostic, and therapeutic approaches. We investigated the influence of various clinical and molecular prognostic factors on survival outcomes in radically treated GBM patients.Medical records of 160 GBM patients treated between January-2012 and December-2018 with surgery followed by post-operative external beam radiotherapy (EBRT) with/without temozolomide (TMZ) were reviewed. Immunohistochemical (IHC) assays were performed for IDH1mutation, ATRX loss, TP53 overexpression and Ki-67% index. Apart from disease and treatment-related factors' influence on clinical outcomes, the impact of IHC markers in prognostication was analyzed using appropriate statistical tests.The median overall survival (OS) was 14 months. EBRT with concurrent TMZ was given to 60% of patients and 42.5% completed the standard Stupp-protocol. Significant improvements in OS was observed in patients aged ≤ 50years (2-year OS: 22.1% vs. 12.5%, p = 0.001), those who underwent gross total resection (2-year OS: 21.8% vs. 12.8%, p = 0.002), received concurrent TMZ (21.9% vs. 12.5%, p = 0.005), completed the entire Stupp-protocol (2-year OS: 23.4% vs. 6.5%, p = 0.000), and with Ki-67 index20% (2-year OS: 23.3% vs. 11.6%, p = 0.015). On multivariate analysis, IDH1 mutation, ATRX loss, TP53 expression, and Ki-67 ≤ 20% were significant prognosticators of outcomes.GBM patients treated with concurrent chemoradiation and those who completed the full Stupp-protocol experienced better survival outcomes. Molecular biology significantly impacts clinical outcomes and plays a key deterministic role in newer management strategies.

Background: The available literature confirms the effectiveness of intraligamentary injections equal to nerve blocks and articaine equal to lignocaine with better depth of penetration for single tooth pulpectomy procedures with less postoperative soft tissue trauma. An advancement in the field of local anesthesia delivery is the Single Tooth Anesthesia-Wand (STA-Wand) which is relatively pain-free and offers comfort to the child. Aims: This study aims to evaluate and compare the anesthetic effectiveness and postoperative complications of 4% articaine and 2% lignocaine intraligamentary injection administered as single tooth anesthesia using a computer-controlled local anesthetic delivery system, the STA-Wand. Settings and Design: Using a randomized, split-mouth, cross-over study design, twenty children aged 4–10 years who required bilateral mandibular pulpectomies were administered intraligamentary injections with 4% articaine and 2% lidocaine in two appointments using STA-Wand. Pain, anxiety, and cooperation levels were scored by an operator and an observer at four phases of treatment using Wong-Baker Faces Pain Rating Scale and Two-6 point Co-operation Anxiety Rating Scale. Results were tabulated and analyzed. Statistical Analysis: Mann–Whitney U-test, paired t -test, and Student's t -test. Results: Both the local anesthetic agents were equally effective with no significant difference ( P > 0.05) throughout rest of the treatment procedure compared to injection phase in minimizing pain, anxiety, and gaining the cooperation levels of children whereas during injection phase, 4% articaine showed superior effectiveness in minimizing pain compared to 2% lignocaine ( P = 0.054). Conclusion: Both the local anesthetic agents delivered using STA-Wand is clinically acceptable, effective, and safe for usage in children.

Background: Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques. Methods: Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/m 2 weekly or 100 mg/m 2 thrice weekly. Results: The incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073). Conclusion: SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers. World J Oncol. 2017;8(4):117-121 doi: https://doi.org/10.14740/wjon1049w Correction in World J Oncol. 2017;8(5):174-174, https://doi.org/10.14740/wjon1049wc1

Epithelial ovarian cancers typically spread by intraperitoneal exfoliation and retroperitoneal lymph nodal involvement along the ovarian vascular supply. Pericardial involvement in ovarian malignancies is very rare with only few cases reported in the literature. Malignancy is the most common cause for pericardial effusion in the western world. In this case report, we present a 58-year-old woman treated for high-grade serous carcinoma of the ovary in 2010, relapsed with pericardial effusion and cardiac tamponade in 2017. Imaging studies revealed gross pericardial effusion. Two-dimensional echocardiogram showed massive pericardial effusion, with cardiac tamponade, New York Heart Association—IV. Pericardiocentesis and pigtail drain was placed under echo guidance. Immunocytochemistry has confirmed the tumour cells to be of the ovarian origin. The patient underwent surgical pericardial window via thoracotomy, followed by paclitaxel and carboplatin-based chemotherapy and olaparib maintenance.

Objective Intracranial germ cell tumors (GCTs) are relatively rare neoplasms, representing 2–3 % of paediatric brain tumors in Western countries and 8–15 % in East Asia. Here, we discuss the clinical features and treatment outcomes in patients with central nervous system (CNS) GCTs treated at our institute. Methods Medical records of all primary CNS GCT patients were retrieved retrospectively from 2007 to 2019. Demographic, clinical, treatment and follow up details were entered in a predesigned proforma. Overall survival (OS) and progression-free survival was computed using Kaplan-Meier method and Log-Rank test. Effect of various prognostic factors on survival outcomes was assessed by univariate and multivariate analysis. Results A total of 28 CNS GCT patients were included in this analysis. Median age at presentation was 17 years (range, 7–45 years) with a male to female ratio of 1.8:1. Pineal region was the commonest location, encountered in 15 patients (53.6 %). Pure germinoma was the most frequent histology observed, seen in 19 patients (67.9 %). Male gender and germinoma histology were highly associated with pineal location (p = 0.043 and p = 0.052, respectively). Fourteen patients underwent surgical intervention and nine patients underwent biopsy for diagnostic purpose or to relieve the obstructive symptoms. Only 23 patients (82.1 %) received chemotherapy. However, all patients received radiotherapy (Craniospinal irradiation/whole brain radiotherapy/whole ventricular radiotherapy/ or local radiotherapy). After a median follow-up of 53 months (range, 7–150), 23 patients (82.1 %) were alive. OS was significantly affected by histology (89 % in germinoma vs. 60 % in non-germinomatous, p = 0.054) and location (93 % in pineal region vs. 64.2 % in other location, p = 0.042). Age, gender and surgery did not have any impact on the survival outcomes. Conclusion CNS GCTs are relatively rare and heterogeneous neoplasms commonly seen in pineal and suprasellar locations. A combination of chemotherapy and radiotherapy had shown excellent outcomes.

Background Ovarian cancer leaves a detrimental effect on sexual health due to treatment modalities, hormonal imbalance, inability to accept body image after treatment related deformity and other psychological reasons. As the proportion of ovarian cancer survivors is increasing, it is very important to address the issue of sexual health in these patients, an issue which is generally unaddressed. The aim of our study was to asses sexual health in patients treated for ovarian cancer who were disease free at the time of analysis. Methods This single institute prospective study was conducted from April 2017 to November 2017. During the routine follow up visit to the hospital, patients who were disease free were recruited in the study. European Organisation of Research and Treatment for Cancer (EORTC) QLQ-OV 28 questionnaire was used to assess the sexual health. The impact of various factors on quality of life (QOL) scores was analysed using one-way analysis of variance (Univariate ANOVA). A p value of Results A total of 84 ovarian cancer patients were recruited. Median age at presentation was 45 years. All patients were clinically and biochemically disease free at the time of analysis. Seventy-two patients were married whereas 12 women were either unmarried or divorced or widows. Out of these 72 women, only 34 (47%) women were found to have had sex in last 3 months. A median score of 33.3 (22.2-66.6) was recorded for sexual function in QLQ-OV 28 questionnaire which was lesser than other domains of functional scale. The sexual score was significantly affected by presence of co-morbidities (p Conclusions Sexual health is a fundamental quality of life domain which is often compromised and underestimated in ovarian cancer patients. The present study showed that diagnosis and treatment of ovarian cancer has a negative impact on sexual health. As the proportion of ovarian cancer survivors continuously rising, there is a need to acknowledge and address the impact of treatment on sexual health. Legal entity responsible for the study The authors. Funding Has not received any funding. All authors have declared no conflicts of interest.

Objectives: The present study was undertaken to evaluate and compare the apical extrusion of irrigant and depth of irrigant penetration into dentine using the EndoVac irrigating system and manual irrigation system in primary molar teeth. Study Design: Twenty five extracted primary molars satisfying the inclusion and exclusion criteria were divided into two groups with 29 roots in each group with an equal distribution of apical foramen area. The teeth were mounted in pre-weighed glass bottles and the canals were irrigated with 5.25% sodium hypochlorite solution mixed with acid fuchsin using either of irrigating systems according to the group ascertained. The amount of irrigant extruded was recorded. The roots were sectioned at two mm, four mm and six mm from the apex and examined under a stereomicroscope for depth of irrigant penetration. Results: Apical extrusion of the irrigant solution was significantly less with the EndoVac system (1.18±1.04) when compared with the manual irrigation system (2.3±1.55) (P=0.002)*. Results showed that greater irrigant penetration was achieved using the EndoVac irrigation system compared to the manual irrigation system (P= 0.000)*. With both the irrigation systems, the depth of irrigant penetration was better in the six mm sections followed by the four mm sections and two mm sections (P=0.000)*. Conclusion: The EndoVac irrigation system demonstrated better efficacy compared to manual irrigation system with less apical extrusion and better depth of irrigant penetration into dentine.

Carcinoma of nasopharynx is a radiosensitive tumor and therapeutic response during radiation treatment can result in dosimetric variations in the delivered dose to the tumor and critical organs. This study was done to evaluate the volumetric and dosimetric changes seen in tumor tissue and organs at risk in a mid treatment planning scan and its implications for adaptive replanning. Twenty patients of locally advanced carcinoma nasopharynx were evaluated. All patients were started on treatment with a baseline treatment plan on SIB-VMAT. To evaluate volumetric and dosimetric changes during treatment, a mid treatment CT scan (MTS) was taken at the 17

Objectives. Locoregional recurrence is the predominant pattern of treatment failure in advanced head and neck cancers. Reirradiation is a useful modality to treat inoperable head and neck cancer patients with recurrent disease. The aim of the present study was to analyze the treatment toxicity and early clinical outcomes in patients undergoing reirradiation. Methods. Twenty patients of head and neck cancers with recurrences or second cancers were evaluated. Reirradiation was done using simultaneous integrated boost volumetric modulated arc therapy (SIB VMAT), intensity modulated radiotherapy (IMRT), or conventional radiotherapy using 6MV photons. Dose prescription ranged from 30 to 60 Gy in conventional fractionation. Results. Seventeen males and three females were evaluated in this analysis. The median age of patients under study was 56.5 years. At time of analysis 8 patients (40%) had a complete response, 7 patients (35%) had progressive disease, and 25% had partial response or stable disease. Grade III-IV mucositis, dermatitis, xerostomia, dysphagia, and trismus were seen in 20%, 20%, 50%, 35%, and 45% patients, respectively, during retreatment. Patients receiving a radiotherapy dose less than 45 Gy showed a higher incidence of progressive disease (p=0.01). The median disease-free survival for patients receiving reirradiation dose of ≥46 Gy was 19±3.3 months (median ± S Error) compared to 8±2.61 months for those with a dose prescription less than 45 Gy (p=0.03). At 18-month follow-up 26% of patients undergoing reirradiation were disease-free. Conclusions. Our results show improved tumor control using a prescription of doses ≥46 Gy in retreatment setting.

Objective: The present study was undertaken to evaluate and compare the apical extrusion of irrigant and depth of irrigant penetration into the dentinal tubules using the EndoVac irrigating system and the manual irrigation system in primary molar teeth. Study design: Twenty five extracted primary molars satisfying the inclusion and exclusion criteria were divided into two groups of 29 roots in each group with an equal distribution of apical foramen area. The teeth were mounted in pre-weighed glass bottles and the canals were irrigated with both the irrigating systems using 5.25% sodium hypochlorite solution mixed with acid fuchsin which enables the irrigating solution to penetrate efficiently into the dentinal tubules. The amount of irrigant extruded was recorded. The roots were sectioned at 2mm, 4mm and 6mm from the apex and examine the depth of irrigant penetration into the dentinal tubules under a stereomicroscope. Results: Apical extrusion of the irrigant was significantly less with the EndoVac system (1.18±1.04gms) when compared to manual irrigation system (2.3±1.55gms) (P

Poor oral intake and associated nutritional depletion can affect treatment outcome in locally advanced head and neck cancers. The aim of this study was to evaluate the pre radiotherapy nutritional status as a predictor for response to radiotherapy treatment.Fifty patients of locally advanced head and neck cancers undergoing radical chemoradiotherapy were evaluated in this prospective analysis. Patients were treated with definitive radiotherapy to a total dose of 60-70 Gy along with concurrent chemotherapy with injection Cisplatin 100mg/m2 delivered three weekly. The patients were evaluated for pre-treatment nutritional status using the Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire. The PG-SGA evaluation was completed just before starting radiotherapy treatment and scores correlated to treatment outcome.Forty-seven male and three female patients were evaluated in this analysis. The median PG-SGA score was 8 with a range from 2-14.Grade 3-4 mucositis was seen in seven patients (21.8%) with PGSGA9 compared to 55.5% in those with PG-SGA score = 9 (p=0.01). At the time of evaluation a complete response was seen in 16 patients (32%) with a PG-SGA score9 compared to 4 patients (8%) with a PGSGA =9 (p=0.05). The median survival was 16±2.8months (Median ±S. Error) and 17±2.9 months in those with PG-SGA9 and =9 respectively (p=0.49, log rank).PG-SGA nutritional score9 is associated with a better local control and acute toxicity profile in radically treated head and neck cancer patients.

Aim: The purpose of this study was to determine the closest matching shade for primary maxillary anterior teeth from the most widely used Vitapan classical shade guide available for permanent teeth. Materials and Methods: A total of 313 children aged between 3 and 5 years were evaluated. Vitapan classical shade guide was used to determine the shade of six primary maxillary anterior teeth. Scores obtained were noted down in a scoring sheet and values were tabulated. Data collected were tabulated and statistically analyzed using Pearson Chi-square test. Results: A1 was found to be the closest matching shade for primary maxillary anterior teeth. D3 was found to be the least prevalent shade for primary maxillary anterior teeth. There was no statistical significant difference in the shades among teeth of same quadrant (p > 0.05) and also between teeth of right and left quadrants (p > 0.05), respectively. Conclusion: A1 shade of Vitapan classical shade guide is the most prevalent shade for primary maxillary anterior teeth and can be satisfactorily reproduced to all primary maxillary anterior teeth in general.

Background: Delivery of effective dental treatment to a child patient requires thorough knowledge to recognize dental fear and its management by the application of behavioral management techniques. Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) helps in identification of specific stimuli which provoke fear in children with regard to dental situation. Audiovisual modeling can be successfully used in pediatric dental practice. Aim: To assess the degree of fear provoked by various stimuli in the dental office and to evaluate the effect of audiovisual modeling on dental fear of children using CFSS-DS. Materials and Methods: Ninety children were divided equally into experimental (group I) and control (group II) groups and were assessed in two visits for their degree of fear and the effect of audiovisual modeling, with the help of CFSS-DS. Results: The most fear-provoking stimulus for children was injection and the least was to open the mouth and having somebody look at them. There was no statistically significant difference in the overall mean CFSS-DS scores between the two groups during the initial session (P > 0.05). However, in the final session, a statistically significant difference was observed in the overall mean fear scores between the groups (P < 0.01). Significant improvement was seen in group I, while no significant change was noted in case of group II. Conclusion: Audiovisual modeling resulted in a significant reduction of overall fear as well as specific fear in relation to most of the items. A significant reduction of fear toward dentists, doctors in general, injections, being looked at, the sight, sounds, and act of the dentist drilling, and having the nurse clean their teeth was observed.

Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques.Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/mThe incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073).SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers.

Background: Restoration of carious primary molars is still a major concern while treating the young children that too in deep carious lesion which extends below the cemento-enamel junction (CEJ) where pulp protection and achieving adequate marginal seal are very important to prevent secondary caries. The needs were met with the development of new materials. One such of new bioactive material is tricalcium silicate-based restorative material (Biodentine), recommended for restoring deep lesions. Aim: To evaluate and compare shear bond strength and microleakage of tricalcium silicate-based restorative material (Biodentine) and glass ionomer cement (Fuji IX GP) in primary and permanent teeth. Materials and Methods: Occlusal surface of crowns were ground flat. PVC molds were stabilized over flat dentin surface and filled with tricalcium silicate-based restorative material (Biodentine)/glass ionomer cement (Fuji IX GP) according to group ascertained. Shear bond strength was evaluated using universal testing machine (INSTRON). Standardized Class II cavities were prepared on both primary and permanent teeth, and then restored with tricalcium silicate-based restorative material (Biodentine)/glass ionomer cement (Fuji IX GP) according to group ascertained, over which composite resin material was restored using an open sandwich technique. Microleakage was assessed using dye penetration. Microleakage was examined using a stereomicroscope. Results: Results showed that glass ionomer cement (Fuji IX GP) exhibited better shear bond strength than tricalcium silicate-based restorative material (Biodentine). Mean microleakage score for glass ionomer cement (Fuji IX GP) in permanent teeth was 1.52 and for primary teeth was 1.56. The mean microleakage for tricalcium silicate-based restorative material (Biodentine) in permanent teeth was 0.76 and for primary teeth was 0.60. Glass ionomer cement (Fuji IX GP) exhibited more microleakage than tricalcium silicate-based restorative material (Biodentine), which was statistically significant both in permanent (P = 0.02) and primary (P = 0.006) teeth. Conclusion: Shear bond strength of glass ionomer cement (Fuji IX GP) is greater than tricalcium silicate-based restorative material (Biodentine) in both primary and permanent teeth. Tricalcium silicate-based restorative material (Biodentine) exhibited less microleakage compared to glass ionomer cement (Fuji IX GP) in both primary and permanent molars.