Development of an Index for a Tooth to Receive a Full-Coverage Crown

PURPOSE

To develop a system for assessment of the status of a tooth to receive a full coverage crown and depict it on a measurable scale, and to validate its use by assessing examiner reproducibility.

METHODS

The index was developed based on the inputs from experts in the field with a consensus on factors (4 periodontal, 2 endodontic, and 4 prosthodontic), stages of severity (stage 1 to stage 4), assigned scores, and relative weights pertaining to varied clinical scenarios. Based on the selection of factor-stage combination, an overall tooth crownability index (TCI) score along with three-factor scores were computed. The validation study included clinical and radiological assessment of cases based on the index criteria by four independent examiners (periodontist, prosthodontist, endodontist, and general practitioner).

RESULTS

Forty teeth were assessed. The distribution of repeated selection by the examiners was quite identical to the initial (kappa = 0.93). There was no statistically significant difference in the mean scores of examiners in TCI and factorial scores. An excellent agreement between the measurements was observed among the examiners (ICC =0.993; Crohnbach α = 0.993).

CONCLUSIONS

A tooth crownability index has been developed for a tooth to receive a full coverage crown which has an excellent agreement and good reproducibility among the examiners. TCI will serve as a baseline tool in treatment plan decision-making based on the status of the teeth and in research for evaluating the efficacy of various treatment options available (standard criteria for outcome assessment).

Impact of Auxiliary Features on Retention of Short Dental Crowns: An In-Vitro Analysis of Box and Groove Preparations

BACKGROUND Several auxiliary features have been proposed to achieve sustainable retention for short-prepared dental crowns; however, achieving retention is challenging. This study aimed to assess the impact of increased total occlusal convergence and auxiliary preparation factors like box and groove on the retention form of short tooth preparations. MATERIAL AND METHODS Eighty resin machine-milled dies with a height of 3 mm and a deep chamfer margin of 1 mm were prepared to mimic the short-prepared molar. Initially, 2 teeth were prepared following the guidelines, and the total occlusal convergence was kept at 10° and 20°, respectively. Auxiliary features such as the proximal box and buccal groove were prepared on separate 20° dies. Eighty dies were prepared with 10 samples each for 10°, 20°, 20° with proximal box and 20° with buccal groove for zirconia (n=40) and metal crowns (n=40). Cementation was done with glass ionomer luting cement, and a pull-off test was conducted. Data were analyzed using one-way analysis of variance and post hoc fisher least significant difference test (P<0.05). RESULTS The highest mean was observed in the proximal box group with the metal crown (14.59), and the lowest in the group with 20° zirconia crowns (9.12). Within groups, the highest retentive values were found for the 20° taper with proximal box preparation; the lowest was for the 20° taper group. CONCLUSIONS Within the study limitations, it could be concluded that incorporating a proximal box or buccal groove in short tooth preparations with an increased total occlusal convergence improved retentive values.

Bibliographic analysis and evaluation of the mesh keywords in the journal of prosthodontics: Implant, esthetic, and reconstructive dentistry

BACKGROUND

Various studies have been conducted to analyze data via bibliometric analysis in different dentistry, including prosthetic dentistry. However, these studies evaluated the most cited published articles in dentistry.

OBJECTIVE

To analyze and evaluate the characteristic development of several mesh keywords in the Journal of Prosthodontics - Implant, Esthetic, and Reconstructive Dentistry between 1992 and 2022.

METHODS

The Scopus databases was searched to retrieve the data related to 8 categories, including published articles, most cited documents, authors and organizations, and maximum articles cited during the evaluation period. The data retrieved were exported to a Microsoft Excel sheet and were analyzed using the bibliometrix package. The data were first analyzed for ten years and then for 30 years. The highest of 10 were reported for each category, and co-authorship, reoccurrence, and linked data were also reported.

RESULTS

2603 published documents were recorded from the Scopus databases. Articles comprised 87.9% of the total published work, followed by review articles at 5.46%. The most productive decade was between 2013 and 2022. 3793 terms were used during the evaluation period, with the maximum number in 2003-2012 (2481). A total of 5392 keywords were used during 1992-2022, with the highest number (3232) from 2013 to 2022. A total of 6108 authors were acknowledged, with the maximum number (3964) from 2013 to 2022 and the fewest (767) from 1992 to 2002. Authors from different countries increased from 17 countries in 1992-2002 to 52 countries in 2013-2022 (total = 63 countries). Similarly, the number of organizations increased from 312 organizations in 1992-2002 to 1315 organizations in 2013-2022 (total = 1976 organizations).

CONCLUSION

The current bibliometric analysis delivered a comprehensive overview about more spread research topics and its impactful role in contemporary dentistry, especially prosthetic dentistry.

Pediatric corneal transplantation: techniques, challenges, and outcomes

Pediatric corneal transplant is a highly demanding and technically challenging procedure for the cornea surgeon in today's era. These cases pose unique challenges in clinical and surgical management. The indications of pediatric corneal transplant can be therapeutic, tectonic, optical, and cosmetic. Pediatric patients undergoing corneal transplants are at a high risk of graft infection, failure, rejection, dehiscence, and amblyopia due to young age, robust immune system, increased incidence of trauma, and compliance issues. The other factors contributing to graft failure can be allograft rejection, secondary glaucoma, corneal vascularization, multiple surgeries, vitreous prolapse, and lack of treatment compliance. A successful corneal transplant in children depends on meticulous preoperative evaluation, uneventful surgery, the expertise of a corneal surgeon, and regular and timely postoperative follow-up. Therapeutic and optical penetrating keratoplasty are the most commonly performed transplants in children. However, with the advancements in surgical technique and management protocol, the current focus has shifted toward lamellar keratoplasty. Lamellar keratoplasty offers early visual recovery and potentially fewer complications. Visual rehabilitation through corneal transplant in otherwise blind eyes can be a boon for the children. Recently, keratoprostheses have been promising in children with multiple graft failures. The current review gives insights into epidemiology, etiology, indications, clinical characteristics, investigations, management options, recent advances, and the future of pediatric corneal transplants. As surgical techniques continue to grow and comprehension of pediatric corneal transplants is improving, we can safeguard these eyes with the best possible anatomical and functional outcomes.

Transforming Dental Caries Diagnosis Through Artificial Intelligence-Based Techniques

Diagnosing dental caries plays a pivotal role in preventing and treating tooth decay. However, traditional methods of diagnosing caries often fall short in accuracy and efficiency. Despite the endorsement of radiography as a diagnostic tool, the identification of dental caries through radiographic images can be influenced by individual interpretation. Incorporating artificial intelligence (AI) into diagnosing dental caries holds significant promise, potentially enhancing the precision and efficiency of diagnoses. This review introduces the fundamental concepts of AI, including machine learning and deep learning algorithms, and emphasizes their relevance and potential contributions to the diagnosis of dental caries. It further explains the process of gathering and pre-processing radiography data for AI examination. Additionally, AI techniques for dental caries diagnosis are explored, focusing on image processing, analysis, and classification models for predicting caries risk and severity. Deep learning applications in dental caries diagnosis using convolutional neural networks are presented. Furthermore, the integration of AI systems into dental practice is discussed, including the challenges and considerations for implementation as well as ethical and legal aspects. The breadth of AI technologies and their prospective utility in clinical scenarios for diagnosing dental caries from dental radiographs is presented. This review outlines the advancements of AI and its potential in revolutionizing dental caries diagnosis, encouraging further research and development in this rapidly evolving field.

Comparison of Composite Resin (Duo-Shade) Shade Guide with Vita Ceramic Shades Before and After Chemical and Autoclave Sterilization

BACKGROUND This study aimed to compare a composite resin (Duo-Shade) shade guide with Vita ceramic shades before/after chemical and autoclave sterilization. MATERIAL AND METHODS Color values (L*a*b*) were recorded directly from shade tabs of prefabricated composite resin (Brilliant NG Universal Duo-Shade) and ceramic (Vita classic) shade guide with a calibrated spectrophotometer (Vita Easy Shade Advance 4.0). Seventy-two composite resin disk samples with 6 different shades (A1/B1, A2/B2, A3/D3, A3.5/B3, A4/C4, and C2/C3) (n=12 each) were divided into 2 groups (Gp) - Gp A (Autoclave) and Gp C (Chemical) (15 cycles) - to assess their influence on respective shades. Mean values calculated the color differences (ΔE) while differences in color values (L*a*b*) were graded on the National Bureau of Standards (NBS) 6-grade scale and assessed for Clinical Acceptance/Perceptible Threshold (CAT), (CPT). All differences were considered significant if the color difference ΔE was ≥3.3. RESULTS Only 2 out of 12 Shade tabs (C2C3, A4C4) of composite resin matched to Vita shade tab C2 and C4 (ΔE ≤3.3). Both groups showed notable color differences after respective sterilization protocols, with color differences in Gp A significantly higher than Gp C (DE ³3.3). Within groups, all shades in Gp A showed remarkably different color changes, with shade C2C3 and A1B1 being denoted as clinically unacceptable. CONCLUSIONS Manufacturer-provided shade guides do not match ceramic shades as claimed and chemical sterilization using 10% Deconex was associated with less color changes than with autoclave sterilization.

Radiographic Evaluation of the Gap between Cemented Post and Remaining Gutta-Percha in Endodontically Treated Teeth Performed by Undergraduate Students: A Retrospective Cross-Sectional Study

The coronal seal in root canal-treated teeth may be compromised depending on the accuracy of post space preparation and post cementation along with remaining gutta-percha. Root canal treatment can be compromised by endotoxins released by the coronal bacteria as a result of microleakage. The study was conducted by undergraduate students to measure the gap between the cemented post and residual gutta-percha. In total, 217 endodontically treated teeth were evaluated with intraoral peri-apical radiographs. Based on the intraoral periapical radiographic examination in the CS-R4 program, Group I had no gap, Group II had a gap of >0 to 2 mm, and Group III had a gap of more than 2 mm between the end of the cemented post and the remaining gutta-percha. In total, 40% (n = 87) of the teeth had no gap, 59% (127) had a gap of >0 to 2 mm, and 1% (n = 3) had a gap of more than 2 mm between the cemented post end and remaining gutta. Chi square test revealed a significant difference in the gap between the post and remaining gutta-percha between males and females students (p < 0.001). In terms of the gap between the cemented post end and the residual gutta-percha, the root canal treated teeth with post and core by undergraduates were clinically acceptable.

Comparison of corneal endothelial cell loss during manual small-incision cataract surgery using viscoelastic-assisted nucleus removal versus continuous balanced salt solution plus technique - Randomized controlled trial

Purpose

The purpose of this study was to compare and analyze the endothelial cell loss during manual small-incision cataract surgery (MSICS) using the viscoelastic-assisted nucleus removal versus basal salt solution plus technique.

Methods

This was a prospective randomized trial of 204 patients who underwent MSICS using viscoelastic-assisted nucleus removal (Group 1- OVD) versus basal salt solution plus technique (Group 2- BSS) at a tertiary eye care hospital in North India from January 2018 to 2021. Of these 204 patients, 103 (50.5%) and 101 (49.5%) were allocated to Group 1 and 2, respectively. The parameters assessed were detailed history, demographics, and anterior and posterior segment details. Visual acuity, intraocular pressure (IOP), keratometry, pachymetry, and endothelial cell density were evaluated preoperatively and postoperatively on day 1 and 30.

Results

The mean age of the patients was 64.5 ± 8.2 years (range 48-82 years). There were 129 (63.2%) males and 75 (36.8%) females. The mean LogMAR visual acuity for both groups on day 1 (Group 1- 0.3 ± 0.1, Group 2- 0.5 ± 0.2) and day 30 (Group 1- 0.1 ± 0.2, Group 2- 0.1 ± 0.1) was statistically significant (P &lt; 0.001), and the mean IOP value showed a statistically significant value (P &lt; 0.009) on day 1 in Group 2 (15.0 ± 2.4 mmHg) and on day 30 (P &lt; 0.001) in both the groups (Group 1- 13.6 ± 1.8 mmHg, Group 2- 13.5 ± 2 mmHg). The horizontal and vertical k values also showed a statistically significant difference on day 1 and day 30 (P &lt; 0.001). The mean percentage change of central corneal thickness (CCT) in Group 1 was 17.7% and in Group 2 was 17.4% on day 1, and it was 1.1% on day 30 in both the groups, which was statistically significant (P &lt; 0.001) compared to preoperative values. The percentage change in endothelial cell density on day 1 was 9% in Group 1 and 4.6% in Group 2, which was statistically significant (P &lt; 0.001). On day 30, it was 9.7% and 4.8%, respectively, which was statistically significant (P &lt; 0.001).

Conclusion

Our study highlights statistically significant endothelial cell loss with viscoelastic-assisted nuclear delivery compared to BSS-assisted nuclear delivery during MSICS in a short follow-up of 1 month. The CCT values showed a slight increase, and the keratometry and IOP were unaffected compared to the preoperative parameters in both the groups.

Effect of Miswak Derivatives on Color Changes and Mechanical Properties of Polymer-Based Computer-Aided Design and Computer-Aided Manufactured (CAD/CAM) Dental Ceramic Materials

Background

Miswak is a form of chewing stick used to clean teeth in different parts of the world, including Saudi Arabia. We present a description of the effects of miswak derivatives, namely toothpaste, mouthwash, and brushing sticks, on the mean color changes (ΔE₀₀), compressive fracture resistance values, and fracture modes of polymer-based computer-aided design (CAD) and computer-aided manufactured (CAM) prosthetic materials.

Material/Methods

Eighty-one rectangular-shaped samples were prepared from lithium disilicate glass-ceramic (IPS e.max CAD), zirconia-reinforced lithium silicate (Vita Suprinity), and monochromatic tooth-colored feldspar (Vitablocs Mark II) CAD/CAM ceramics. The color parameters were recorded using spectrophotometer before and after exposing the specimens to the different miswak oral hygiene derivatives for 15 days. Compressive fracture resistance values and fracture types were also assessed, and statistical analysis was performed.

Results

Vita Suprinity and Vitablocs Mark II miswak sticks had the highest ΔE₀₀ values. Moreover, miswak mouthwash had the lowest ΔE₀₀ values, with significant differences among groups. IPS e.max CAD miswak sticks had the highest mean values of compressive fracture. Vitablocs Mark II had the lowest values for mouthwash and toothpaste. Significant differences were found within the IPS e.max CAD group. Reparable fractures were found in IPS e.max CAD, while semi-reparable fractures were seen in other groups.

Conclusions

Most ΔE₀₀ values were within the acceptable clinical range, with IPS e.max CAD showing superior color stability. The mouthwash group showed minimal ΔE₀₀. IPS e.max CAD had the highest mean compressive fracture resistance values with reparable fracture types.

Designing an immunoinformatic vaccine for peri-implantitis using a structural biology approach

OBJECTIVES

Peri-implantitis is a destructive inflammatory process that affects the soft and hard tissues around dental implants. porphyromonas gingivalis, an anaerobic gram-negative bacterium, appears to be the main culprit. Since there is no efficient and specific vaccine to treat peri-implantitis, the goal of our research has been to develop a multi-epitope vaccination utilizing an immunoinformatics approach that targeted P. gingivalis type I fim A.

MATERIALS AND METHODS

P. gingivalis peptides 6JKZ and 6KMF are suitable for vaccine development. B- and T-cell epitopes from 6KMF and 6JKZ were detected and evaluated based on critical factors to produce a multi-epitope vaccine construct. It was assessed based on allergenicity, antigenicity, stability. The vaccine's dual major histocompatibility complex (MHC-I and MHC-II) binding epitopes allowed it to reach a larger population. P. gingivalis fimbriae induce immune subversion through TLR -CXCR4 receptor complex pathway. The ClusPro 2.0 server was used to do the molecular docking using TLR2 - CXCR4 and vaccine epitopes as receptor and ligand respectively.

RESULTS

The designed vaccine was non-allergenic and had a high antigenicity, solubility, and stability. The 3D structure of the vaccine revealed strong interaction with CXCR4(TLR2) using molecular docking. The vaccine-CXCR4 interface was more consistent, possibly because the vaccination has a higher affinity for the CXCR4-TLR2 complex.

CONCLUSION

This study details the vaccine's distinct and sustained interaction with the CXCR4(TLR2) immunological receptor and its consistent and effective utterance in the bacterial system. As a result, our vaccine formulation will evoke a significant memory response and induce an adaptive immune response against P. gingivalis.

An Update on Assessment, Therapeutic Management, and Patents on Insomnia

Insomnia is an ordinary situation related to noticeable disability in function and quality of life, mental and actual sickness, and mishappenings. It represents more than 5.5 million appointments to family doctors every year. Nonetheless, the ratio of insomniacs who are treated keeps on being low, demonstrating the requirement for proceeding with advancement and dispersal of effective treatments. Accordingly, it becomes significant to provide a compelling treatment for clinical practice. It indicates a need for the determination of various critical viewpoints for the evaluation of insomnia along with various accessible alternatives for treatment. These alternatives incorporate both nonpharmacological therapy, specifically cognitive behavioural therapy for insomnia, and a number of pharmacological treatments like orexin antagonists, "z-drugs," benzodiazepines, selective histamine H1 antagonists, nonselective antihistamines, melatonin receptor agonists, antipsychotics, antidepressants, and anticonvulsants. Besides in individuals whose insomnia is due to restless leg syndrome, depression/mood disorder, or/and circadian disturbance, there is insignificant proof favouring the effectiveness of different prescriptions for the treatment of insomnia though they are widely used. Other pharmacological agents producing sedation should be prescribed with care for insomnia therapy because of greater risk of next-day sleepiness along with known adverse effects and toxicities. This review is also aimed at providing an update on various patents on dosage forms containing drugs for insomnia therapy.

Surface roughness and color measurements of glazed or polished hybrid, feldspathic, and Zirconia CAD/CAM restorative materials after hot and cold coffee immersion

Background

The purpose of this study evaluates and compares the effect of surface roughness (Ra) and color stability on computer-aided design/computer-aided manufacturing (CAD/CAM) hybrid resin (Vita Enamic), feldspathic (Vitablocs® Mark II), and lithium disilicate Zirconia (Vita Suprinity) glazed or polished ceramics immersed in hot Arabic Qahwa and cold coffee.

Methods

A total of 96 standardized samples were prepared from CAD/CAM restorative materials. Half of the samples were polished as per the manufacturer’s instructions using a porcelain polishing kit, and the other half were glazed. Samples were distributed and immersed in hot Arabian Qahwa and cold coffee followed by thermocycling. Ra measurements and color changes were conducted before and after immersion. SEM images were captured from each type of glazed or polished ceramic. One-way ANOVA paired Student’s t-test, and Bonferroni test were conducted to detect significant difference between the groups. P > 0.05 was a significant level.

Results

Of all the tested samples, Ra increased without any significant difference; however, mean color changes (ΔE*) showed significant differences. An increase in Ra was noted for all the glazed and polished samples after immersion and thermocycling. However, differences were significant only in VM II. In addition, ΔE* was significant only in Vita Suprinity (VS) samples. For immersion groups, significant Ra changes were noticed in glazed samples, only in Vita Enamic (VE) with no ΔE*. In polished samples, mean Ra changes were observed in VM II and VS samples. Significant differences were also noticed in polished VE and VS subgroups of ΔE*.

Conclusions

Ra affects all the tested samples, providing higher values on the polished specimens. The ΔE* caused by hot Arabic Qahwa and cold coffee on glazed or polished CAD/CAM restorative materials were clinically acceptable.

Comparing keratometry readings with manual separation of lids and wire speculum in children under general anesthesia

Purpose:

Keratometry (K) readings are crucial for intraocular lens power calculation in cataract surgery. In children who do not cooperate, the keratometry is done under general anesthesia with a handheld autokeratometer. However, there is little consensus regarding the method for the measurement of K readings. The lids can be separated either by fingers or a wire speculum may be placed to separate the lids for measurement.

Methods:

The children selected for the study were patients cooperative for keratometry reading. Nidek KM-500 handheld keratometer was used first in the awake period. Then under general anesthesia, readings were taken first by separating the lids manually with fingers and then after putting a wire speculum in both the eyes.

Results:

The average keratometry reading for participants in the OPD, anesthetized with lids manually opened and with lids separated with speculum was 44.7 ± 1.7 D, 44.4 ± 1.9 D, and 44.7 ± 1.7 D, respectively.

Conclusion:

No significant change was observed in keratometry values in children with manual separation of eyelids or with wire speculum.

A Split Mouth Study on Crestal Bone Architectural Changes by Flapped and Flapless Implant Surgical Procedures

Background: Rehabilitations by dental implants have often been utilized as an efficient procedure for restoring missing teeth. For implant placement two types of surgical methods are well documented. Conventional surgical approach involves raising a mucoperiosteal flap to gain access and see the underlying alveolar bone, instead there is this procedure which does not involve the reflection of the flap. Both the techniques are known to have their individual benefits and shortcomings. The present study was aimed to evaluate the longitudinal comparison and evaluation of hard tissue changes around endosseous implants placed using flapped as well as flapless surgical procedures in mandibular first molar region. Materials and Methods: A total of 10 healthy patients with bilateral mandibular first molar were involved in the study and 20 endosseous implants were inserted (10 in each group). Radiographic assessment was done for deviations in the marginal bone levels on both mesial and distal side and their average value was calculated at 1 month, and 3 months. All these parameters were statistically analyzed using the paired Student t test, and two-way ANOVA test and were considered to be significant if the p value was ≤ 0.05. Results: During the 3 months observation period, the change in crestal bone height around the implants placed by flapless and flap surgery were statistically significant. The flapless group showed less reduction in the crestal bone height compared to the flap group. Conclusion: Both flap and the flapless techniques of endosseous implant placement had statistically significant effect on peri-implant bone loss over the 3 month period.

Clinical and Radiographical Measurements of Supraeruption and Occlusal Interferences in Unopposed Posterior Teeth

AIMS AND OBJECTIVES

This study compared the supraeruption of teeth for study casts (SCs) and panoramic radiographs (PRs) and its relation to tooth type, arch, facial sides, presence of occlusal interferences, and type of tooth movements.

MATERIALS AND METHODS

A total of 65 patients with their SCs and PRs were recruited. Supraerupted tooth type, arches, sides involved, and the presence of occlusal interferences were recorded. The SCs for supraerupted teeth were photographed, and supraeruption from PRs was recorded from the patients' files. The values were transferred to a software program and assessed.

RESULTS

The highest frequency was observed among the younger-age group and molars in both arches. Working side (WS) and retruded cuspal position (RCP) interferences were recorded the highest. Supraeruption values of 0.7-1.2 mm accounted for 47.5% (38) of the total. Tilting and tipping of teeth were the highest, followed by buccolingual displacement. Kappa tests showed good intraexaminer reliability and Bland-Altman plot showed 95% confidence interval band.

CONCLUSIONS

No significant differences were observed in the supraeruption values between the type of tooth among different subgroups of SCs and PRs. Significant differences were recorded between the types and sites of teeth, with a higher ratio observed in molar teeth, mandibular arch, and young age group. RCP and WS were the most recorded occlusal interferences and buccolingual displacement, and tilting and tipping were the most noticeable occlusal tooth movements.

CLINICAL SIGNIFICANCE

Diagnosis and measurements of supraeruption are essential, useful, and significant steps before treatments for replacement of missing tooth/teeth as well as corrections of occlusal interferences during different mandibular movements.

Oral Biofilm on Dental Materials Among Khat Chewers

BACKGROUND

Nowadays khat chewing habit is increasing among population in southern part of Saudi Arabia, Jazan and till date there is no literature investigating the effect of khat on oral biofilm on dental materials.

OBJECTIVE

To evaluate and compare the bacterial biofilm on different types of dental restorative materials used in replacing missing tooth structures among khat chewers and non-khat chewers.

MATERIALS AND METHODS

Hundred and twenty biofilm samples were collected from different dental restorations, such as All-ceramic (AL), Metal Ceramic (MC), Metal crowns or bridges (M), Composite (C), Glass Ionomer (GI) and Amalgam (A) restorations in non-khat and khat chewers (K). DNA extraction was done and subjected to PCR. Bacterial species, such as Streptococcus, Neisseria, Bacillus, Granulicatella and Veillonella were identified and counted. PCR products were also sequenced to detect similarity. Association between bacterial type and dental materials among non-khat and khat chewers were tested with Chi-Square test (Fishers Exact test).

RESULTS

The frequency and percentage of Streptococcus species were marginally higher among khat chewers (42; 70%) compared with non-khat chewers (38; 63.3%) group. But the Veillonella species were higher among non-khat chewers (9: 15%), compared to the khat chewers group (7; 11.7%). No statistically significant difference was detected among species in both groups. In non-khat and khat chewer group, the maximum hits were related to Streptococcus spp. in glass ionomer, amalgam, and composite (restorative materials), followed by metal ceramic and metal (prosthetic materials). Veillonella spp. showed maximum hits in the metal group among non-khat chewers and in all-ceramic among khat chewers. Statically significant differences were recorded among composite and amalgam samples with p values 0.047 and 0.036 in khat chewer group.

CONCLUSION

Khat chewers showed statistically significant differences in oral biofilm in the composite and amalgam restorative materials, but there were no significant differences found among any materials and species between the groups.

A new normal with cataract surgery during COVID-19 pandemic

Cataract is the second leading cause of preventable blindness on the globe. Several programs across the country have been running efficiently to increase the cataract surgical rates and decrease blindness due to cataract. The current COVID-19 pandemic has led to a complete halt of these programs and thus accumulating all the elective cataract procedures. At present with the better understanding of the safety precautions among the health care workers and general population the Government of India (GoI) has given clearance for functioning of eye care facilities. In order to facilitate smooth functioning of every clinic, in this paper, we prepared preferred practice pattern based on consensus discussions between leading ophthalmologists in India including representatives from major governmental and private institutions as well as the All India Ophthalmological Society leadership. These guidelines will be applicable to all practice settings including tertiary institutions, corporate and group practices and individual eye clinics. The guidelines include triage, use of personal protective equipment, precautions to be taken in the OPD and operating room as well for elective cataract screening and surgery. These guidelines have been prepared based on current situation but are expected to evolve over a period of time based on the ongoing pandemic and guidelines from GoI.

Khat Chewing Induces a Floral Shift in Dental Material-Associated Microbiota: A Preliminary Study

Background

The habit of khat (Catha Edulis Forskal) chewing is widely practiced in the southern regions of Saudi Arabia, Yemen, and East Africa. This social habit has tremendous effects on oral and general health of khat chewers. Khat may affect bacterial species in plaque biofilms on oral rehabilitation materials. This preliminary case-controlled study aimed to assess and compare the effect of khat chewing on bacterial biodiversity between non-khat chewers (NKC) and khat chewers (KC) in oral biofilms on oral rehabilitation materials using polymerase chain reaction (PCR).

Material/Methods

Fifty participants were organized into 2 equal groups of NKC and KC, each containing 5 subgroups related to filling material type. Some participants had amalgam (A) or composite (C) restorations, while others had feldspathic porcelain (FP), nickel chromium (NC), and zirconia ceramic (ZC) crowns or bridges. Oral biofilm samples were collected from all participants, DNA was extracted, and samples were subjected to PCR. Bacterial species were then identified and counted. PCR products were sequenced to detect similarity. Partial 16S rRNA gene sequences of the current study samples were compared with 16S rRNA gene sequences from GenBank using BLAST on the National Center for Biotechnology Information website.

Results

The Streptococcus sp. was the most common bacterial species among our participants (40; 80%), followed by Lactobacillus and Veillonella spp., accounting for 12% (6) and 8% (4), respectively. Streptococcus sp. was observed equally among NKC and KC, but Lactobacillus and Veillonella spp. were higher in KC and NKC, respectively. Lactobacillus was associated mainly with prosthetic materials, and Streptococcus was found among all examined dental restorative materials.

Conclusions

This research concluded that khat chewing significantly affects bacterial biodiversity in oral biofilms in the presence of different restorative and prosthetic dental materials.

Gastroretentive bilayer film for sustained release of atorvastatin calcium and immediate release of amlodipine besylate: pharmaceutical, pharmacokinetic evaluation, and IVIVC

The present study was aimed to optimize capsulated unfolding type gastroretentive bilayer film constituting immediate release (IR) layer of amlodipine besylate and sustained release (SR) layer of atorvastatin calcium. A three-factor, three-level Box-Behnken-design was used to optimize bilayer film with dual-release characteristics. The selected independent variables were HPMC-K3, Eudragit RSPO, and Carbopol 934P and the responses were floating duration, swelling index, and in vitro release from SR layer in 8 h. The films were also assessed for pharmacotechnical characteristics, release kinetics, DSC, FTIR, and SEM. The pharmacokinetics of the drugs from the optimized formulation was compared with the marketed formulation in rabbits. The capsulated accordion film unfolded and provided SR of atorvastatin for 8 h (96.76% ± 0.71) and IR of amlodipine within 25 min (98.07% ± 0.62) for the optimized formulation (F14). The swelling index and floating duration for the optimized formulation were 140.48 ± 0.57 and 8.53 ± 0.10 h, respectively. Results of pharmacokinetics showed that faster absorption of amlodipine and improved bioavailability (2.16-fold) of atorvastatin in blood was made available through bilayer film. In vitro-in vivo correlation was established using numerical deconvolution method. It can be concluded that the capsulated gastroretentive system provided site specific simultaneous SR of antihyperlidemic drug and IR of antihypertensive drug as single pill that has therapeutic potential to manage cardiovascular risk.

Cost and cost-effectiveness of health behavior change interventions implemented with self-help groups in Bihar, India

Introduction

Health interventions implemented with self-help groups (SHGs) enhance the relevance and acceptability of the health services. The Parivartan program was implemented in eight districts of Bihar with women’s self-help groups to increase adoption of maternal and newborn health behaviors through layering health behavior change communication. This study estimates the cost and cost-effectiveness of a health behavior change program with SHGs in Bihar.

Methods

Cost analysis was conducted from a provider’s perspective. All costs have been presented in US dollars for the purpose of international comparisons and converted to constant values. The effectiveness estimate was based on the reported changes in select newborn care practices. A decision model approach was used to estimate the potential number of neonatal deaths averted based on adoption of key newborn care practices. Using India’s life expectancy of 65 years, cost per life year saved was calculated. A one-way sensitivity analysis was conducted using the upper and lower estimates for various variables in the model, and functionality of SHGs.

Results

The cost of forming an SHG group was US$254 and that of reaching a woman within the group was US$19. The unit cost for delivering health interventions through the Parivartan program was US$148 per group and US$11 per woman reached. During an 18 months period, Parivartan program reached around 17,120 SHGs and an estimated 20,544 pregnant women resulting in an estimated prevention of 23 neonatal deaths at a cost of US$3,825 per life year saved.

Conclusion

SHGs can be an effective platform to increase uptake of women’s health interventions and follow-up care, and also to broaden their utility beyond microfinance, particularly when they operate at a larger scale.

Effect of Different Surface Treatments on Biaxial Flexural Strength of Yttria-stabilized Tetragonal Zirconia Polycrystal

INTRODUCTION

Ceramics are widely applied in dentistry owing to their excellent mechanical and physical attributes. The most popular ceramics are Lava™, KaVo Everest, and Cercon. However, it is unclear whether or not a different surface treatment along with low-temperature aging and mechanical loading (ML) affects the physical properties of computer-aided design (CAD)/computer-aided manufacturing (CAM)-machined yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramic.

AIM

The objective of this research was to assess the impact of various surface treatments as air-particle abrasion, ML, low-temperature degradation (LTD), and their cumulative effects on biaxial flexural properties of Y-TZP.

MATERIALS AND METHODS

Totally, 50 specimens were fabricated by CAD-CAM machining from Cercon® and divided into five groups following different surface treatments as control (C), air-particle abrasion (Si), ML, LTD, and cumulative treatment (CT) group. Results were investigated by two-way analysis of variance (ANOVA) and Tukey honest significant difference (HSD) test.

RESULTS

The highest biaxial flexural strength was observed in the Si group (950.2 ± 126.7 MPa), followed by the LTD group (861.3 ± 166.8 MPa), CT group (851.2 ± 126.5 MPa), and the least with ML (820 ± 110 MPa). A significant difference was observed in the two-way ANOVA test. X-ray diffraction (XRD) analysis showed that the control group consists of 100% tetragonal zirconia and the maximum amount of monoclinic phase was obtained after LTD.

CONCLUSION

No negative effect on biaxial flexural strength was observed; indeed, it increases the biaxial strength. Hence, these surface treatments can be done in routine clinical practice to improve the performance of ceramic restoration.

Evaluation of the Current Techniques and Introduction of a Novel Approach for Estimating Maxillary Anterior Teeth Dimensions

INTRODUCTION

Several techniques and methods have been proposed to estimate the anterior teeth dimensions in edentulous patients. However, this procedure remains challenging especially when preextraction records are not available. Therefore, the purpose of this study is to evaluate some of the existing extraoral and intraoral methods for estimation of anterior tooth dimensions and to propose a novel method for estimation of central incisor width (CIW) and length (CIL) for Saudi population.

MATERIALS AND METHODS

Extraoral and intraoral measurements were recorded for a total of 236 subjects. Descriptive statistical analysis and Pearson's correlation tests were performed. Association was evaluated between combined anterior teeth width (CATW) and interalar width (IAW), intercommisural width (ICoW) and interhamular notch distance (IHND) plus 10 mm. Evaluation of the linear relationship between central incisor length (CIL) with facial height (FH) and CIW with bizygomatic width (BZW) was also performed.

RESULTS

Significant correlation was found between the CATW and ICoW and IAW (p-values <0.0001); however, no correlation was found relative to IHND plus 10 mm (p-value = 0.456). Further, no correlation was found between the FH and right CIL and BZW and right CIW (p-values = 0.255 and 0.822). The means of CIL, CIW, incisive papillae-fovea palatinae (IP-FP), and IHND were used to estimate the central incisor dimensions: CIL = FP-IP distance/4.45, CIW = IHND/4.49.

CONCLUSION

It was concluded that the ICoW and IAW measurements are the only predictable methods to estimate the initial reference value for CATW. A proposed intraoral approach was hypothesized for estimation of CIW and CIL for the given population.

CLINICAL SIGNIFICANCE

Based on the results of the study, ICoW and IAW measurements can be useful in estimating the initial reference value for CATW, while the proposed novel approach using specific palatal dimensions can be used for estimating the width and length of central incisors. These methods are crucial to obtain esthetic treatment results within the parameters of the given population.

Effect of Cast Modification on Denture Base Adaptation Following Maxillary Complete Denture Processing

PURPOSE

To investigate the effect of cast modifications on denture base adaptation in coronal and sagittal projections following maxillary complete denture processing.

MATERIALS AND METHODS

A total of 60 edentulous maxillary casts (n = 10) were distributed among six groups. Group 1 was the control group with no modification, groups 2 through 6 included a butterfly postdam preparation, groups 3 and 4 also included a 10-mm wide/4-mm deep box with addition of four round holes in group 4, and groups 5 and 6 also included a 20-mm wide/4-mm deep box with addition of four round holes in group 6. The boxes were prepared at the mid-heel area of the casts. Two layers of baseplate wax (1 mm each) were used to standardize denture base thickness across the groups. A standard technique was used to replicate the denture tooth set-up, and standardized processing was done for all the groups. Following deflasking, casts with the dentures were sectioned in the coronal and sagittal directions. Microscopic pictures were taken at preselected points. Data were organized in tables, and statistical analyses were performed using repeated measure ANOVA, Tukey post hoc tests, and post hoc comparison tests set at 5% level of significance.

RESULTS

Maximum gaps were measured at the mid-palatal area followed by nearby areas and the areas near ridge crests in both coronal and sagittal projections. The analyses revealed significant differences between the groups in coronal projection (1/2, 3/4, 5/6) and sagittal projection (1, 2, 3/4, 5/6) without significant differences within the pairs. The groups were ranked from the highest group 1 to the lowest group 6 relative to the gap means. Post hoc comparisons showed that points 1C and 2A had the highest gap means across the study groups.

CONCLUSIONS

Within the limitations of this study, it can be extrapolated that the denture base adaptation can be effectively increased with the box preparation at the mid-heel aspect of the casts. Significant reduction of gaps was seen when the box size increased from 10 to 20 mm in coronal and sagittal projections; however, the addition of four holes had no significant effect on gap size alterations.

Association of Neutral Zone Position with Age, Gender, and Period of Edentulism

PURPOSE

The changing dynamics of an aging mouth influence the position of the neutral zone (NZ). While the advantage of the NZ concept in complete denture treatment is quite established, what is not clearly understood is its position in relation to the crest of the residual ridge due to conflicting reports from previous studies. The purpose of this study was to investigate the distance and direction of NZ position in relation to crest of the residual ridge in edentulous patients and its association with age, gender, and period of edentulism.

MATERIALS AND METHODS

A cross-sectional study was conducted in 133 patients (70 males, 63 females) with a mean age of 58.81 ± 11.78 years. NZ recording was done using admix material by following standard procedures. Two metallic wires were adapted, one on the ridge and another on the center of the occlusal rims, and standardized digital radiographs were made. The position of NZ in relation to the crest of the residual ridge was recorded by noting the direction and measuring the distance between the adapted wires digitally at five locations (right molar, right premolar, incisor, left molar, left premolar regions).

RESULTS

Age, gender, and period of edentulism had no significant association with the position of NZ. No specific trend was observed in the in NZ position with a non-significant correlation.

CONCLUSIONS

Distance and the direction of neutral zone position in relation to crest of the residual ridge in edentulous patients bear no significant relationship with factors such as age, gender, and period of edentulism.

Serum interleukin-1β in subjects with abdominal obesity and periodontitis

BACKGROUND & OBJECTIVE

Abdominal obesity and periodontal diseases are believed to share close relation through commonality of chronic inflammation. Both inflammatory periodontal disease and excess abdominal fat modulate their systemic influences through several inflammatory mediators. The present study was carried out to evaluate and compare serum interleukin-1β levels in subjects with abdominal obesity and periodontal disease.

METHODS

Sixty non-diabetic and non-smoking subjects (aged 25-49 years; 28 females and 32 males) were assessed for abdominal obesity by waist to hip ratio. Full-mouth clinical periodontal measurements were recorded for determination of periodontal status. Serum samples were obtained and interleukin-1β was assessed using commercially available ELISA kit. Obtained data were analyzed statistically.

RESULTS

Measures of abdominal obesity and periodontal disease were found to significantly influence the serum interleukin-1β. Abdominally obese subjects had significantly higher serum interleukin-1β in healthy (p=0.006), gingivitis (p<0.001) and periodontitis (p<0.001) groups. There was a significant difference in serum interleukin-1β levels among subjects with different periodontal status in both non obese (F(2,27)=18.17, p<0.0001) and obese groups (F(2,27)=15.70, p<0.0001). Serum interleukin-1β was significantly correlated with PI, GI, BOP%, PD and CAL non obese and obese groups. A significant correlation was also seen with WC, HC and WHR only in obese group.

CONCLUSION

Significant changes in serum interleukin-1β are influenced by abdominal obesity and periodontal status independently even in the absence of diabetes mellitus and smoking. Serum interleukin-1β was significantly higher in patients with abdominal obesity and periodontitis.

Clinical and histopathological changes in palatal mucosa following two treatment modalities in patients wearing maxillary complete dentures with suction cup

Aim:

The aim of the study was to determine the clinical and histopathological effect on palatal hyperplasia caused by suction cups by different methods of management used for recovery of abused tissues.

Materials and Methods:

A total of 35 subjects agreed for biopsy procedure, from 50 patients who gave consent for the study. Out of the 35 subjects, 20 were randomly selected for treatment with discontinuation of denture (Group I) and 15 selected for denture relined with tissue conditioner (COE-comfort) (Group II). Punch biopsy procedure was performed on these patients to study the histopathology of the lesion before the two modalities of treatment was administered on them.

Results:

Inflammation caused by suction cup decreased considerably by both the treatment modalities, i.e., the use of tissue conditioner as well as discontinuation of denture (tissue rest) for a period of 2 weeks.

Conclusion:

It was concluded that wearing denture day and night considerably increased the severity of inflammatory papillary hyperplasia of palate. Healing was better with tissue conditioner when compared with tissue rest.

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.

The effect of thermocycling on the bonding of different restorative materials to access opening through porcelain fused to metal restorations

PURPOSE

Porcelain fused to metal (PFM) crowns provide the best treatment option for teeth that have a large or defective restoration. More than 20% of teeth with PFM crowns or bridges require non-surgical root canal treatment (NSRCT). This may be due to the effect of restorative procedures and the possible leakage of bacteria and or their by-products, which leads to the demise of the tooth pulp. Thus, this study was planned to compare the ability of the restorative materials to seal perforated PFM specimens.

MATERIALS AND METHODS

The study evaluates the ability of amalgam, composite or compomer restorative materials to close perforated PFM specimen's in-vitro. Ninety PFM specimens were constructed using Ni-Cr alloys and feldspathic porcelain, and then they were divided into 3 groups: amalgam (A), composite + Exite adhesive bond (B) and compomer + Syntac adhesive bond (C). All the PFM samples were embedded in an acrylic block to provide complete sealing of the hole from the bottom side. After the aging period, each group was further divided into 3 equal subgroups according to the thermocycling period (one week for 70 cycles, one month for 300 cycles and three months for 900 cycles). Each subgroup was put into containers containing dye (Pelikan INK), one maintained at 5℃ and the other at 55℃, each cycle for 30 sec time. The data obtained was analyzed by SPSS, 2006 using one way ANOVA test and student t-test and significant difference level at (P<.01).

RESULTS

The depth of dye penetration was measured at the interfaces of PFM and filling materials using Co-ordinate Vernier Microscope. The lowest levels of the dye penetration for the three groups, as well as subgroups were during the first week. The values of dye leakage had significantly increased by time intervals in subgroups A and C.

CONCLUSION

It was seen that amalgam showed higher leakage than composite while compomer showed the lowest level of leakage.

Modified technique for retaining silicone auricular prosthesis: a case report

Prosthetic rehabilitation of auricular defects can be a demanding procedure due to a broad variety of clinical presentations and a wide array of treatment options. The retention of auricular prostheses is a major factor influencing the successful outcome of rehabilitative treatment following cancer surgery or trauma. Auricular prostheses have been retained by methods including implants, adhesives and spectacle frames but the choice of repair ultimately depends on patient factors, amount of soft tissue loss, and location of the auricular defect. This article describes a newer technique of using resin template for silicone auricular prosthesis, for better retention and orientation. Moreover it is cost effective and aesthetically acceptable for patients who decline or need to postpone implant retained prosthesis reconstruction.

Comparison of linear dimensional change, surface hardness and surface roughness of refractory model prepared from two different duplicating media

The aim of this study was to evaluate and compare the linear dimensional change, surface hardness and surface roughness of the refractory casts poured against different duplicating media. Polyvinyl siloxane and Agar-agar were used for duplicating the stainless steel die. Sixty refractory models were prepared which were divided into two groups: I and II with 30 samples each respectively. Each group was subdivided into 3 subgroups with 10 samples each which were treated differently. All the specimens were measured for the linear dimensional change and surface hardness and the obtained data was statistically analyzed. Surface roughness was evaluated qualitatively taking SEM photomicrographs. Statistical analysis of linear dimensional change using one-way ANOVA showed statistically significant difference between subgroups of group I and non-significant difference between subgroups of group II. One-way ANOVA for Brinell hardness number showed statistically significant difference between the subgroups of group I & II. Student's 't' test results for linear dimensional change among different subgroups of group I & II showed significant difference between IA-IIA, IB-IIB, IC-IIC. Similarly 't'-test results for Brinell hardness number showed significant difference between subgroups IA-IIA, IB-IIB, and IC-IIC. Surface characteristics of the refractory casts poured against polyvinyl siloxane duplicating media were found to be better than the Agar media.

Effect of porcelain-firing cycles and surface finishing on the marginal discrepancy of titanium copings

PURPOSE

The aim of the study was to evaluate the effect of simulated porcelain firing cycles and surface finishing on the marginal fit of commercially pure titanium (Cp Ti) copings.

MATERIALS AND METHODS

A machined stainless steel die system with standard 0.5-mm copings was fabricated. Wax patterns were prepared by pouring the molten wax on a two-part stainless steel die. Thirty specimens were cast in Cp Ti. These were divided into three groups with ten specimens in each group. Group 1 was treated with conventional cold working and later oxidized. Group 2 specimens were oxidized initially and then cold worked. Group 3 was heat treated in its original investment and later treated as in group 1. All specimens were later subjected to sequential simulated porcelain firing cycles, that is, oxidation, bonder, opaque, body, and glaze firing. Following the completion of each firing cycle, marginal discrepancy was measured in μm using a traveling microscope. The obtained data were subjected to one-way analysis of variance (ANOVA) and Student's t-test. The statistical level of significance was set at 1%.

RESULTS

The results showed that the mean and SD values (in μm) were 55 ± 2.6, 43 ± 3.0, and 68 ± 4.0 after oxidation for groups 1, 2, and 3, respectively. Mean and SD values (in μm) after glaze firing were 76 ± 3.9, 64 ± 4.1, and 89 ± 4.3 for groups 1, 2, and 3, respectively. The mean marginal opening was largest for group 3 specimens. One-way ANOVA showed the difference within the three groups was highly significant after oxidation (F-value 149.37 at p-value 0.0000) and glaze firing (F-value 82.43 at p-value 0.0000).

CONCLUSIONS

(1) The Student's t-test values demonstrated that increased marginal openings of the specimens resulted after the sequential simulated porcelain firing cycles. (2) Marginal discrepancy values improved when the specimens were thermocycled prior to cold working.

Preparation and evaluation of sustained release microballoons of propranolol

BACKGROUND AND THE PURPOSE OF THE STUDY

The purpose of the present investigation was to characterize, optimize and evaluate microballoons of Propranolol hydrochloride and to increase its boioavailability by increasing the retention time of the drug in the gastrointestinal tract.

METHODS

Propranolol hydrochloride-loaded microballoons were prepared by the non-aqueous O/O emulsion solvent diffusion evaporation method using Eudragit RSPO as polymer. It was found that preparation temperature determined the formation of cavity inside the microballoon and this in turn determined the buoyancy. Microballoons were subjected to particle size determination, micromeritic properties, buoyancy, entrapment efficiency, drug loading, in vitro drug release and IR study. The correlation between the buoyancy, bulk density and porosity of microballoons were elucidated. The release rate was determined in simulated gastric fluid (SGF) of pH 1.2 at 37±0.5°C.

RESULTS

The microballoons presented spherical and smooth morphologies (SEM) and were porous due to presence of hollow cavity. Microballoons remained buoyant for >12 hrs for the optimized formulation. The formulation demonstrated favorable in vitro floating and release characteristics. The encapsulation efficiency was high. In vitro dissolution kinetics followed the Higuchi model. The drug release from microballoons was mainly controlled by diffusion and showed a biphasic pattern with an initial burst release, followed by sustained release for 12 hrs. The amount of the drug which released up to 12 hrs was 82.05±0.64%. Statistical analysis (ANOVA) showed significant difference (p<0.05) in the cumulative amount of drug released after 30 min, and up to 12 hrs from optimized formulations.

CONCLUSION

The designed system for propanolol would possibly be advantageous in terms of increased bioavailability and patient compliance.

Modified mandibular advancement appliance for an edentulous obstructive sleep apnea patient: a clinical report

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep and observed apneas with prevalence up to 54% in elderly people. Treatment of OSA varies from simple measures such as dental appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Dental appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement appliances are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 61-year old edentulous OSA patient for whom a modified mandibular advancement appliance was designed. The patient reported an improvement in AHI index and he was satisfied with the modified appliance. This clinical report describes the newer technique of fabricating oral appliance for edentulous OSA patient.

A simple method of positioning the iris disk on a custom-made ocular prosthesis. A clinical report

We report two cases of ocular prosthesis fabrication that make use of a transparent graph grid for positioning the iris disk. The custom-made ocular prostheses achieved intimate contact with the tissue bed enabling ideal fit. As asymmetry may result in a squint-eyed appearance, proper positioning of the iris disk in the scleral wax pattern is vital to fabricating the custom-made artificial eye. The position of the iris disk in the custom-made ocular prosthesis was in symmetry with that of the natural eye, restoring esthetics of the patient.

Prevalence of hepatitis viruses among multi-transfused homogenous thalassaemia patients

Thalassaemic children being multi-transfused are at increased risk of parenterally transmissible hepatitis viruses and majority of them prone to develop chronic liver disease. The study is designed to find out the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) and hepatitis D virus (HDV) seromarkers and correlation of age, sex, number of transfusions and the viral aetiology in thalassaemics of central India. One hundred and four thalassaemic children were subjected to clinical, biochemical and serological analysis for the HBV, HCV and HDV viruses. The chi(2) test was applied to check the statistical significance of different variables. In the present study HBV markers were detected in 57 (56%) of the subjects while anti-HCV antibodies were observed in 21% of the patients. However, only four subjects were detected hepatitis B surface antigen (HBsAg) reactive but none of them were reactive for anti-HDV antibodies. Forty patients had raised alanine transaminase (ALT) levels and among them two were HBsAg reactive, 16 were anti-HBc antibody positive and 14 were anti-HCV reactive. The prevalence of hepatitis viruses and raised ALT levels are found to be significantly associated with the increasing age and number of blood units transfused to them. The present findings also document the excellent contribution of stringent screening of blood units and HBV vaccination programme for containing the HBV infection among thalassaemics.