Increased life expectancy is causing an explosion of the aging population that will continue now and in the foreseeable future. Improved quality of life at old age will demand tooth retention and consequently the need for restorative care. Retaining teeth disease free and maintaining them amidst multitude of risk factors associated with old age, is a multi- faceted challenge. This review article discusses the etiology of various dental diseases seen in older dentate population and their management keeping in mind the special needs of these matured people, so as to render a professional service that is sensitive and caring.

The long-term success of the reimplanted teeth is related to the maintenance of periodontal ligament (PDL) cell viability. Dental tissues are unique in comparison to most other tissues in the body due to their marked capacity for regeneration. Understanding the circumstances leading to repair and regeneration in oral tissues has been a formidable challenge. Numerous storage media have been introduced by many authors that help to maintain the PDL cell viability. To present an overview of the various available storage media. A literature search for the past 20 years was performed across the Internet database (Pubmed) and relevant citations using the keywords PDL cell viability, tooth avulsion, storage media, and the combination of all to retrieve around (n=225) citations. Articles that included follow-up of intervention for avulsed and re-implanted teeth were considered (n=44) and some literature review from well-known text books were considered. Literature supports that moist storage appears to be a more productive approach to optimize PDL cell survival. However, no medium is ideal and in vivo studies are inadequate.

Supernumerary paramolars are the rare anomalies of the maxillofacial complex. These are more common in the maxilla than in the mandible. This article reviews the etiology, frequency, classification, complications, diagnosis and management of supernumerary teeth (bilateral maxillary paramolars)

Light polymerizable tooth colored restorative materials are most widely preferred for advantages such as esthetics, improved physical properties and operator's control over the working time. Since the introduction of these light polymerizable restorative materials, there has been a concern about the depth of appropriate cure throughout the restoration. Photopolymerization of the composite is of fundamental importance because adequate polymerization is a crucial factor for optimization of the physical and mechanical properties and clinical results of the composite material. Inadequate polymerization results in greater deterioration at the margins of the restoration, decreased bond strength between the tooth and the restoration, greater cytotoxicity, and reduced hardness. Therefore, the dentist must use a light curing unit that delivers adequate and sufficient energy to optimize composite polymerization. Varying light intensity affects the degree of conversion of monomer to polymer and depth of cure.

Aim: The aim of this study is to evaluate the shear bond strength of composite to tooth using different adhesive techniques and rotary instruments under simulated pulpal pressure. Materials and Methods: Sixty extracted human molars were randomly divided into two groups of 30 samples each (group I and II), according to the adhesive technique followed (i.e. total etch and self etch groups). Each group was further divided into two sub-groups (Sub-groups A and B) of 15 samples each according to the cutting instrument (diamond abrasive or carbide burs) used. Class II cavities were made with diamond abrasive or carbide burs, and restored with nano-composite under positive intra-pulpal pressure. Shear bond strength of the specimens were recorded simultaneously. Results: After statistical evaluation using two-way ANOVA and t-test, the mean shear bond strength values of the groups are as follows: Group IA- 4.69 MPa, Group IB-6.15 MPa, Group IIA-4.3 MPa, and Group IIB-6.24 MPa. It was seen that group IIB showed highest bond strength followed by group IB. Group II A showed the least bond strength. Conclusions: Within the limitations of the study, diamond abrasive gave better bond strength than carbide bur with both the adhesive techniques.

Aim: To evaluate in vivo the remineralizing efficacy of silver diamine fluoride (SDF), glass ionomer Type VII (GC VII) and calcium hydroxide (Dycal). Materials and Methods: 60 subjects in the age group of 18-35 years, matching the inclusion criteria and having deep carious lesions in the permanent first and second molars were selected. The teeth were aseptically opened under rubber dam and after gross caries removal, approximately 0.4mg of soft discolored dentin was removed with a sharp spoon excavator from the mesial or distal aspect of the cavity. The test material was randomly selected and applied in a thickness of 1.5-2mm and the cavity sealed with cavit. The patients were followed up at regular intervals with radiographic evaluation at 12 weeks. At 3 months the temporary restoration was removed and dentin samples were collected from the other half of the cavity which was left in the first appointment. Atomic absorption spectrophotometry, Colorimetric test using UV-vis spectrometer and potentiometric titration were used for determining calcium, phosphorous and fluoride respectively. Results: Almost equivalent rise in the percentage of calcium level was seen in GC VII and Ca(OH) ₂ groups, followed by SDF group. Highest percentage rise in phosphate ions was seen in GC VII group followed by SDF group and Ca(OH) ₂ group. Highest percentage of fluoride rise was seen in GC VII group followed by SDF group and Ca(OH) ₂ group. Conclusions: The results indicated that both GC VII and SDF can be potential indirect pulp capping materials.

Aim: To compare the cleaning efficiency of manual and rotary instrumentation in the apical third of the root canal system. Materials and Methods: In group 1 (n=10), instrumentation was performed with stainless steel K-file; in group 2 (n=10), it was done with hand ProTaper files; and in group 3 (n=10), instrumentation was done with ProTaper rotary. Distilled water was used for irrigation. The apical third was sectioned transversally and histologically processed. The cross sections were examined under optic microscope and debris was measured using Motic software. Results: Instrumentation with stainless steel K-files showed minimum amount of debris, followed by ProTaper hand files, and rotary ProTaper files were least effective with maximum amount of debris; however, there were no significant differences between the three experimental groups. Conclusions: Both the manual and rotary instrumentation are relatively efficient in cleaning the apical third of the root canal system and the choice between manual and rotary instrumentation should depend on case to case basis.

Objective: The aim of this study was to comparatively investigate the neutralizing effect of antioxidant treatment and delayed bonding after bleaching with hydrogen peroxide on the shear bond strength of a composite resin (CR) and resin-modified glass ionomer (RmGI) to enamel. Materials and Methods: Ninety-six freshly extracted human 3rd molars with flat enamel surfaces were divided into six experimental groups (n=12/group) and two control groups (n=12/group). After initial preparation, specimens in Groups 1 and 5 (control groups) were not bleached and the buccal enamel surface of specimens were bonded immediately with CR and RmGI. The samples of the remaining groups were all bleached six hours a day for seven days consecutively. Immediately after bleaching, groups two and six specimens were bonded with CR and RmGI. Groups 3 and 7 specimens were immersed in distilled water at 37°C for 7 days and the specimens in Groups 4 and 8 were treated with 10% sodium ascorbate as an antioxidant agent after bleaching. Specimens in Groups 3 and 4 were bonded with CR and Groups 7 and 8 specimens were bonded with RmGI immediately. After specimens were bonded, the shear bond strength (SBS) was measured. The SBS data analyses were subjected to one-way analysis of variance (ANOVA) followed by Tukey test for comparison of specific mean values. Results: The mean SBS value in Group 2 (immediately bonded with CR after bleaching) was significantly lower than other CR groups (P=0.045). RmGI did not bond to buccal enamel surface of specimens in group 6. There was no significant difference between other groups bonded with RmGI (P>0.05). Conclusions: Applying 10% sodium ascorbate hydrogel and one week delay before bonding resulted in reversal of reduced bond strength of CR and RmGI to bleached enamel.

Aim: The aim of this in vitro study was to compare the shear bond strengths of two different dentin bonding agents with two different desensitizers. Materials and Methods: Eighty molars were taken which were ground to expose the dentin. The teeth were divided into two major groups. Each major group was subdivided into four subgroups of 10 samples each. Groups Ia and IIa were treated as dry bonding groups, groups Ib and IIb were treated as a moist bonding groups, groups Ic and IIc were rewetted with Gluma desensitizer, and groups Id and IId were rewetted with vivasens desensitizer. Major group I was treated with Gluma comfort bond and Charisma. Major group II was treated Prime and Bond NT and TPH. The samples were thermo cycled and shear bond test was performed using an Instron machine. The data were analyzed using one-way analysis of variance and Tukey's Honestly significant different test. Results: The results revealed that the specimens rewetted with Gluma desensitizer showed the highest shear bond strength compared to all other groups, irrespective of the bonding agent or composite resin used. Conclusions: It can be concluded that rewetting with desensitizer provided better bond strength than the other groups.

Aims: To assess the reliability of ultrasound imaging coupled with Color Power Doppler for monitoring the healing after nonsurgical endodontic therapy. Materials and Methods: Ten asymptomatic maxillary anterior teeth with approximately similar-sized periapical radiolucent lesions of average dimension 1.3 - 1.9 cm, as observed on an intraoral periapical radiograph, and confirmed by ultrasound was selected for the study. After confirming the diagnosis all the teeth were subjected to nonsurgical endodontic treatment. Postoperative healing was monitored using postoperative subjective feedback, a radiograph, and an ultrasound with a color power doppler, at intervals of six weeks, three months, and six months. Results: Eight among the ten cases studied showed signs of healing, with an ultrasound, as early as six weeks postoperatively, but the radiographs showed a noticeable change only at the end of three months. At the end of the follow-up period of three months and six months, the findings in terms of change in the lesion size were the same with both the radiograph and ultrasound. Ultrasonography was able to predict the healing very consistently at all recall periods from six weeks onward providing vital information such as changes in vascularity and bone formation as compared to radiographs. Conclusions: Ultrasound with Color Power Doppler is an efficient tool for monitoring bone healing as compared to the conventionally employed radiographic method.

Aim: To evaluate and compare the microleakage of self-etch adhesives placed under different clinical techniques and to analyze the resin-dentin interfacial ultrastructure under scanning electron microscope (SEM). Materials and Methods: 100 extracted human premolars were divided into two groups for different adhesives (Clearfil S ³ and Xeno III). Class V cavities were prepared. Each group was further divided into four subgroups (n = 10) according to the placement technique of the adhesive, i.e. according to manufacturer's directions (Group 1), with phosphoric acid etching of enamel margins (Group 2), with hydrophobic resin coat application (Group 3), with techniques of both groups 2 and 3 (Group 4). The cavities were restored with composite. Ten samples from each group were subjected to microleakage study. Five samples each of both the adhesives from groups 1 and 3 were used for SEM examination of the micromorphology of the resin-dentin interface. Results: At enamel margins for both the adhesives tested, groups 2 and 4 showed significantly lesser leakage than groups 1 and 3. At dentin margins, groups 3 and 4 depicted significantly reduced leakage than groups 1 and 2 for Xeno III. SEM observation of the resin-dentin interfaces revealed generalized gap and poor resin tag formation in both the adhesives. Xeno III showed better interfacial adaptation when additional hydrophobic resin coat was applied. Conclusions: In enamel, prior phosphoric acid etching reduces microleakage of self-etch adhesives, while in dentin, hydrophobic resin coating over one-step self-etch adhesives decreases the microleakage.

Aim: The purpose of this study was to investigate change of working length in curved molar root canals after preparation with Profile, ProTaper and K3 Rotary Nickel-Titanium (Ni-Ti) instruments. Materials and Methods: One hundred and eighty maxillary and mandibular molars were divided into group I having root curvature angle <300 and group II having root curvature angle >300 comprising 90 teeth in each group based on Schneider's method. Group II and I were further divided into sub group A, B and C having 30 teeth each based on type of instrument used. Profiles, ProTaper and K3 Rotary Ni-Ti files were used to prepare mesial and buccal roots of molars. Radiography platform was made to allow technique for constant object to film distance and object to sensor distance. Conventional access opening was prepared in each tooth. Preoperative and postoperative working length was measured to an accuracy of 0.1 of mm on Dexis 3.0 direct digital radiograph's onscreen measurement device. Results: Mean loss of working length varied from 0.28 to 0.92 mm. Highest working length loss was seen in ProTaper followed by K3 files and Profiles, which is statistically significant.

Aim: The aim of this study was to examine various storage environments for storing fragments before being bonded to the remaining teeth and also estimate the required force to fracture the restored teeth. Materials and Methods: Sixty mandibular incisor teeth were fractured on the incisal one-third and were divided into five groups of 12 each to be stored in normal saline, water, milk, saliva and dry environments for 24 hours. All the fractured parts in each group were bonded to their relevant apical parts by an etch and rinse bonding system and a flowable composite resin. The fracture resistance was measured by a universal testing machine, and the results were analyzed using one-way ANOVA and Tukey statistical tests. Results: The results revealed that the difference among the five groups was statistically significant (P<0.001). Tukey tests showed that the force required for fracturing fragments kept in the milk and saliva environments were significantly higher than those for the normal saline, water and dry environments (P<0.05 ). Conclusions: It was concluded that keeping the fractured parts in milk and saliva environments can increase the required force for fracturing teeth more than the other environments.

Aim: The purpose of this study was to evaluate the adequacy of three obturation techniques namely lateral condensation, EQ Fil (backfill obturation) and thermafil (core carrier obturation) techniques using three-dimensional (3D) helical computed tomography (CT) by volume rendering method. Materials and Methods: Thirty freshly extracted teeth were randomly divided into three groups of 10 teeth each. Biomechanical preparation was done in all the teeth using rotary instruments. All three sets of teeth were placed in helical CT slice scanner and were imaged before obturation. The three sets were then obturated by following methods: Group I: lateral condensation, Group II: EQ Fil (backfill) and Group III: thermafil (core carrier obturation).Volume of the pulp chamber and gutta-percha after obturation were calculated using volume rendering technique and adequacy of the obturation techniques were calculated. Statistical Analysis Used: One-way ANOVA and Multiple-Range Tukey Test by Tukey-HSD procedure Results: Mean change in lateral condensation (0.005±0.002) was significantly higher than that of thermafil obturation (0.002±0.001) [P<0.05]. Conclusions: Conventional lateral condensation technique showed maximal inadequacy of obturation and thermafil obturation technique showed the least inadequacy of obturation when the volume of the specimens were calculated and reconstructed

Purpose: To determine the fatigue resistance and failure mode of endodontically treated premolars using direct composite resin restorations. Materials and Methods: Eighty-four human premolars were divided into seven groups of 12, prepared as follows: Intact teeth used in Group 1 as control, the second group covers the endodontically treated teeth, restored with direct onlays using Z250 composite resin, the next two groups (i.e. 3,4) were similar to the second group, but subjected to 1 and 2 million fatigue load cycles, respectively. Groups 5, 6, 7 were similar to groups 2, 3, 4, however, in these groups Tetric Ceram was used as the restorative material. All specimens were loaded using a Universal Testing Machine until fracture occurred. One-way Anova andTukey's HSD tests were used to analyze the data of onlay groups. Results: All specimens withstood the masticating simulation. The mean fracture strength for Goups 1 to 7 was: 1276.92, 1373.47, 1269/70, 486/35, 484/12, 1130/49, 1113/79 Newton, respectively. No statistically significant differences were found between the groups in fracture strength and failure mode. Conclusions: No statistically significant differences in fracture strength were found between sound teeth and composite onlays that were subjected to 1 and 2 million fatigue load cycles.

Aim: To evaluate the surface alterations seen in four kinds of Nickel-Titanium (Ni-Ti) instruments using a scanning electron microscope (SEM) for five successive uses in preparing root canals of extracted human molars and also to determine whether the design of the instrument influenced the appearance of defects on the instrument surface. Materials and Methods: Four different types of instruments namely; ProFile, ProTaper Rotary, ProTaper Hand and K3 Endo were used in 300 mesio-buccal canals. The instruments were examined under the SEM, after every use, to assess the progress of changes on their surfaces for a maximum of five uses. Statistical analysis used: Chi-square test. Results: The most prevalent defects observed were pitting, followed by metal strips. Signs of discontinuity, microfractures and disruption of cutting edge were also evident. Number of defects increased with successive uses. Conclusions: ProTaper Hand showed significantly more microfractures and metal strips than other instruments from third use onwards. ProTaper Rotary and K3 Endo also showed significant changes.

Aim: This study evaluated the color stability of four provisional materials: 1) Poly-methyl methacrylates (DPI); 2) Bis-acryl composite (ProtempTM II - 3M ESPE); 3) Bis-acryl composite (Systemp^; c and b - Ivoclar Vivadent) and 4) Light polymerized composite resin (Revotek LC- GC). Materials and Methods: The color and color difference of each specimen after immersion in different staining solutions i.e. 1) tea and artificial saliva, 2) coffee and artificial saliva, 3) Pepsi and artificial saliva, 4) turmeric solution and artificial saliva was measured using reflectance spectrophotometer with CIELAB system before immersion and after immersion at 2, 5 ,7 , 10 and 15 days. Results: Revotek LC- GC (light polymerized composite resin) was found to be the most color stable provisional restorative material followed by Protemp II (Bis-acryl composite), Systemp (Bis-acryl composite) and DPI (Methylmethacrylate resin). Turmeric solution had the maximum staining potential followed by coffee, tea and Pepsi.

Aims and Objectives: To study the stress concentrations in endodontically treated maxillary central incisor teeth restored with 3 different fiber post systems subjected to various oblique occlusal loads. Materials and Methods: FEM analysis was used to analyze stress concentrations generated in maxillary anterior teeth. Computer aided designing was used to create a 2-D model of an upper central incisor. Post systems analyzed were the DT Light Post (RDT, Bisco), Luscent Anchor (Dentatus) & RelyX (3M-ESPE). The entire design assembly was subjected to analysis by ANSYS for oblique loading forces of 25N, 80N & 125 N Results: The resultant data showed that the RelyX generated the least amount of stress concentration. Conclusions: Minimal stress buildups contribute to the longevity of the restorations. Thus RelyX by virtue of judicious stress distribution is the better option for restoration of grossly decayed teeth.

Aim: The aim of this study was to evaluate the effect of pre and post fluoride therapy on the microleakage of composite resin and glass ionomer restorations. Materials and Methods: Class V cavities were prepared on the buccal surfaces of sixty extracted human third molars. Based on the restorative materials the samples were assigned into two essential groups of thirty and each of them divided into three subgroups regarding the mode of Acidulate Phosphate Fluoride (APF) gel usage. Fluoride therapy was applied pre and post restoration whether OptiBond Solo Plus as a total-etch adhesive system with Herculite XRV as a light cured composite resin or Fuji II LC glass ionomer as an restoration. Each essential group contained a control group without fluoride therapy. Thermo cycling was done, and then the rate of microleakage was evaluated by the fluid filtration method. Results: There were no significant differences by pre and post-treatment with APF on microleakage of composite resin restorations. A significant difference was found on microleakage of glass ionomer restorations based on different APF therapy. Conclusions: In contrast to composite resin restoration which had not influenced by fluoride therapy, after glass ionomer placement, the gel of fluoride led to significantly increase the microleakage of the restoration.

Objective: This in vitro study investigated the effect of a desensitizer on the degree of conversion of two bonding resins using Fourier transform infrared (FTIR) spectroscopy. Materials and Methods: An etch-and-rise bonding resin and a self-etching adhesive resin were selected for the study. Vivasens (Ivoclar Vivadent) was used as a desensitizing agent. Grouping was done as follows: Group I: Adper Single Bond (n=10), Group II: Adper Single Bond + Vivasens (n=10), Group III: AdheSE One (n=10), Group IV: AdheSE One + Vivasens (n=10). The bonding resin alone was light cured for 20 seconds in groups I and III. For groups II and IV, 1 ml each of the bonding resin and the desensitizer was mixed in a vial and light cured for 20 seconds. The specimens were analysed using FTIR spectroscopy. Results: Group II (Adper Single Bond + Vivasens) showed a significantly higher degree of conversion compared to Group I (Adper Single Bond). Comparing Groups III and IV, Group IV (AdheSE One + Vivasens) showed a significantly higher degree of conversion compared to Group III (AdheSE One). Conclusions: The degree of conversion is increased when a dentin bonding agent is used along with a desensitizer. Hence, this combination can be recommended to effectively control postoperative sensitivity.

Aim: The objective of this study was to analyze the application of PA agent that improves the bond strength of root dentin treated with NaOCl. Materials and Methods: Group 1: root canals were irrigated using 0.9% isotonic saline as an irrigant (negative control); Group 2: root canals were irrigated using 5.25% NaOCl (positive control); Group 3: root canals were irrigated with 5.25% NaOCl followed by 10% sodium ascorbate for 10 minutes; Group 4: root canals were irrigated with 5.25% NaOCl followed by 5% PA for 10 minutes. All the canals were then coated with self-etch dentin bonding agent, filled with resin cement, stored for one day in water, and then cross sectioned into three slabs of 2-mm thickness that were prepared and tested for microtensile bond strength. Results: The results demonstrated that 5.25% NaOCl caused significant reduction (P<0.05) in the bond strength, but this can be reversed by 5% PA significantly more than the 10% sodium ascorbate.

Aim: To assess the biocompatibility of an experimental endodontic paste based on the ethyl acetate fraction of Pothomorphe umbellata + calcium hydroxide, using propylene glycol as vehicle, in connective tissue of rats. Materials and Methods: Fifteen rats had four polyethylene tubes implanted in their backs, with each one containing the experimental paste. The tube side was considered the control group. After 7, 21, and 42 days, animals were euthanized. Results: Intense inflammatory reaction was noticed after 7 days for experimental paste and it was moderate for control group. At 21 days, the inflammatory reaction was moderate for experimental paste and discrete for control group; and at 42 days, it was discrete for experimental paste and control group. Statistical analysis (Dunn's test, P < 0.01) demonstrated significant difference between the fibrous capsule area at 7 and 42 days (P > 0.01) for experimental paste. Conclusions: Experimental endodontic paste presented satisfactory tissue reaction in the connective tissue of rats.

Background: Different proportions are described in the literature for smile designing, such as Golden proportion, Golden percentage, Preston's proportion, and recently, Recurring Esthetic Dental (RED) proportion. Aims and Objectives: To evaluate the existence of RED proportion in natural dentition. To determine the relative height of maxillary lateral incisor and canine occurring in natural dentition so that it can be used in any of the above proportions. Materials and Methods: Fifteen male subjects and 15 female subjects in each of the different age groups of 18-23 years, 24-29 years and 30-35 years were selected for this study (total 90). Photographs of the subjects were taken using Nikon D200 camera with 135 mm lens and analyzed using Adobe Photoshop CS4 extended software. The height and width of maxillary central incisors, lateral incisors and canines were found out using the measuring tool provided in the software. Results: Average width ratio and height ratio of maxillary lateral incisor to central incisor and maxillary canine to lateral incisor were calculated to check the existence of RED proportion in natural dentition. Average lateral incisor to central incisor height ratio for "small"- and "medium"-sized teeth was found to be 88% and for "tall"-sized teeth was found to be 84%. Average canine to lateral incisor height ratio for "small"- and "medium"-sized teeth was found to be 106% and for "tall"-sized teeth was found to be 105%. Conclusions: Within the limitations of the study, RED proportion was not seen in natural dentition.

Extrusion of fractured anterior teeth with fracture line extending subgingivally requires exposure of sound tooth structure. Orthodontic extrusion is the preferred method of choice. Conventional orthodontic appliance is usually unesthetic because of exposure of brackets. This case report describes an esthetic management of such a tooth with a lingually placed orthodontic appliance which also allows placement of a labial composite resin laminate so as to restore esthetics at the earliest. This was followed by a post-endodontic restoration. This approach enabled us to establish not only to a long-term restorative success, but also an immediate replacement of esthetics so that the patient is able to confidently smile during the course of treatment also.

Familiarity with the intricacies and variations of root canal morphology is essential for successful endodontic treatment. Maxillary central and lateral incisors are known to be single rooted with one canal. This case report describes endodontic retreatment of maxillary lateral incisors with two root canals, one of which was missed during the initial treatment.