The dental clinician frequently comes across lesions that involve the hard and soft tissues of the oral cavity. Most of these conditions do not pose a diagnostic problem for the dental surgeon. However, the clinical dentist is sometimes accosted with a lesion, the diagnosis of which is not only challenging, but influencing the choice of treatment. This review article provides a systematic and logical approach for diagnosing common lesions encountered in the dental practice.

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

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

Aim: The aim was to investigate the association between cortisol and dehydroepiandrosterone (DHEA) levels in patients with periodontitis and healthy controls. Materials and Methods: Cortisol and DHEA levels in saliva were determined in 20 subjects, with clinical examinations including oral hygiene index, sulcus bleeding index (Muhlemann and Son) and probing depth was also performed. Statistical Analysis: Data were analyzed with the help of SPSS software package (version 7.0), and the significance level was set at 95% confidence interval. Mann-Whitney test and t-test were used to see the correlation between the groups. Results: In cortisol and DHEA the mean and standard deviation of periodontitis group were (2.6 ± 0.37) and (66.7 ± 8.7) respectively. Conclusion: This shows there is an increase in the mean value of cortisol and DHEA in periodontitis than the control group. Salivary cortisol and DHEA level were found to be increased in concordance with disease severity. This was statistically significant with P < 0.001.

Background and Objectives: Dental Casting involves various stages of processing, out of which any may affect the dimensional accuracy. The fit of a casting depends not only on the method of fabrication employed but also on the type of materials utilized. One important variable in the casting process is the type of pattern material employed. This study was carried out to determine and compare the effect of different pattern materials on the vertical marginal accuracy of complete cast crowns. Materials and Methods: A standardized metal master die simulating a prepared crown was used to prepare 60 models on which patterns were fabricated using Inlay Pattern Wax; Auto-polymerized Pattern Resin and Light Cured Modeling Resin and cast immediately. Castings of the patterns were subjected to analysis of marginal fit using a scanning electron microscope (SEM). Results: One-way ANOVA result showed a significant difference in the gap observed between the castings fabricated using the three types of pattern materials (P < 0.001). Post-hoc Bonferroni tests showed significant difference between the castings fabricated using Inlay Type B pattern wax and Auto-polymerized pattern resin as well as between Inlay Type B pattern wax and Light-cured modeling resin (P < 0.01). Significant difference exists between Auto-polymerized pattern resin and Light-cured modeling resin (P > 0.05). Conclusion: With strict adherence to the principles of pattern fabrication and immediate casting, Inlay wax can still be the pattern material of choice to produce a casting with minimal marginal discrepancy with added advantages of being user friendly and cost effective.

Context: The term "oral malodor" is used to describe a foul or offensive odor emanating from oral cavity. Dentist is the first professional whom individuals turn up for help. Gram-negative anerobic pathogens implicated in periodontal disease have also been linked to oral malodor. A semi-conductor, hand-held gas sensor with 6 levels of display, brand name FITSCAN^® Breath Checker (Tanita Corporation, USA) used to detect oral malodor. Antibiotics are now being tried and used to treat oral malodor and periodontal disease. Aims: To evaluate the association between malodor and periodontal status of patients before and after antibiotic rinse. Materials and Methods: Systemically healthy subjects were divided into three groups - control group, gingivitis group, periodontitis group. Measurement of oral malodor was done by FITSCAN^® Breath Checker. Antibiotic rinse preparation containing metronidazole was given to patients. An association between oral malodor and periodontal disease status of patients was determined. Statistical analysis used: For intragroup analysis paired "t" test and for intergroup analysis of halitosis and gingival index "Kruskal-Wallis test" and "Mann-Whitney U test" were applied. Results: Intragroup - Statistical significant decrease in halitosis, Gingival Index (GI) at baseline and 14 days in persons with gingivitis and periodontitis group, no statistical significant decrease in pocket depth before and after antibiotic rinse. Intergroup - Statistical significant decrease in Gingival Index status at baseline and 14 days in both gingivitis andperiodontitisgroups. Conclusion: Strong correlation exists between malodor and periodontal status and antibiotic rinse is effective in reducing oral malodor.

Background: This human study was carried out to evaluate the possible effects of severe chronic periodontal disease on the different aspect of dental pulp structure. Materials and Methods: A total of 20 permanent teeth with a hopeless prognosis due to severe chronic periodontitis were extracted from systemically healthy adults, with a pocket probing depth of ≥8 mm and a mobility of grade 3. After extraction, the apical 2-3 mm of the roots were immediately sectioned with a fissure bur. Results: Inflammation was usual finding in the samples, however, only 15% of the teeth showed no inflammation. Pulpal necrosis (partial or complete) was seen in different sections, and it was observed that 50% sections had no necrosis. Partial necrosis was a common finding seen when compared to complete necrosis (6.7%). About 60% of samples showed edematous pulp. Only 6.7% of samples showed absence of fibrosis. Pulp with moderate fibrosis was seen commonly seen in many sections. A majority of teeth (70%) also displayed a loss of odontoblastic integrity. In only 25% of samples, pulp stones were detected. Conclusion: Our results revealed that severe chronic periodontitis can affect dental pulp. The cumulative effect of the periodontal disease, as indicated by the factors of calcifications, apposition of calcified tissue, resorption or inflammation from the root caries or from the involved lateral canals, is damaged pulp tissue, but total disintegration is a certainty only when all main apical foramina are involved by bacterial plaque. Proper evaluation and treatment of periodontal-endodontic involvement is recommended.

While widespread advances have occurred in all details of science over the past decade, regenerative dentistry has also seen its part of breakthrough innovations. Tooth regeneration offers new and innovative approaches to common problems encountered in oral and dental sciences. In cases where a tooth is lost, it may be replaced with an implant, bridge, or a denture capable of mastication. However, in many developing countries, it is often simpler (and far more cost-effective) to remove the tooth. Strategies based upon regenerative medicine that facilitates the repair or replacement of damaged teeth may hold particular promise as a means to reduce the cost of dental care. Dental maladies aside, the tooth is also a compelling candidate as a template for organogenesis which could have far-reaching implications for the field of regenerative medicine. ^[1] A systematic review of the literature was performed using various internet-based search engines (PubMed, Medline Plus, Cochrane, Medknow, Ebsco, Science Direct, Hinari, WebMD, IndMed, and Embase) using keywords such as "dental pulp stem cells," "regeneration," "medical applications," and "tissue engineering." This review explores existing and visionary approaches in the revolutionary field of regenerative dentistry, as an extension to the familiar concepts of regenerative medicine.

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

The aim of this article is to present the use of spiral computed tomography (CT) in endodontic management of a mandibular molar with an unusual morphology of C-shape canal. An accurate assessment of this unusual morphology was made with the help of spiral CT. This report extends the range of known possible anatomical variations to include teeth with an abnormal number of roots and canals. This report also highlights the role of spiral CT, over conventional intra-oral periapical radiographs, as an objective method to confirm the three-dimensional anatomy of teeth.

Introduction: Hemisection involves sectioning of a periodontally involved mandibular molar so as to remove the involved root and save the remaining tooth. This procedure helps in saving a tooth which otherwise would have been deemed for extraction. Hemisection refers to removal or separation of root with its accompanying crown portion of two-rooted teeth, most commonly mandibular molars. Method: In this case report, an advanced Endo-Perio lesion on a left mandibular first molar was successfully treated by root-canal treatment and hemisection. This procedure helps preserve the tooth structure, alveolar bone and promote cost savings over other treatment options. Conclusion: Hemisection is a treatment option for saving a mandibular molar which is in advanced stage of periodontal disease of one root. Removal of the affected root will help in retaining the remaining tooth structure.

One of the main objectives of periodontal therapy is to prolong the lifespan of dentition as there is no ideal substitute for natural dentition even in the era of dental implants. Treatment of teeth with advanced periodontal disease with hopeless prognosis is always extraction. However in this case report, we discuss a novel regenerative strategy using a combination of platelet rich plasma and bi-phasic tri calcium phosphate for a lower central incisor that was considered for extraction. Clinical and radiographic examination during the six-year follow-up postoperatively revealed stable periodontal health in the lower right central incisor. The surgical re-entry done in the sixth year postoperatively revealed good periradicular healing and alloplastic bone graft incorporation within the host bone.

Aim: To investigate whether sexual dimorphism can be established by odontometric study of permanent maxillary canine teeth as well as inter-canine width in north Indian population. Study Design: The study was carried out at department of oral and maxillofacial pathology, King George's Medical University, Lucknow, India on students and patients reporting at OPD. Out of total 180 subjects examined 90 subjects were female and 90 were male. Impressions of the upper arch were made using alginate and casts poured in dental stone. The mesiodistal diameter (MD) of the crown of permanent maxillary canine both on right and left sides and inter-canine width were measured. From these measurements, maxillary canine index was calculated. The percentage of sexual dimorphism (SD) was assessed for all the parameters. Results: In the present study, the MD of maxillary canine for both right (P = 0.001) and left side (P = 0.005) was significantly higher among male subjects than females, Similar observation was found for inter-canine width too (P = 0.0001). However, the maxillary canine index for right and left was almost similar (P > 0.05) for both male and female subjects. The SD in right and left MDs of maxillary canine was 4.2% and 3.6% respectively. For, inter-canine width it was maximum (13.7%). However, SD in right and left canine index showed negative values (−2.1% and -0.9% respectively). Conclusion: There was SD in MD and inter-canine width of permanent maxillary canine teeth. SD was more on right permanent maxillary canine teeth than left permanent maxillary canine.

Dental health care workers are increasingly called upon to provide quality dental care to individuals whose bleeding and clotting mechanisms have been altered by inherited or acquired diseases. This provides an opportunity for the dentist who is trained in the recognition of oral and systemic signs of altered hemostasis to assist in the diagnosis of the underlying condition. A number of dental procedures result in the risk of bleeding that can have serious consequences, such as severe hemorrhage or possibly death, for the patient with a bleeding disorder. Oral care providers must be aware of the impact of bleeding disorders on the management of their patients. These disorders must be recognized from history, clinical examinations, and laboratory investigations, if indicated, prior to surgical procedures including those in dental surgery to prevent bleeding related complications. Safe dental care may require consultation with the patient's physician, systemic management, and dental treatment modifications. The purpose of this article is how to identify these patients with bleeding disorders.