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This review will compare the efficacy of nasoalveolar molding plates fabricated using a digital workflow to conventional fabrication methods or no intervention in infants with cleft lip or palate.Nasoalveolar molding reduces the severity of orofacial defects in infants with cleft lip or palate using a series of adaptable plates for the maxillary arch. The conventional method needs multiple patient visits at short intervals for treatment. A digital workflow can be used to fabricate multiple plates in one appointment, which eliminates human error, reduces the number of appointments, and allocates more time for patient care for the orthodontic team than appliance fabrication.This review will consider clinical studies that report the results of digital nasoalveolar molding in infants with cleft lip or palate and compare it to the conventional method or to no treatment. Outcomes of interest will be objective measures of craniofacial form, nasolabial measurements, or palatal form.This review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including PubMed, Embase, Cochrane Oral Health Group Trial Register, and ClinicalTrials.gov will be searched using appropriate keywords. Publications in English will be considered. Screening based on titles and abstracts will be done after de-duplication, followed by full-text reading for selection based on the inclusion criteria. Data extracted from the studies will be tabulated and assessed for risk of bias. If applicable, a meta-analysis of the pooled data will be conducted.PROSPERO CRD42020186452.

Background Pseudomonas aeruginosa, a major respiratory pathogen, has been isolated from peri-implant sites and is associated with dental implant failure. This in-vitro study (part 1) aimed to fabricate a novel mucoadhesive silver nanoparticle-based local drug delivery chip, evaluate its antimicrobial efficacy against P. aeruginosa, and its safety for the treatment of peri-implantitis. Materials and methods Silver nanoparticles were synthesized and characterized using a transmission electron microscope (TEM). The local drug delivery chip was fabricated using gelatin, glycerol, silver nanoparticle solution (2.5 μg/ml, 5 μg/ml, 7.5 μg/ml, and 10 μg/ml), glutaraldehyde, and sodium alginate solution. These chips were evaluated for physical parameters, effect on viability of murine macrophage cell line J774A.1, and antimicrobial activity (using Kirby-Bauer disc diffusion method with 18 h incubation period) against P. aeruginosa ATCC 27853. Results Silver nanoparticle antimicrobial chip exhibited dimensions of 4 mm × 5 mm x 0.4 mm, 5.8 mg weight, pH 5–6, folding endurance 1.04, and one-year stability. P. aeruginosa was susceptible to ≥ 7.5 μg/ml concentration of silver nanoparticles (spherical shape with particle size ranging from 10 to 100 nm). Murine macrophage cells exhibited 93% viability after 24 h incubation with silver nanoparticle chips. Conclusion The novel silver nanoparticle chip showed dimensional stability, minimal effect on murine macrophage cell viability, and significant antimicrobial activity against P. aeruginosa. With the further establishment of its effective dosage and safety, this chip could be used as an adjunct to mechanical debridement (as a non-aerosol generating procedure) in treating peri-implantitis, especially during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

Finding new, safe strategies to prevent and control rheumatoid arthritis is an urgent task. Bioactive peptides and peptide‐rich protein hydrolyzate represent a new trend in the development of functional foods and nutraceuticals. The resulting tissue hydrolyzate of the chicken embryo (CETH) has been evaluated for acute toxicity and tested against chronic arthritis induced by Freund's full adjuvant (modified Mycobacterium butyricum) in rats. The antiarthritic effect of CETH was studied on the 28th day of the experiment after 2 weeks of oral administration of CETH at doses of 60 and 120 mg/kg body weight. Arthritis was evaluated on the last day of the experiment on the injected animal paw using X‐ray computerized microtomography and histopathology analysis methods. The CETH effect was compared with the non‐steroidal anti‐inflammatory drug diclofenac sodium (5 mg/kg). Oral administration of CETH was accompanied by effective dose‐dependent correction of morphological changes caused by the adjuvant injection. CETH had relatively high recovery effects in terms of parameters for reducing inflammation, inhibition of osteolysis, reduction in the inflammatory reaction of periarticular tissues, and cartilage degeneration. This study presents for the first time that CETH may be a powerful potential nutraceutical agent or bioactive component in the treatment of rheumatoid arthritis., Finding new, safe strategies to prevent and control rheumatoid arthritis is an urgent task. Bioactive peptides and peptide‐rich protein hydrolyzate represent a new trend in the development of functional foods and nutraceuticals. This study presents for the first time that CETH may be a powerful potential nutraceutical agent or bioactive component in the treatment of rheumatoid arthritis.

Data sources The electronic databases Medline, the Cochrane Central Register of Controlled Trials, Embase, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Data, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform, from inception to September 2020, were searched to identify the eligible studies measuring the association between periodontal disease and Alzheimer's disease or mild cognitive impairment.Study selection Cohort, cross-sectional and case-control studies, without any language restrictions, were selected by two reviewers independently.Data extraction and synthesis Data extraction and quality assessment were performed by two reviewers independently. Data was synthesised quantitatively with meta-analyses using a random or fixed-effects model, with P0.1 considered statistically significant. Quality assessment of cohort and case-control studies was carried out using the Newcastle-Ottawa scale (NOS) and quality assessment of cross-sectional studies was undertaken using the Agency for Healthcare Research and Quality (AHRQ) tool. Heterogeneity of included studies was assessed with I2.Results Thirteen studies, including five cross-sectional studies, five case-control studies, two retrospective cohort studies and one prospective cohort study were found to be eligible. Meta-analyses showed elevated risk for Alzheimer's disease (odds ratio = 1.78; random-effects model; significant heterogeneity) and mild cognitive impairment (odds ratio = 1.60; fixed-effects model; low heterogeneity) in patients with periodontal disease. One case-control study and all cohort studies had high quality, while four case-control studies had medium quality, as evaluated by the NOS. Among the cross-sectional studies evaluated by the AHRQ tool, only one had high quality, whereas other studies had medium quality.Conclusions Within the limitations of the included studies, the authors concluded that periodontal disease is related to an elevated risk of Alzheimer's disease and mild cognitive impairment.

The signaling mechanisms for Porphyromonas gingivalis lipopolysaccharide (PgLPS)-induced inflammation in human dental pulp cells are not fully clarified. This in vitro study aimed to evaluate the involvement of phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway in PgLPS-induced pulpal inflammation.Human dental pulp cells (HDPCs) were challenged with PgLPS with or without pretreatment and coincubation with a PI3K/Akt inhibitor (LY294002). The gene or protein levels of PI3K, Akt, interleukin (IL)-6, IL-8, alkaline phosphatase (ALP), osteocalcin and osteonectin were analyzed by reverse transcription polymerase chain reaction (PCR), real-time PCR, western blotting, and immunofluorescent staining. In addition, an enzyme-linked immunosorbent assay was used to analyze IL-6 and IL-8 levels in culture medium.In response to 5 μg/ml PgLPS, IL-6, IL-8, and PI3K, but not Akt mRNA expression of HDPCs, was upregulated. IL-6, IL-8, PI3K, and p-Akt protein levels were stimulated by 10-50 μg/ml of PgLPS in HDPCs. PgLPS also induced IL-6 and IL-8 secretion at concentrations higher than 5 μg/ml. Pretreatment and co-incubation by LY294002 attenuated PgLPS-induced IL-6 and IL-8 mRNA expression in HDPCs. The mRNA expression of ALP, but not osteocalcin and osteonectin, was inhibited by higher concentrations of PgLPS in HDPCs.P. gingivalis contributes to pulpal inflammation in HDPCs by dysregulating PI3K/Akt signaling pathway to stimulate IL-6 and IL-8 mRNA/protein expression and secretion. These results are useful for understanding the pulpal inflammation and possible biomarkers of inflamed pulp diagnosis and treatment.

Aim This study aimed to compare the long-term outcome of implant therapy in partially edentulous patients with severe periodontitis compared to those with no history of periodontitis.Design Retrospective cohort study.Cohort selection Eighty-eight patients (34 men and 54 women; age ranging from 28 to 45 years) with severe periodontitis (47 patients with 108 implants) and no history of periodontitis (41 patients with 78 implants) were included in this institutional study. All these cohorts had received implants 6-8 years previously.Data analysis Probing pocket depth, radiographic marginal bone level and peri-implantitis were the primary outcomes, while bleeding on probing was the secondary outcome. The effect of variables was measured by odds ratio with 95% confidence interval. Both patient-level and implant-level analyses were used to evaluate the association between peri-implantitis and potential risk factors. In addition, the association between probing pocket depth and radiographic marginal bone level with potential risk factors was assessed at implant-level analyses. In contrast, for patient-level data, a positive relationship was assessed with the Chi-square test.Results Patients with a history of severe periodontitis (OR = 11.13; p = 0.045), implants with a lack (2 mm) of peri-implant keratinised mucosa (OR = 14.94; p0.001) and implants placed in bone-grafted sites (OR = 4.93; p = 0.047) were associated with greater risk of peri-implantitis, at 6-8 years post-implant placement. The risk of developing radiographic marginal bone level ≥3 mm was significantly greater (OR = 1.20; p0.001) in patients with higher full-mouth bleeding scores. The chance of peri-implant bleeding on probing was independently and especially higher in patients who brushed their teeth at most once per day (OR = 3.20; p = 0.04), with higher full-mouth bleeding score values (OR = 1.16; p0.001) and irregular recall visits (OR = 15.34; p = 0.001).Conclusion This retrospective cohort study concluded that partially edentulous patients with a history of severe periodontitis were more prone to develop peri-implantitis at 6-8 years post-implant placement.

Camphorquinone (CQ) and resin monomers are included in dentin bonding agents (DBAs) and composite resin to restore tooth defects due to abrasion, crown fracture, or dental caries. DBAs, CQ, and bisphenol A-glycidyl methacrylate (BisGMA) applications influence the biological activities of the dental pulp. The current investigation aimed to delineate the effect of DBAs, CQ, and BisGMA on cathepsin L production/expression, lysosomal activity, and autophagy induction in human dental pulp cells (HDPCs). HDPCs were exposed to DBAs, CQ, or BisGMA with/without inhibitors for 24 h. Enzyme-linked immunosorbent assay was employed to determine the cathepsin L level in culture medium. The cell layer was utilized to measure cell viability by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl -tetrazolium bromide (MTT) assay. Real-time PCR was used to evaluate the mRNA expression. Western blotting or immunofluorescent staining was used to study protein expression. Lysosomal density was evaluated by lysotracker red staining. We found that DBAs, CQ, and BisGMA stimulated cathepsin L mRNA, protein expression, and production in HDPCs. In addition, CQ and BisGMA induced lysosomal activity, Beclin1, ATG12, LC3B, Bax, and p53 expression in HDPCs, indicating the stimulation of autophagy. Glutathione (GSH) prevented CQ- and BisGMA-induced cytotoxicity. Moreover, E64d, cathepsin L inhibitor (two cathepsin inhibitors), and Pifithrin-α (a p53 inhibitor) showed little preventive effect toward CQ- and BisGMA-induced cytotoxicity. Autophagy inhibitors (NH4Cl, Lys05) mildly enhanced the CQ- and BisGMA-induced cytotoxicity. These results indicate that DBAs stimulated cathepsin L, possibly due to their content of CQ and BisGMA that may induce cathepsin L in HDPCs. CQ and BisGMA stimulated lysosomal activity, autophagy, and apoptosis, possibly via induction of Beclin 1, ATG12, LC-3B, Bax, and p53 expression. In addition, CQ and BisGMA cytotoxicity was related to redox change and autophagy. These events are important role in pulpal changes after the restoration of tooth decay using CQ- and BisGMA-containing DBAs and resin composite.

Aim This study aimed to investigate periodontal disease as a non-genetic risk factor for oral cancer.Design Case-control study.Patient population Two hundred patients, regardless of periodontal and adverse habits (smoking and alcohol) status, in the age group of 18-90 years were included in this institutional study. One hundred patients with histologically confirmed oral squamous cell carcinoma (OSCC) were included in the case group, while the control group had 100 patients without any oral cancer.Methods Multivariable examination to obtain socioeconomic and lifestyle risk factors was performed with a questionnaire for both the groups and compared statistically. Additionally, oral status (periodontal stage, clinical attachment loss, periodontal pocket depth, bleeding on probing, Silness-Loe plaque index, and decayed, missing, and filled teeth [DMFT] index) of both the groups was recorded and compared statistically.Results A significant correlation was found between age, gender and development of oral cancer. There was a significant co-relation between alcohol intake and oral cancer development. Surprisingly, there was no correlation between smoking habits and passive smoking with oral cancer development in the case group. Overall, 72.1% of case group patients had Stage 4 periodontitis, whereas 51.6% of control group patients had Stage 2 periodontitis. A significant correlation was found between the incidence of oral cancer and the stage of periodontitis.Conclusion The findings of the study support the hypothesis that periodontitis is an independent risk factor for oral cancer.

BACKGROUND: Pseudomonas aeruginosa, a major respiratory pathogen, has been isolated from peri-implant sites and is associated with dental implant failure. This in-vitro study (part 1) aimed to fabricate a novel mucoadhesive silver nanoparticle-based local drug delivery chip, evaluate its antimicrobial efficacy against P. aeruginosa, and its safety for the treatment of peri-implantitis. MATERIALS AND METHODS: Silver nanoparticles were synthesized and characterized using a transmission electron microscope (TEM). The local drug delivery chip was fabricated using gelatin, glycerol, silver nanoparticle solution (2.5 μg/ml, 5 μg/ml, 7.5 μg/ml, and 10 μg/ml), glutaraldehyde, and sodium alginate solution. These chips were evaluated for physical parameters, effect on viability of murine macrophage cell line J774A.1, and antimicrobial activity (using Kirby-Bauer disc diffusion method with 18 h incubation period) against P. aeruginosa ATCC 27853. RESULTS: Silver nanoparticle antimicrobial chip exhibited dimensions of 4 mm × 5 mm x 0.4 mm, 5.8 mg weight, pH 5–6, folding endurance 1.04, and one-year stability. P. aeruginosa was susceptible to ≥ 7.5 μg/ml concentration of silver nanoparticles (spherical shape with particle size ranging from 10 to 100 nm). Murine macrophage cells exhibited 93% viability after 24 h incubation with silver nanoparticle chips. CONCLUSION: The novel silver nanoparticle chip showed dimensional stability, minimal effect on murine macrophage cell viability, and significant antimicrobial activity against P. aeruginosa. With the further establishment of its effective dosage and safety, this chip could be used as an adjunct to mechanical debridement (as a non-aerosol generating procedure) in treating peri-implantitis, especially during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

The research directions in oral heath in India have largely been deficient. The poor standard of research and its methodology is of grave concern. The applications of novel technologies and translating the newer researches for the benefit of community’s diagnosis, prevention and treatment needs, must be a priority in years to come. As a part of three paper series, the present paper brings forth the burden, current research and future research directions in the field of malocclusion and dentofacial anomalies in India. Malocclusion effects nearly 45% of adolescents, 1/3 of which require orthodontic care. Although technological advances in material sciences and advanced digital technology has refined the appliances much less attention has been paid on etiology and biological basis of orthodontics. The congenital birth defects of face and other denfofacial deformities also require a deeper understanding of etiology and most appropriate treatment protocol. This Manuscript summarizes current research and proposes future areas of research in this field.

Periodontal disease, a cumulative result of neglected oral hygiene, is one of the biggest oral health problem in India. Although the latest researches have paved way to splendid measures for regeneration and rehabilitation, the most feasible strategy is still the prevention at the earliest possible stage of periodontal destruction. Other major areas of neglect and lack of public awareness are geriatric dentistry and patients with special health care needs. This paper attempts to elaborate on the burden, past research and future research directions in less addressed aspects of Periodontal diseases, Geriatric Dentistry and patients with special health care needs.

Finding new, safe strategies to prevent and control rheumatoid arthritis is an urgent task. Of particular interest in this regard are bioactive peptides and peptide-rich protein hydrolyzates, which represent a new trend in the development of functional foods and nutraceuticals. The resulting tissue hydrolyzate of the chicken embryo (CETH) has been evaluated for acute toxicity and tested against chronic arthritis induced by Freund's full adjuvant in rats. The anti-arthritic effect of CETH was studied on the 28th day of the experiment after two weeks of oral administration of CETH at doses of 60 and 120 mg/kg body weight. Arthritis was evaluated on the last day of the experiment on the injected animal paw using X-ray computerized microtomography and histopathology analysis methods. The CETH effect was compared with the non-steroidal anti-inflammatory drug diclofenac sodium (5 mg/kg). Oral administration of CETH was accompanied by effective dose-dependent correction of morphological changes caused by the adjuvant injection. CETH had relatively high recovery effects in terms of parameters for reducing inflammatory edema, inhibition of osteolysis, prevention of osteophitosis, reduction of the inflammatory reaction of periarticular tissues, and cartilage degeneration. This study presents a potential theoretical strategy for the safe correction of this pathological process and, for the first time, shows that CETH may be a powerful potential nutraceutical agent or bioactive component of functional products in the treatment of rheumatoid arthritis.

Periodontitis is microbial infection affecting periodontium, the tooth supporting structure and affects >743 million people worldwide. Neural crest-derived stem cells (NCSCs) hold the promise to regenerate the damaged periodontium. These cells have been identified within adult adipose tissue, periodontal ligament, and palatal tissue. Typical enzymatic isolation protocols are expensive, time consuming and often not clinically compliant. Enzyme-free, mechanical dissociation has been suggested as an alternative method of generating cell suspensions required for cell separation and subsequent expansion ex vivo. In our study, samples of rat skeletal muscle tissue were used to appraise the suitability of a novel mincing method of mechanical dissociation against enzymatic digestion with collagenase and dispase. Skeletal muscle is readily available and has been shown to contain NCSC populations. We used a Rigenera-Human Brain Wave® prototype mincer to produce a suspension of skeletal muscle-derived cells modeling NCSCs. We have compared the resulting cell cultures produced via mechanical dissociation and enzymatic dissociation, producing single cell suspensions suitable for Magnetic Cell Sorting (MACs) and Fluorescence-activated cell sorting (FACS). Despite the Countess Automated Cytometry data demonstrating that cell suspensions produced by mechanical dissociation (n=24) contain on average 26.8 times as many viable cells as enzymatic cell suspensions (n=18), enzymatic suspensions produced more successful cell cultures. Spheroids and subsequently adherent cells formed from 4 enzymatic cell suspensions (44.4%) vs. 1 mechanical cell suspension (8.3%). Enzymatic digestion protocols formed spheroids faster and more plentifully than mechanical cell suspensions. Adherent cells and spheroids isolated via both methods appear morphologically similarly to NCSCs from our previous studies.

Metallothionein (MT), a cysteine rich protein is involved as a radical scavenger in several pathological conditions associated with oxidative stress; however, its role in periodontal disease still remains elusive. The aim of this cross-sectional study is to determine the serum, saliva and gingival crevicular fluid (GCF) levels of MT in smokers (S) and non-smokers (NS) with chronic periodontitis (CP), and compare them with those of periodontally healthy (PH) individuals.A total of 85 participants were enrolled: 45 patients with CP (23 S [CP+S] and 22 NS [CP+NS]) and 40 PH individuals (20 S [PH+S] and 20 NS [PH+NS]). In all the study participants, clinical periodontal parameters (plaque index, gingival index, sulcus bleeding index, probing depth, and clinical attachment level) were recorded and samples of serum, saliva and GCF were collected. Enzyme-linked immunosorbent assay was used to determine the levels of MT in the samples.All periodontal clinical parameters were significantly higher in the CP groups as compared to PH groups (P 0.05). MT levels in CP+S group were significantly raised in comparison to other three groups. There was no statistically significant difference in MT levels among CP+NS and PH+S groups (P 0.05); however, relatively higher levels were observed in GCF and saliva in CP+NS group. When all the study groups were observed together, MT levels were positively correlated with clinical parameters.Results of present study suggest that smoking and CP can induce the synthesis of MT owing to increased oxidative stress and heavy metals intoxication. Further longitudinal studies with large sample size and an interventional arm are needed to substantiate the role of MT as a potential biomarker in periodontitis.

The use of Bisphenol-A (BPA) and its derivatives are rapidly increasing in dentistry for dental sealants and composite filling materials. The release of BPA from polymerized resin into saliva has aroused considerable concern regarding exposure to xenoestrogen by dental treatment. Many shreds of evidence have stated that leakage of BPA and its derivatives has posed health risks problems due to its endocrine-disrupting estrogenic properties. Various conventional techniques were designed for estimating leached BPA from dental sealants but having lengthy, complex procedures and requirements of technical experts, rapid utilization of these techniques is difficult. However, biosensors have emerged as a strong alternative to overcome these limitations. A vast range of electrochemical biosensors based on carbon and metal nanomaterials, molecularly-imprinted polymers, quantum dots, metal-organic frameworks, and polymer nanocomposites have been introduced for screening of BPA in real samples. But no study has been done to test leached BPA from dental sealants using biosensors. Therefore, we have provided an outlook of nanomaterials-based biosensors to test leached BPA from dental sealants. The present review also highlights different studies that assessed the absence/presence of BPA in the oral cavity after its use in dental materials. It also describes the challenges and future prospects in the progress of BPA-based biosensors.

Periodontitis is microbial infection affecting periodontium, the tooth supporting structure and affects >743 million people worldwide. Neural crest-derived stem cells (NCSCs) hold the promise to regenerate the damaged periodontium. These cells have been identified within adult adipose tissue, periodontal ligament, and palatal tissue. Typical enzymatic isolation protocols are expensive, time consuming and often not clinically compliant. Enzyme-free, mechanical dissociation has been suggested as an alternative method of generating cell suspensions required for cell separation and subsequent expansion ex vivo. In our study, samples of rat skeletal muscle tissue were used to appraise the suitability of a novel mincing method of mechanical dissociation against enzymatic digestion with collagenase and dispase. Skeletal muscle is readily available and has been shown to contain NCSC populations. We used a Rigenera-Human Brain Wave® prototype mincer to produce a suspension of NCSCs. We have compared the resulting cell cultures produced via mechanical dissociation and enzymatic dissociation, producing single cell suspensions suitable for Magnetic Cell Sorting (MACs) and Fluorescence-activated cell sorting (FACS). Despite the Countess Automated Cytometry data demonstrating that cell suspensions produced by mechanical dissociation (n=24) contain on average 26.8 times as many viable cells as enzymatic cell suspensions (n=18), enzymatic suspensions produced more successful cell cultures. Spheroids and subsequently adherent cells formed from 4 enzymatic cell suspensions (44.4%) vs. 1 mechanical cell suspension (8.3%). Enzymatic digestion protocols formed spheroids faster and more plentifully than mechanical cell suspensions. Adherent cells and spheroids isolated via both methods appear morphologically similarly to NCSCs from our previous studies.

Class III malocclusion represents a growth-related dentofacial deformity with mandibular prognathism in relation to the maxilla and/or cranial base. Its prevalence varies greatly among and within different races, ethnic groups, and geographic regions studied. Class III malocclusion has a multifactorial etiology, which is the expression of a moderate distortion of normal development as a result of interaction between innate factors or genetic hereditary with environmental factors. Various skeletal topographies of underlying Class III malocclusion are due to discrepancy in the maxillary and mandibular growth along with vertical and/or transverse problems apart from sagittal malformations. The spectrum of complications for Class III malocclusion ranges in gravity from dentoalveolar problems with functional anterior shift of the mandible to true skeletal problems with serious maxillomandibular discrepancies, which makes its diagnosis highly challenging in growing children. Concern regarding early treatment and the need for interceptive care in the case of Class III malocclusion has always been a dilemma, knowing that not all problems will be solved in these cases until maxillomandibular growth is further completed, and the long-term outcome of various treatment approaches may depend on the growth tendency of an individual. Interceptive treatment of Class III malocclusions should be undertaken if it prevents damage to the oral tissues and/or significantly reduces the amount or severity of future orthodontic and surgical interventions. This paper presents an overview of developing Class III malocclusion, with the emphasis on challenges and their solutions based on the best current available evidence.

Oral health disorders are major public health problems globally. There is a vast disparity in access to oral health care between developed and developing world as evident in reports of World Health Organisation (WHO) and Federation Dentaire Internationale (FDI). The oral health goals of WHO, FDI and International Association of Dental Research (IADR) for the year 2020 have brought forth the critical issues prevalent worldwide. India with huge population of 1.21 billion (2011 census) is faced with certain unique issues due to low level of awareness, varied terrain, strained infrastructure, limited access to oral health care and indigenous cultural practices. Research institutes and centrally funded agencies have been working at par with world standards, however, the oral health research has been lacking in terms of quality and addressing of community issues. It was deeply felt that this area requires appropriate summarization and future directions. This has been done in three parts with present paper attempting to address global vision, research orientations and specific burden, past research and future directions related to dental caries in India.

In day-to-day clinical practice, it is essential to obtain a reliable bond between an orthodontic attachment and the tooth enamel. Traditionally, dental (restorative) composite materials have been used for orthodontic bonding. Dental composites are composed of mainly organic synthetic polymer matrices, inorganic fillers, and silane coupling agents that bond the reinforcing fillers to the polymer matrix. The overall mechanical and physical behaviors and clinical performance of the composite resins are largely governed by the size, quantity, and distribution of the filler particles incorporated in the matrix. In conventional dental composites, the filler particle size ranges from mega, to mini, to microfillers. When the inorganic filler particle size in a composite resin becomes nanosized, they are called nanocomposites. When the filler content of resin-modified glass ionomer cements (RMGIC) is replaced with the formulation based on bonded nanofiller technology, it is called a nanoionomer. In this chapter, the physical properties and clinical applications of nanocomposites and nanoionomers in orthodontic bonding are discussed.

Objectives The aim of this systematic review was to evaluate the effectiveness of Azadirachta indica (neem)-based herbal mouthrinse in improving plaque control and gingival health. Methods Literature search was accomplished using electronic databases (PubMed, Cochrane Central Register of Controlled Trials and EMBASE) and manual searching, up to February 2015, for randomized controlled trials (RCTs) presenting clinical data for efficacy of neem mouthrinses when used alone or as an adjunct to mechanical oral hygiene as compared to chlorhexidine mouthrinses for controlling plaque and gingival inflammation in patients with gingivitis. Results Of the total 206 articles searched, three randomized controlled trials evaluating neem-based herbal mouthrinses were included. Due to marked heterogeneity observed in study characteristics, meta-analysis was not performed. These studies reported that neem mouthrinse was as effective as chlorhexidine mouthrinse when used as an adjunct to toothbrushing in reducing plaque and gingival inflammation in gingivitis patients. However, the quality of reporting and evidence along with methods of studies was generally flawed with unclear risk of bias. Conclusion Despite the promising results shown in existing randomized controlled trials, the evidence concerning the clinical use of neem mouthrinses is lacking and needs further reinforcement with high-quality randomized controlled trials based on the reporting guidelines of herbal CONSORT statement.

Background and aims: Fluorosis affects tooth mineralization. The therapeutic benefit provided by lasers on fluorosed and non fluorosed cementum requires studying and comparing. The aim of this study was to evaluate and compare the root surface changes following Er:YAG or Nd:YAG laser irradiation on periodontally healthy fluorosed versus non-fluorosed teeth by scanning electron microscopy (SEM). Materials and methods: A total of 76 periodontally healthy fluorosed (FH) and non-fluorosed (NFH) teeth specimens were included in this study. In one group, the experimental root specimens were irradiated using Er:YAG or with Nd:YAG laser in the other. A SEM evaluation was performed to assess the laser induced ultra structural changes in the root surface followed by statistical analysis using Fisher's exact test. Results: It was observed that both FH and NFH groups were similarly affected by Nd:YAG or Er:YAG laser. However, the former caused more surface changes than the latter on melting of surface (p=0.12 for FH and p=0.08 for NFH), and Er:YAG laser caused more smear layer formation (p=0.51 for FH and p=0.16 for NFH). Conclusion: Results suggest that undesirable morphological changes were observed almost similarly in FH and NFH groups using Er:YAG or Nd:YAG laser. Hence further in-vitro studies at lower energy settings followed by clinical trials are required in this aspect.

Objectives To evaluate the effectiveness of aloe vera containing herbal dentifrices in improving plaque control and gingival health. Methods A manual and electronic literature (MEDLINE and Cochrane Central Register of Controlled Trials) search was performed up to July 2012, for randomized controlled trials presenting clinical, microbiological, immunological, and patient-centered data for the efficacy of aloe vera herbal dentifrices for controlling plaque and gingival inflammation in patients with gingivitis. Results From 79 titles and abstracts, eight full-text articles were screened and finally two randomized controlled trials were selected. These randomized controlled trials reported that aloe vera dentifrices were similar in efficacy to control dentifrices in effectively reducing plaque and gingival inflammation in gingivitis patients based on the assessment of clinical, microbiological, and patient-centered treatment outcomes. However, many important details (composition and characteristics of aloe vera and control dentifrices along with appropriate randomization, blinding, and outcomes assessed) were lacking in these trials, and therefore, the quality of reporting and methods was generally flawed with high risk of bias. Conclusion Even though there are some promising results, the clinical effectiveness of aloe vera herbal dentifrices is not sufficiently defined at present and warrants further investigations based on reporting guidelines of herbal CONSORT statement.

Traditional tooth-supported and implant-supported fixed/removable restorations are currently used to replace teeth lost due to periodontal disease. This article reviews the existing literature for oral rehabilitation of partially edentulous periodontal patients with various designs of removable dental prosthesis (RDP), fixed dental prosthesis (FDP) and implant-supported single crown (SC), by addressing their (a) general features, (b) survival and complication rates, along with considerations for treatment planning in periodontal patients, and (c) preference by patients. To answer these issues, relevant articles were searched and critically analyzed, and their data were extracted. Data reviewed indicated that despite many advantages, implant-supported restorations have higher complication rates than tooth-supported restorations. Systematic reviews on conventional RDPs are lacking, but existing literature reviews provide limited evidence suggesting the use of RDPs with design modifications along with strict periodontal care in periodontal patients. Numerous systematic reviews on conventional FDPs and implant-supported restorations provide a moderate level of evidence favoring their survival in periodontal patients; however, for long-term success of these restorations, the patient's periodontal condition needs to be stabilized. In terms of patient preference, no restoration is superior, as they all are governed by their cost, advantages, and disadvantages. Thus, in the wake of existing weak evidence for prosthodontic rehabilitation of periodontal patients by these restorations (especially, conventional RDPs and for FDPs and SCs in implant-supported restorations), longitudinal studies with standardized treatment protocol and methodology are needed to evaluate and compare tooth-supported and implant-supported restorations in periodontal patients with regard to survival rates, cost, maintenance, and patient-centered outcomes.

doi: 10.1111/j.1741-2358.2012.00624.x Gingival overgrowth in partially edentulous ridges in an elderly female patient with epilepsy: a case report Background: Drug-influenced gingival overgrowth is an unaesthetic overgrowth of gingiva principally associated with intake of drugs like phenytoin, cyclosporin A and nifedipine. Its occurrence in both dentate and edentulous regions of oral cavity is poorly understood. Objectives: This report highlights clinical and histological description, aetiology and management of gingival overgrowth in a partially edentulous (non-denture wearer) 60-year-old female patient with epilepsy on phenytoin and phenobarbital drugs from past 7 years. Materials and methods: Patient’s intraoral examination revealed lobulated and fibrotic consistency gingival overgrowth around teeth and on partially edentulous ridges of upper and lower arches along with generalised tooth mobility. Under medical consultation, full mouth extraction, surgical excision of overgrowth followed by complete denture rehabilitation and replacement of combination drugs with sodium valproate were accomplished. Results: Histologically, the lesion showed fibro-epithelial hyperplasia. Clinical results after 6 months demonstrated almost complete resolution of gingival overgrowth. Conclusion: The findings of present case suggest that gingival overgrowth can occur even in partially edentulous ridges (not exposed to denture wear) that could be due to persistence of gingival overgrowth, which may not resolve completely following tooth extraction or occurs because of incorporation of specific subpopulation of gingival fibroblasts in alveolar ridge mucosa.

Dhingra K. Methodological issues in randomized trials assessing probiotics for periodontal treatment. J Periodont Res 2012; 47: 15–26. © 2011 John Wiley & Sons A/S Background and Objective: Probiotics traditionally used in medicine field are now being used in an attempt to control and treat periodontal disease. However, the trials used to analyze the effects of probiotics have been subject to methodological criticism. The aim of this review was to assess the methodological deficiencies in randomized controlled trials evaluating the efficacy and safety of oral administration of probiotics for the treatment of periodontal disease. Material and Methods: A manual and electronic literature search (of MEDLINE and The Cochrane Library) was made, to March 2011, for randomized controlled trials presenting clinical, microbiological, immunological and patient-centered data for the efficacy of probiotics compared with a placebo/standard periodontal therapy for the treatment of periodontal disease. Results: The literature search yielded only four randomized double-blind, placebo-controlled studies that evaluated the efficacy of probiotics (using Lactobacillus reuteri and Lactobacillus salivarius probiotic strains) in patients with gingivitis. The studies were too methodologically flawed (of mediocre quality) with a high risk of bias for any meaningful conclusions to be reached. These studies lacked adequate descriptions of appropriate randomization, allocation concealment, blinding, formulation and dosage of probiotic and placebo, extent and severity of periodontal disease in patient populations, patient-centered outcomes, results data and potential confounding factors. Conclusion: The existing randomized controlled trials have important methodological limitations; consequently, there is insufficient evidence to support the efficacy of probiotics in treating periodontal disease. More rigorous scientific research, in accordance with existing guidelines and research recommendations of the present review, is required to examine the safety and efficacy of probiotics before they are embraced in periodontal therapy.

To cite this article: Int J Dent Hygiene9, 2011; 296–302 DOI: 10.1111/j.1601-5037.2011.00506.x Dhingra K, Vandana KL. Management of gingival inflammation in orthodontic patients with ozonated water irrigation – a pilot study. Abstract: Objective: Ozonated water irrigation has recently been tried for its antimicrobial and anti-inflammatory effects in treatment of periodontitis. During orthodontic treatment, gingival inflammation occurs along with increased lactate dehydrogenase (LDH) enzyme levels in gingival crevicular fluid (GCF). Thus, the aim of this pilot study was to evaluate the clinical effects of a single subgingival irrigation with ozonated water on gingival inflammation in orthodontic patients and also to correlate the clinical effects with LDH enzyme activity in GCF. Methods: Fifteen systemically healthy orthodontic patients (seven men and eight women, mean age 17.3 years) with full-mouth brackets were included in this prospective, cross-sectional, clinical and laboratory investigation. Clinical parameters, LDH enzyme activity and GCF volume were measured at baseline (0 day) followed by subgingival irrigation with 0.01 mg l−1 ozonated water. These parameters were again assessed on 14th and 28th day. Results: There was significant (P

Objective: To evaluate and compare the root surface morphological changes after 980-nm diode laser–aided circumferential supracrestal fiberotomy (CSF) on fluorosed and non-fluorosed teeth. Materials and Methods: The sample comprised 27 orthodontic patients (14 males and 13 females; mean age = 17.3 years) with and without fluorosis, from whom 40 fluorosed and 40 non-fluorosed premolar teeth were extracted for orthodontic reasons. Conventional (control group) and laser-aided (experimental group) CSF was performed on fluorosed and non-fluorosed teeth indicated for orthodontic extraction, using a scalpel and a 980-nm diode laser at 2.5 W power, respectively. Subsequently, teeth were extracted, sectioned, and examined by scanning electron microscope to assess the ultrastructural changes. Results: There were differences in surface morphology among fluorosed and non-fluorosed roots in the control group. The root specimens of both fluorosed and non-fluorosed teeth irradiated by diode laser exhibited no evidence of smear layer, laser-induced pitting or cavitation, linear cuts/markings, carbonization of surface, and heat-induced surface cracking. However, a glazed or slightly melted appearance was observed in root specimens of fluorosed teeth after diode laser irradiation. Conclusions: These findings suggest that the diode laser–aided CSF procedure is free from thermal hazard on non-fluorosed root surfaces but may provoke some thermal changes on fluorosed root surfaces.

Periodontal vaccine against periodontopathic bacteria has been tested in various animal models, such as in non-human primates and murine species. The aim of this preliminary study is to systematically review all preclinical (i.e., animal) studies that present supporting evidence for the feasibility of formulating a prophylactic human periodontal vaccine.A manual and electronic literature search was made for animal studies up to February 2010 that presented clinical, morphologic (alveolar bone level), and immunologic data for the efficacy of a prophylactic periodontal vaccine. A systematic approach was followed by two independent reviewers and included eligibility criteria for study inclusion, quality assessment, determination of outcome measures, screening method, data extraction, data synthesis, and drawing of conclusions.Only two randomized controlled animal trials qualified, and they reported exactly opposite effects of vaccine administration in Macaca fascicularis experimental periodontitis models by administration of two different agents (i.e., a negative effect with combined whole-cell antigens of Porphyromonas gingivalis and Prevotella intermedia in contrast to a positive effect with cysteine proteases of P. gingivalis). However, no statistical process could be applied to their results (data inadequately reported) in order to pool and evaluate the changes in outcome measures after vaccine administration, which, highlighted their mediocre study quality.Because of the insufficient quantity and quality of animal trials, no adequate evidence could be gathered to use the beneficial effects of these animal experiments to formulate a prophylactic human periodontal vaccine. Thus, good-quality animal trials are needed in this field of vaccine testing.