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Context Increased bone fragility and reduced energy absorption to fracture associated with type 2 diabetes (T2D) cannot be explained by bone mineral density alone. This study, for the first time, reports on alterations in bone tissue’s material properties obtained from individuals with diabetes and known fragility fracture status. Objective To investigate the role of T2D in altering biomechanical, microstructural, and compositional properties of bone in individuals with fragility fracture. Methods Femoral head bone tissue specimens were collected from patients who underwent replacement surgery for fragility hip fracture. Trabecular bone quality parameters were compared in samples of 2 groups, nondiabetic (n = 40) and diabetic (n = 30), with a mean duration of disease 7.5 ± 2.8 years. Results No significant difference was observed in aBMD between the groups. Bone volume fraction (BV/TV) was lower in the diabetic group due to fewer and thinner trabeculae. The apparent-level toughness and postyield energy were lower in those with diabetes. Tissue-level (nanoindentation) modulus and hardness were lower in this group. Compositional differences in the diabetic group included lower mineral:matrix, wider mineral crystals, and bone collagen modifications—higher total fluorescent advanced glycation end-products (fAGEs), higher nonenzymatic cross-link ratio (NE-xLR), and altered secondary structure (amide bands). There was a strong inverse correlation between NE-xLR and postyield strain, fAGEs and postyield energy, and fAGEs and toughness. Conclusion The current study is novel in examining bone tissue in T2D following first hip fragility fracture. Our findings provide evidence of hyperglycemia’s detrimental effects on trabecular bone quality at multiple scales leading to lower energy absorption and toughness indicative of increased propensity to bone fragility.

Regenerative endodontics (RE) is a dynamic field with widespread global impact. The aim of this bibliometric analysis is to highlight India's contribution in the field. Electronic search was performed in PubMed and Web of Science database till December 2019 using the search terms "Dental pulp regeneration," "Pulp revascularisation," "Revitalisation," "Regenerative endodontic," and their permutation. Articles of Indian authors with affiliation to Indian institutes were included. The following data were extracted: first author, institute and state of affiliation, year and journal of publication, study design, level of evidence (LOE), and number of citations. A total of 76 articles (case reports [n = 29, 38.15%], review [n = 25, 32.8%]) were published between 2008 and 2019. Majority (42.6%) were categorized as LOE 4. 7.4% articles were in LOE1 category. Eight percent articles had citations above 100 (highest cited-354 citations). The average yearly growth rate between 2011 and 2019 was 33.28% and highest number of publications was in the year 2015. The south zone had the maximum publications. At an institutional level, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, had the maximum publications. Journal of Conservative Dentistry published the highest number of articles. India contributed 7.6% of the global PubMed indexed publications and reported 22% of clinical trials. This analysis reveals increasing trend of research in RE in India. However, it highlights the need to generate articles with higher LOE by conducting quality multicenter trials and promote national and international collaborations.

Radiation therapy, either used alone or in combination with surgery and or chemotherapy, is the most commonly utilized modality for treating head and neck cancers. Patients undergoing radiation therapy usually experience significant early and late-onset toxicities/adverse effects. Radiation-related caries (RRC) is a common complication that detrimentally affects patients' quality of life (QoL). A clearer understanding and more uniform approach to scoring systems help provide a more accurate diagnosis, form treatment protocols, plan, and evaluate outcomes of preventive initiatives and create scientific databases. Many indices have been used to assess and quantify the dental caries experience after radiotherapy. Considering the need for uniform standards for measuring radiation caries, indices specific to radiation caries have been proposed in the literature to capture postradiation damage to the dentition accurately. This narrative review aims to consolidate the evolution of different indices used for scoring RRC to improve the understanding of radiation caries assessment.

Objective Periapical extrusion is frequently observed during endodontic therapy. It can lead to acute injury of periapical tissues, resulting in interappointment pain or swelling. The effect is pronounced in teeth with immature teeth which are more susceptible to the extrusion of irrigant. The aim of this study was to evaluate the effect of gravity on apical extrusion of irrigating solution with different irrigation protocols in immature anterior teeth. Methods An extracted maxillary central incisor was modified to simulate an open apex with an apical diameter of 1.3 mm and parallel canal walls. The tooth was subjected to a cone-beam computed tomographic scan, and the image data set was utilized to prepare 30 resin tooth models with a 3D printer. These resin teeth were used to form an open-ended Myers and Montgomery extrusion models. These were then randomly divided into two groups to simulate their orientation in the jaw during endodontic therapy, i.e., group I (maxillary arch, n=15) models fixed at 45° inclined plane and group II (mandibular arch, n=15) models placed at a plane parallel to the floor. Five models from each group (n=5) were tested by three different irrigation protocols: positive pressure (PP) Irrigation, passive ultrasonic irrigation (PUI), and negative pressure (NP) irrigation. The extruded irrigating solution was collected in glass vials, and the volume was measured. Results The volume of extruded irrigating solution in groups I and II was compared using Mann-Whitney U-test. The median values for PP, PUI, and NP irrigation protocols were 0.6, 1, and 0 ml and 10, 10, and 0.5 ml for groups I and II, respectively. PP and PUI protocols were associated with significantly less extrusion in group I when compared to group II (P=0.004). There was no statistically significant difference in the volume of irrigating solution extruded in groups I and II (P=0.007) for NP irrigation protocol. Conclusion Gravitation force has an influence on periapical extrusion of irrigant in immature permanent teeth irrespective of the irrigant system used. NP performed better when compared to PP or PUI irrigation protocol irrespective of the tooth orientation.

Context: Coronavirus disease 2019 (COVID-19) is declared as a global pandemic by the WHO. Due to lack of proper vaccine, social distancing and restriction of movement in the form of“lockdown” have been implemented to curb the spread. This has crippled dental care in the country. Aims: The aim of this article is to highlight the management of endodontic emergencies during the COVID-19 lockdown phase. Settings and Design: Retrospective analysis of patient's data at a tertiary care center Materials and Methods: The data of 247 patients referred to the specialty clinic between March 23 and May 31, 2020, were retrospectively analyzed. COVID-19 risk assessment was performed for all the patients. Based on the diagnosis, the cases were classified as emergency, urgent, or nonemergency. The endodontic intervention was performed for all the emergency cases. Minimally invasive dentistry and pharmacotherapy were provided for urgent and nonemergency cases. Results: One hundred and seventeen patients presented with true endodontic emergencies (symptomatic irreversible pulpitis with or without apical periodontitis [80%], pulp necrosis and acute apical abscess [18%] or traumatic dental injury [2%]). About 82% of the emergency cases were managed by nonsurgical endodontic therapy, and vital pulp therapy was performed in 15.4% of the cases. Conclusions: Management of most of the endodontic emergencies required the use of aerosol-generating procedures. Irreversible pulpitis was the most common cause for the patients seeking emergency endodontic treatment.

Mucormycosis is a life-threatening, opportunistic, deep fungal infection frequently evident in patients with moderate to severe forms of COVID-19. It is usually detected within 2-8 weeks after the onset of symptoms and is categorized into six types depending on its location. The rhinocerebral form is most prevalent and involves orofacial structures. The fulminant nature of Mucormycosis necessitates rapid diagnosis and aggressive multidisciplinary treatment planning. This report presents a case of post-COVID-19 rhinocerebral Mucormycosis, where the failure to identify the disease by the dentist led to treatment delay. The patient was successfully managed by a combined approach of surgical debridement and systemic antifungal drug administration. The function and esthetics were restored by prosthetic rehabilitation. Etiopathogenesis of post-COVID-19 Mucromycosis and the dentist’s role in the diagnosis and treatment of mucormycosis following COVID-19 infection is discussed.

The aim of this systematic review was to compare the effect of body temperature (I) on the cyclic fatigue resistance (O) of nickel-titanium (NiTi) endodontic instruments (P) to that of room temperature (C).The study was registered in the PROSPERO database (CRD42020204286). A systematic search in PubMed, Scopus, Web of Science, Google Scholar, and OpenGrey was conducted in English until December 31, 2021.Twenty-one studies out of 347 met the criteria for inclusion. The meta-analysis included six studies (Within the limitation of the study, the cyclic fatigue resistance of heat-treated NiTi endodontic files is significantly reduced at body temperature when compared to room temperature. Cyclic fatigue testing should be conducted at simulated body temperature.

Regenerative endodontic procedures (REP) have the advantage of restoring root canal's native defense ability by re-establishing vital pulp-like tissue. This review aims to determine the overall clinical and/or radiographic success rate (O) of REP (I) in mature permanent teeth (P) and to compare it (C) with nonsurgical endodontic treatment (NSET).Sources: PubMed, Web of Science, Embase, EBSCO, Cochrane Central Register of Controlled trials, ClinicalTrials.gov, Clinical Trials Registry-India and OpenGrey. Inclusion: Randomized clinical trials and single-arm prospective studies evaluating the treatment outcomes of REP in mature permanent teeth. Exclusion: Incomplete trials/studies,Ten studies (A limited number of randomized clinical trials were available, and only two of them had a low risk of bias. Consistent results were obtained in both types of included studies.Based on a limited number of comparative studies, REP has a similar success rate to NSET in mature permanent teeth.Funding: Nil. Registration: PROSPERO (CRD42020204882).

Palliative care (PC) represents an approach that encompasses the procedures to relieve pain and distressing symptoms and maintain function as much as possible in the terminally ill patient until death. PC dentistry (PCD) is an approach for providing supportive and palliative dental care in patients with serious life-threatening illness (cancer, chronic heart failure, chronic obstructive pulmonary disease and cognitive impairment). The care is provided at different time points of diseases (i.e., from in-therapy care to survivorship care to end-of-life care). Dentists have a significant role to play in the multidisciplinary team of PC. Oral health problems (ulcers, mucositis, pulpitis and abscess) have a negative impact on general health and quality of life and can be acutely debilitating in these patients. These patients with existing comorbidities are at increased risk of developing oral complications. Furthermore, social isolation can cause an increase in anxiety, hopelessness, psychosocial and existential suffering amongst these patients. It is essential to incorporate PCD in the guidelines of critical dental care during the COVID-19 pandemic to decrease the suffering of these patients by symptom management. Teledentistry can be used with caution to provide at-home care to such patients during the pandemic.

Multiple idiopathic cervical root resorption (MICRR) is a rare condition. The etiology is unknown and occurs spontaneously in healthy controls in the absence of local, systemic, or any other plausible cause. The teeth themselves appear clinically normal. The pattern of resorption begins in cementoenamel junction and can progress rapidly over a short time. It is a debilitating condition which often leads to extraction of all the involved teeth. This article describes a case of MICRR over a period of 7 years with emphasis on the history, clinical/histological findings, cone beam computed tomographic examination, therapeutic intervention as well as the final prosthodontic rehabilitation with implants.

A wire composite splint (WCS) is most commonly used in clinical practice for the management of luxation dental injuries (LDIs). Wire thickness and adhesive point dimensions influence the rigidity of WCS. However, the influence of presplint tooth mobility on the rigidity of splint is not yet addressed.The aim of this study is to identify the optimal thickness of WCS that achieves physiologic mobility in teeth with varying degrees of loosening (DoL) in a simulated LDI model.Three typodont models with resin teeth were used. Right central incisor (Tooth 11) was simulated as an injured tooth and adjacent right lateral and left central incisor teeth (12 and21) acted as uninjured teeth. Each typodont model was modified to reproduce DoL 1, 2, and 3 in tooth 11 and categorized as Groups I, II, and III, respectively. The simulated injured tooth 11 was splinted with adjacent teeth 12 and 21 using 0.3, 0.5, and 0.8 mm WCS. Postsplinting DoL was assessed with Periotest.Two-way ANOVA andIrrespective of the thickness of WCS, the postsplint PTVs corresponding to DoL 0 for simulated injured right central incisor tooth (11) were not achieved in Groups II and III. In three study groups, there was no statistically significant difference in the splint effect produced by 0.3 mm versus 0.5 mm WCS or 0.5 mm versus 0.8 mm WCS for tooth 11.The postsplint DoL for a luxated tooth is affected by both the degree of presplint tooth mobility and the thickness of the wire.

This study aims to investigate the prevalence of palatogingival groove (PG) in anterior maxillary teeth in an Indian cohort using cone beam computed tomography (CBCT) scans.Retrospective study.Analysis of 119 CBCT scans (64 males, 55 females, and mean age 31.6 ± 13.5 years) was performed. The data of 636 anterior maxillary teeth (220 canine, 212 lateral incisor, and 204 central incisor teeth) were studied for PG's presence. Demographic details of patients and characteristics of PG, i.e., location, extension, depth, and type were recorded.Out of the 636 anterior maxillary teeth studied, PGs were detected in 12 (1.88%) teeth (3 [1.47%] central incisors, 9 [4.2%] lateral incisors, and 0 canines). All the teeth were categorized as having either type I (Seven teeth) or type II (Five teeth) radicular groove. Two of the 12 PGs were present in the mesial, six in the mid-palatal, and four were present in the distal portion of the palatal surface of the teeth.The prevalence of PG in maxillary incisors in this Indian cohort is 2.88%. Maxillary lateral incisors are the most affected teeth.

Stevens-Johnson syndrome (SJS) is a rare medical condition with severe mucocutaneous reaction due to infection or adverse drug reaction. The present case reports the impact of chloroquine-induced SJS on the tooth root development. A 20-year-old Indian male reported to conservative dentistry and endodontics speciality clinic with the chief complaint of food lodgement and sensitivity in maxillary and mandibular posterior teeth. He had a past medical history of severe cutaneous reaction after taking Tab. Lariago (chloroquine) for treatment of malarial fever at the age of 8 years. The acute inflammatory immune response was managed by hospitalization and administration of steroids and anti-inflammatory drugs. Clinical examination revealed dry mucosa, carious teeth with adequate oral hygiene. Panoramic X-ray showed multiple teeth with short roots. A detailed cone beam computed tomographic scan (CBCT) demonstrated a healthy bone trabecular pattern with the absence of any periapical radiolucency. Short, blunt roots with immature apex were seen in many teeth. Based upon the measurement of root to the crown ratio on the CBCT scan and correlating the development status of teeth with the medical history, a diagnosis of short root anomaly (SRA) after chloroquine-induced SJS was made. This is the first report to describe the three-dimensional features of teeth with SRA in a patient with SJS. Diagnostic, restorative, and endodontic implications of SJS are highlighted.

Dens invaginatus (DI) is a dental developmental abnormality, probably resulting from an infolding of the dental papilla during tooth development. The following case report presents a case of Type III DI with apicomarginal defect and peri-radicular lesion, diagnosed with cone-beam computed tomography scan and treated with combined orthograde endodontic therapy and peri-radicular regenerative surgery. Follow-up examination at 2 years revealed uneventful healing and improvement in the status of the tooth-supporting structures.

Aims and Objectives: The study aims at determining pulp response of two high fluoride releasing materials silver diamine fluoride (SDF) and Type VII glass ionomer cement (GIC) when used as indirect pulp treatment (IPT) materials. Materials and Methods: Deep Class V cavities were made on four first premolars indicated for extraction for orthodontic reasons. SDF, Type VII GIC, and calcium hydroxide base are given in three premolars, and one is kept control. Premolars were extracted 6 weeks after the procedure and subjected to histopathological examination to determine the pulp response. The results were analyzed using Chi-square test. Results: No inflammatory changes were observed in any of the groups. Significantly more number of specimens in SDF and Type VII GIC groups showed tertiary dentin deposition (TDD) when compared to control group. No significant difference was seen in TDD when intergroup comparison was made. Odontoblasts were seen as short cuboidal cells with dense basophilic nucleus in SDF and Type VII GIC group. Conclusion: The study demonstrated TDD inducing ability of SDF and Type VII GIC and also established the biocompatibility when used as IPT materials.

Background The optimal treatment of femoral neck fracture in the elderly patient is still under debate. In patients aged 60–80 years, the decision between internal fixation and arthroplasty remains controversial. The primary aim of the present study is to evaluate the functional outcome of patients aged 60–80 years with femoral neck fracture treated with total hip arthroplasty or closed reduction and internal fixation. The secondary aim is to evaluate the incidence of nonunion and avascular necrosis in femoral neck fracture in different age groups. Materials and Methods We studied 100 patients affected by displaced fracture of the femoral neck from May 2007 through June 2010. There were 60 men and 40 women with mean age of 66 years. Fifty patients were treated with closed reduction and internal fixation with cannulated screws (group A), and the other 50 patients with total hip arthroplasty (group B). Mean surgical time, blood loss, duration of hospital stay, Harris hip score, complications, and need for reoperation were recorded. Results Harris hip score was significantly higher in group B at 3-, 6-, 12-, and 18-month follow-up evaluation. The overall complication rate was 28 % in group A and 32 % in group B, which was not statistically significant. A statistically significant difference was found regarding patients who required reoperation in group A (20 %) compared with group B (no one). The average Harris hip score in the internal fixation group was 90.6 and in the total hip arthroplasty group was 93.7, which was statistically significant (p