Background: Nanotechnology application has rapidly extended into all areas of life. It provides new methods to solve scientific and medical problems. Nanomaterials such as titanium dioxide nanoparticles (TiO2 NPs) has been used in biomedical applications. Biological influence of the nanoparticles appears to be as a result of the interactions between the nanoparticles and proteins. Salivary alkaline phosphatase (ALP) is an enzyme that is linked to the outer membrane of some cells and formed by many others. ALP activity increase in periodontal diseases especially in the active phase of the disease. Aim: The aim is to determine the effect of titanium dioxide nanoparticles on the enzymatic activity of alkaline phosphatase in the saliva of patients suffering from chronic periodontitis. Materials and methods: The influence of titanium dioxide nanoparticles on the enzymatic activity of salivary alkaline phosphatase was examined in 75 participants (44 with chronic periodontitis and 31 nonperiodontitis subjects). The age range of the participants was 35-50 years for both groups. The periodontal disease was determined based on the criteria of periodontal health through examination of plaque and gingival indices together with clinical attachment level and probing pocket depth. Unstimulated saliva was collected from all participants and analyzed. Results: The results showed that salivary alkaline phosphatase activity was higher in chronic periodontitis patients compare to the nonperiodontitis group and the enzyme activity was found to be not correlated with the periodontal parameters. The enzyme was activated by titanium dioxide nanoparticles. Conclusion: The effect of titanium dioxide nanoparticles may be attributed to the biological activity of this type of nanoparticles in addition to the conformational changes that can occur on the protein structure after interaction with NPs. Clinical significance: Recognition of the effect of some nanomaterials (such as titanium dioxide nanoparticles) on enzymes like alkaline phosphatase, may provide a potential therapeutic opportunity for some pathological conditions such as periodontal diseases.

Aim: Postoperative coverage of periodontal surgery sites can help protect the treated area, facilitate wound healing and decrease postperiodontal surgery pain. The aim of this study was to compare the cytotoxic and clinical efficacy of two periodontal dressings after periodontal flap surgery. Materials and methods: In this study 23 patients requiring modified Widman flap in at least two quadrants in the same arch were selected; one quadrant was dressed with Reso-pac, and the other was dressed with Coe-pak. The clinical efficacy of these two dressings was evaluated by comparing plaque, granulation tissue formation, pain, bleeding on probing, and color of gingiva. To compare their cytotoxicity, human gingival fibroblast were exposed to 1- and 3-day extracts of the dressings and MTT test was used to measure cell viability after 24 and 48 hours. Cell apoptosis and necrosis were evaluated by flow cytometric analysis. Data were analyzed by Chi-square and independent t-test and SPSS 20 Software. Results: Plaque and granulation tissue formation rates were significantly lower in Reso-pac covered sites compared to coe-pak (p value < 0.001). Other variables including pain, bleeding and gingival color did not show any significant differences (p value 0.05). V iable fi broblast c ells w ere h igher f or R eso-pac compared to Coe-pak (p < 0.05). A higher percentage of necrotic cells in the day one Coe-pak extract group after 24 and 48 hours were observed compared to Reso-pac (6.23 and 4.97 vs. 2.71 and 2.76%). Conclusion: According to our results, Reso-pac is as effective as Coe-pack. It also has further positive effects of less plaque accumulation and granulation tissue formation and is more biocompatible for HGF cells with less cytotoxic effects on cells in the first days after surgery. Clinical significance: Reso-pac may be considered as a dressing of choice in periodontal surgeries with less plaque accumulation and granulation tissue formation plus better biocompatibility and ease of application compared to Coe-pak.

Aim: In the postoperative period of maxillofacial oncological operations, tracheostomy is the most commonly used method for securing the airway. These untoward complications made practitioners chose alternative modalities like submental intubation, but literature support on alternatives to tracheostomy for oral oncologic cases is limited. The aim of this observational study is to ascertain whether the use of overnight intubation is a safer and cost-effective practice and if it can be considered an alternative to tracheostomy. Materials and methods: Thirty patients, 23 males and 7 females in the age group of 34-80 years who underwent treatment for head and neck cancer with major intraoral resection and a unilateral or bilateral neck dissection were included in the study. The following variables were recorded: age, sex, site of a tumor, type of neck dissection, use of mandibulotomy/ mandibulectomy, type of reconstruction, duration of stay in ICU, mean hospital stay and Mallampati classification. Postoperative complications, associated with the airway, if any, were recorded simultaneously. Results: None of the 30 patients required re-intubation nor did they develop any respiratory distress post-extubation. Conclusion: To conclude, mandatory unquestioned use of tracheostomy in every head and neck oncological case should be avoided and its use should be limited to the situations where overnight intubation is not feasible, prolonged duration of postoperative intubation is required or it is anticipated that return visits will be made by the patient. Clinical significance: The clinical significance of this study is to show that the mortality and morbidity associated with a tracheostomy can be avoided. Overnight intubation is the modality to replace tracheostomy and can be considered as the gold standard.

Aims: To assess the success rate and implant stability changes of narrow dental implants (NDIs) during the osseous healing period. Materials and methods: This prospective observational clinical study included 21 patients with narrow alveolar ridge of restricted mesiodistal interdental span who received NDIs. The alveolar ridge width was determined by the ridge mapping technique. Implant stability was measured using Periotest® M immediately after implant insertion then after 4 weeks, 8 weeks and 12 weeks postoperatively. The outcome variables were success rate and implant stability changes during the healing period. The statistical analysis included one-way analysis of variance (ANOVA) and Tukey's multiple comparisons test, values < 0.05 were considered statistically significant. Results: Twenty-one patients received 54 implants, the success rate was 92.6% (50/54). The mean ± SD periotest value (PTV) was significantly increased at 4 weeks (7.62 ± 6.39 PTV) compared with primary stability (1.48 ± 3.16 PTV), at 8 weeks (4.46 ± 4.45 PTV). It significantly decreased compared with that at 4 weeks and at 12 weeks (1.82 ± 3.22 PTV); it decreased significantly compared to that at 8 weeks. Conclusion: Narrow dental implants have a high early success rate. The implant stability during the healing period drops significantly in the first 4 weeks postoperatively and then increases steadily in the following weeks to reach to a level close to that of primary stability after 12 weeks. Clinical significance: Narrow dental implants are indicated in cases of insufficient alveolar bone width obviating the need for bone augmentation and reduced interdental space such as in cases of congenitally missing teeth or after orthodontic treatment. Knowledge of the stability changes during the osseous healing period enables the clinicians to determine the optimum time for functional loading.

Aims: The aims of this study were to determine the prevalence of Bolton intermaxillary tooth-size discrepancy among Saudi orthodontic patients and to evaluate gender differences. Materials and methods: Pretreatment study models of 98 Saudi orthodontic patients (45 men and 53 women) were included in this study. The mesiodistal width from 1st molar to the opposite 1st was measured by a digital caliper, and Bolton anterior ratio (BAR) and Bolton overall ratio (BOR) were calculated. The independent samples t-student test was used to compare the values of BAR and BOR between men and women. The Chi-square test was used to test the gender differences in patients having Bolton tooth-size ratio away from 2 SD of Bolton mean value. Results: Significant differences were not found between men and women in BAR and BOR. The frequency of intermaxillary tooth-size discrepancy was 21.6% and 17.3% for anterior and overall ratio, respectively. Significant differences were found between men and women in the anterior and overall intermaxillary tooth-size discrepancy. Conclusion: Male orthodontic patients possess significantly more anterior and overall intermaxillary tooth-size discrepancies than female patients. Furthermore, the prevalence of Bolton tooth-size discrepancy in Saudi orthodontic patients is quite large enough to lead clinicians to be aware of it and proceed Bolton index in their quotidian orthodontic diagnosis. Clinical significance: The failure to diagnose intermaxillary tooth-size discrepancies prevents obtaining optimal occlusal relationship and increases the duration of the orthodontic therapy. Clinicians must consider Bolton tooth-size analysis as a primordial tool in their quotidian orthodontic diagnosis process and treatment planning so that they can avoid embarrassing situations at the end of the treatment.

Aim: Dental decay and periodontal diseases are very common allover the world with outcomes ranging from dental loss to systemic diseases. In this study, we aim to determine the impact of sociodemographic disparities and health behaviors on dental and periodontal health (DPH). Materials and methods: An epidemiological study was conducted amongst 600 dental patients in two private dental clinics in the region of Marrakesh, Morocco from 2012 to 2015. Three hundred seventeen patients between 25 years and 46 years old who were contacted by telephone to carry out a supplementary survey and of these 317 patients, 82 subjects were maintained. A questionnaire was followed to assess sociodemographic dis-parities, self-reported oral health status, and hygiene behaviors. Results: The age of the sample varies between 3 years and 78 years with an average of 31.2 ± 14.3 years. Also, the dominant age group is between 26 and 44 years old with a percentage of 47.6%. The distribution of the population by sex shows good equity (53.4% of men and 46.6% of women). For the educational level, 7.3% of the population is illiterate, 17.1% have a primary level, 39.0% have a high school level and 36.6% have a university level. In addition, habitation is urban at 79.3%, and rural at 20.7%. Furthermore, we note that only 28.8% of patients have a good daily toothbrushing frequency which is equal to or greater than 3. Conclusion: Dental and periodontal health (DPH) are indeed affected by sociodemographic and economic status with higher dental problems among rural and poor people. Clinical significance: Dental and periodontal diseases are serious problems of public health allover the world.   The lack of oral education and dental cares, particularly in developing countries and rural areas may increase these affections. The result of this study shows the implication of sociodemographic disparities and health behaviors in dental and periodontal outcomes.   This work will complement the limited knowledge of the existing interaction between sociodemographic disparities and health behaviors and dental and periodontal affections. It is also a fundamental starting of public health preventive or therapeutic strategies.

Introduction: Snacks and bakery foodstuffs like biscuits are the most preferred food items in the present decade. Thus it is important to know its cariogenicity. Aim: To study the effect of five commercially available biscuits on salivary pH, flow rate and oral clearance rate among children. Materials and methods: The study consisted of five groups of commercially available biscuits: oats, salt, glucose, cream, chocolate biscuits. Samples of saliva were collected, and pH was measured using an electrode, the flow rate directly from the calibrated test tube and the oral clearance time was estimated based on the time taken for the salivary pH to return back to the baseline values. After which, children were given one biscuit each and stimulated saliva samples were collected at different time intervals. Obtained values were subjected to the paired t-test, one-way analysis of variance (ANOVA) and post-hoc Tukey's test. Results: Salivary pH had decreased compared to baseline for all the five commercially available biscuits with maximum drop seen for glucose, cream and chocolate biscuit group at 5 minutes. Oats group showed a maximum drop in mean salivary pH at 15 minutes and salt biscuits at 10 minutes. Increased salivary flow rate was seen for oats, salt, and cream biscuit group at 15 minutes and chocolate and glucose group had reduced when compared to its baseline value. The pH at 15 minutes had not returned back to the baseline values for all groups. Conclusion: The consumption of commercially available biscuits had an effect on salivary pH, flow rate and oral clearance rate in children. Clinical significance: snacks and bakery foodstuffs are the most preferred diet in the present decade by most of the age group. Biscuits being the commonest snack, this study helps in choosing the right biscuits for the children causing less harm to the general and dental health.

Aim: The study aimed to evaluate the level of knowledge and awareness of the general population of Hail regarding oral cancer and assess their ability to identify the risk factors that may lead to oral cancer. Materials and methods: An observational study having cross-sectional design was carried out among Hail city population, Saudi Arabia. The study was conducted in November 2017. Data were gathered from 400 respondents, through survey questionnaire, with 95.5% response rate. Nonprobability, convenient sampling technique was used in this study. Saudi citizens above 15 years old were able to participate in this study. Results: Three hundred eighty-two (382) out of 400 (95.5%) responded to the questionnaire including 203 (53.1%) male and 179 (46.9%) female. One hundred eighty-two (182) (47.6%) of the participants were aware of the disease while the rest 200 (52.4%) of them were not. There was a significant difference between the age and the awareness of oral cancer (p <0.001) and between the level of education and the awareness of oral cancer (p <0.001). The respondents succeeded to identify smoking and alcohol as risk factors 328 (85.9%), 271 (70.9%), respectively. While only 47 (12.3%), 20 (5.2%), 139 (36.4%) participants said that old age, sunlight exposure, and diet are risks factors, respectively. Conclusion: The present study concluded that people lacked knowledge, and awareness regarding established risk factors of oral cancer. Health education related to primary prevention of oral cancer at the community and individual level needed to improve. Awareness of maintaining a healthy lifestyle which excludes the consumption of established risk factors of oral cancer was below par. Clinical significance: Improving oral cancer awareness of the population will lead to early detection of the lesion, and this eventually will help in primary prevention and better prognosis among those who have a lesion.

Objectives: The prime aim of the following study is to measure the facial parameters of the horizontal plane, mandibular morphology and linear asymmetries using Grummons analysis (GA). Materials and methods: Standard posterior-anterior cephalogram (PAC) of 100 esthetically pleasing faces without any orthodontic treatment and craniofacial deformity were taken from the radiology archive. All radiographs are digitally analyzed for the GA. Various linear and angular variables were measured for horizontal plane, mandibular morphology, and linear asymmetries. Results: Descriptive analysis has been done using SPSS software. Mean disparities has been calculated to check the difference between different parameters with other ethnics. GA of PAC of Saudi adult male showed variable degrees of facial asymmetry. The lower third of the face showed greater asymmetries. Mandibular deviation, maxillary midline deviations, and mandibular midline deviation are 3.51 mm, 2.52 mm and 2.86 mm, respectively. Conclusion: This study has measured PAC; horizontal plane, mandibular morphology and linear asymmetries for the Saudi adult male using GA. Facial asymmetries are found to have a common finding in Saudi adult male subjects who have normal facial harmony.

Aim: The aim of this study was to evaluate and compare the beverages effect on the microhardness of composite and compomer direct restorative materials in comparison with mineral water. Materials and methods: Two types of direct restorative materials of A3 shade were selected for this study: Composan Bio-esthetic Nano-ceram Composite (PROMEDICA) and Composan compomer (PROMEDICA). Forty specimens were prepared from each restorative material (total number of specimens were 80). Each specimen was prepared by compressing a sufficient amount of material into a mold of 4 mm in diameter and 2 mm in thickness by two glass slides with acetate celluloid strip in between and curing the specimen for 20 seconds from only the top surface by making the curing tip in intimate contact with the acetate celluloid strips covering the composite and compomer surface with LED Woodpacker light curing unit. The top and bottom surfaces were divided into two halves: 1st half was subjected to microhardness testing before immersion, while microhardness testing was performed on the 2nd half after immersion in beverages. PH values were recorded for each beverage solution with pH meter (Mettler Toledo, Canada). Vickers microhardness testing was performed with a microhardness tester (Microhardness tester FM-800, Future-Tech, Japan) at 300 g load and 15 seconds according to ISO 4049 for both top and bottom surfaces by making three indentations and considering the mean micro-hardness value for each surface to be the Vickers hardness number for that surface. Three types of beverages were used in the study (Coca Cola, orange juice, Red Bull) and a fourth immersion solution of mineral water was used as a control group. The 80 specimens were immersed for 30 days at 37°C. The immersion solutions were replaced in a daily manner. After immersion, the composite and compomer specimens were incubated in distilled water at 37°C for 24 hours before the microhardness testing.   Data were statistically analyzed before and after immersion of the 80 specimens using mean, standard deviation, one way ANOVA and t-test at a 5% level of significance. Results: One-way analysis of variance (ANOVA) for VHN composite top, bottom, and compomer top, bottom revealed that there was a statistically significant difference (p ≤ 0.05). t-tests comparing all the groups before and after immersion showed that there were statistically significant differences (p ≤ 0.05) in all groups being tested in this study. pH values for all the solutions were recorded as the followings: pH for Cola was 1.87, orange juice was 2.63, Red Bull was 2.55 and for water was 6.96. Conclusion: (a) All the beverages being tested including mineral water groups significantly resulted in general microhardness reduction; (b) Compomers tops and bottoms displayed a significantly general lower hardness values than composite restorative materials before and after immersion; (c) Composites showed higher differences in microhardness values than compomers in all the beverages when microhardness values were being compared before and after immersion; (d) Water sorption was the major factor affecting the microhardness rather than the acidic component of the different beverages used in the study; (e) Orange juice was significantly the highest beverage in microhardness reduction of both restorative materials. Clinical significance: Beverages contain chemical components and their acidic nature or water content might affect the hardness of direct restorative materials that might lead to the degradation at the matrix/filler interface by acid attack and consequently a negative effect on the general performance of the affected restoration in oral service.

Aim: The present study aimed at correlating the flow rate of the stimulated and unstimulated saliva in chronic periodontitis. Materials and methods: This study composed of 100 subjects between the age group of 25 years and 45 years. These subjects are categorized into four groups, placing 25 subjects in each. Group 1 with 25 healthy patients (no loss of attachment clinically), group 2 with 25 mild chronic periodontitis subjects (1-2 mm of attachment level clinically), group 3 with 25 moderate chronic periodontitis subjects (3-4 mm of attachment level clinically), group 4 with 25 severe chronic periodontitis subjects (5 mm of attachment level clinically), split method was used to collect the stimulated and unstimulated saliva. A calibrated digital balance was used to weigh the bottle before and after the collection of saliva. The result was considered to be statistically significant at a p value less than 0.05 (p <0.05). Result: The stimulated and unstimulated flow rate of saliva was high in group 1 subjects (0.920 ± 0.240, 1.366 ± 0.280) followed by group 2 subjects (0.780 ± 0.246, 0.920 ± 0.146), group 3 subjects (0.408 ± 0.132, 0.590 ± 0.110), and group 4 subjects (0.221 ± 0.348, 0.301 ± 0.216). There was a significant difference in the salivary flow rate between the groups statistically with p value 0.0001. Conclusion: The stimulated and unstimulated salivary flow rate decreased with the severity of the progression of the chronic periodontitis. Clinical significance: The importance of saliva on oral function includes antimicrobial activity, buffering function of pH, cleansing action, mastication, and swallowing. Therefore, a decrease in the ability to produce saliva leads to various oral infections.

Aim: The present report aims in determining the efficacy of orthodontic button assisted coronally advanced flap in the treatment of multiple teeth gingival recession and to analyze the literature evidence for the same. Background: Gingival recession is one of the commonest periodontal problems encountered in daily practice. Coronally advanced flap is the treatment of choice for a recession in multiple teeth. But stabilizing the flap in coronally advanced position is a challenge. In this case report, orthodontic buttons are used to stabilize the coronally advanced flap for root coverage in multiple teeth Case description: A 36-year-old male patient with multiple gingival recession in maxillary teeth reported with a complaint of sensitivity in the same region. So the case was managed with orthodontic button-assisted coronally advanced flap. Clinical periodontal parameters were recorded at baseline and the patient was followed for 1, 3 and 6 months postoperatively. Conclusion: Clinically there was a significant improvement in the parameters from baseline to 1 and 3 months, and the results were stable until 6 months. Literature evidence also showed that coronally advanced flap with orthodontic buttons was clinically better that coronally advanced flap alone. Clinical significance: Stabilization of the coronally advanced flap by orthodontic buttons will prevent apical movement of the advanced margins and will result in better root coverage and stable results over a long period.

Aim: Managing a case of velopharyngeal insufficiency (VPI) using speech aid prosthesis (SAP) fabricated using computer-assisted designing (CAD)-computer-assisted manufacturing (CAM) laser sintering technology. Background: Velopharyngeal insufficiency (VPI) is a failure of the body's ability to temporarily close the communication between the nasal cavity and the mouth because of an anatomic dysfunction of the soft palate or the lateral or posterior wall of the pharynx.   Velopharyngeal insufficiencies (VPIs) can be congenital or acquired which may require surgical intervention. However, when the surgical treatment is not feasible or opted (due to various reasons), by a patient, prosthetic management of velopharyngeal insufficiency can be carried out non-surgically using a speech-aid prosthesis. Case description: A single case, where a 37-year-old male patient reported with the complaint of inadequate clarity of speech due to the defect in the palate since birth. The patient exhibited symptoms of velopharyngeal insufficiency. The patient was not motivated to undergo surgery and also had associated medical contraindications due to uncontrolled diabetes. To manage this case a speech aid prosthesis (SAP) with speech bulb on a Co-Cr metal framework was fabricated with the use of CAD-CAM laser sintering. Conclusion: A logical approach to the history taking and treatment planning resulted in a successful outcome for the patient, using speech aid prosthesis. In the current case, there was an appreciable improvement in the ease of speech and its clarity for the patient. Clinical significance: The CAD-CAM laser sintering fabricated speech aid prosthesis helps in better management of velopharyngeal insufficiency with enhancing phonetics and muscle response.

Aim: Removal of the third molars is the most common minor oral surgical procedure being performed. Though controversy is minimal when there is a pathology involved with the third molar, prophylactic removal of impacted third molars has always been debated. This review focuses on the prophylactic removal of the third molar Background: Many a time an impacted third molar can remain asymptomatic throughout life. What is to be considered is the risk of just retaining an asymptomatic third molar against overt problems that arise if it becomes pathological. Review results: Quite a number of systematic reviews have been compiled by various authors on this topic. However, still, there is no decision with a black and white certainty when it comes to prophylactic removal of impacted third molars. Conclusion: This article highlights the review on surgical removal of impacted molars, the associated complications during removal and the complications associated with retention.

Aim: This review aims to discuss the structure, origin of toto bodies and demonstrate the possible theories responsible for its formation. Background: The eosinophilic Toto bodies are characterized by homogeneous or irregular masses varying in size and number. These unusual bodies are found in the top most layers of oral epithelium and derive its name “mucopolysaccharide keratin dystrophy” based on the nature of its composition. The incidence and severity of toto bodies have been correlated with the amount of the inflammatory response present in the connective tissue. These bodies have various theories of origin like fibrin, keratin, mucins, and glycoproteins. Review results: To demonstrate the nature of these eosinophilic bodies; two cases-pyogenic granuloma and oral squamous cell carcinoma were studied using special stains. It was observed that Toto bodies were positive for periodic acid-Schiff (PAS), modified Papanicolaou (Pap), Masson's trichrome and combined PAS-PAP staining techniques. However, staining with Alcian blue, Congo red, mucicarmine and toluidine blue were negative for Toto bodies. Conclusion: It may be concluded that Toto bodies can be best identified using Masson's trichrome stain followed by combined PAS-PAP, PAS, and PAP which characterizes them mainly as glycoproteins and keratins. Clinical significance: The presence of Toto bodies is indicative of inflammatory reaction, and their differential staining in the positive stains depends on the nature and severity of inflammation present in a lesion.