Aim: This systematic review and meta-analysis evaluated the clinical survival of axial and tilted implants in atrophic edentulous maxilla after three years of immediate loading and also the corresponding marginal bone loss. Setting and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). Materials and Methods: The relevant studies were retrieved from MEDLINE(PubMed), the Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar databases. The search was limited to studies published in the English language with no date restrictions. A further hand search was conducted on individual journals and reference lists of studies. The risk of bias in included studies was assessed by using the Evidence Project risk of bias tool. Statistical Analysis Used: Statistical meta-analysis was conducted using RevMan 5.4 software. The assessment for the level of evidence was done using GRADEpro software. Results: Eleven studies were finalised. All were included in the meta-analysis for implant survival, while only seven studies were included in the meta-analysis of marginal bone loss. After three years, the meta-analysis results for implant survival showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (RR = 1.00 (95% CI: 0.98-1.01); P-value = 0.59). After three years, the meta-analysis results for marginal bone showed no statistical difference between axial and tilted implants, with the forest plot neither favouring axial nor tilted implants (MD = -0.02; 95% CI; -0.09-0.06; P-value = 0.69). Conclusion: In the immediately loaded rehabilitation of completely edentulous atrophic maxillae, tilting of implants did not induce any significant alteration in their survival and their corresponding marginal bone loss levels compared to conventionally placed axial implants even after three years of function.

Aim: To systematically review the reported techniques, for evaluating the risk and difficulty encountered in the management of fractured abutment screw in accordance with the location of fracture, and to develop a logical sequence in managing an implant abutment screw fracture. Settings and Design: Systematic review following PRISMA guidelines. Materials and Methods: A systematic search of the PubMed/MEDLINE database for articles published between January 2000 and March 2020 was performed by 2 independent reviewers. Case reports and case series that described the management of fractured implant abutment screw were included. Published articles were qualitatively analyzed employing CARE guidelines and were classified according to the location of screw fracture with respect to implant platform, risk of damage to the implant, and intervention for managing the fractured screw. Statistical Analysis Used: Qualitative analyisis. Results: A total of 28 articles were included in the review. Two of them explained the management of screw fracture at or above the implant platform and required only mild approach with low risk while the others explained the management of screw fracture below the level of implant platform. Among them, 6 were considered mild approach with low risk, 13 moderate approach with moderate risk, and 8 of them severe approach with high risk. Conclusion: Irrespective of the technique, any attempt to retrieve abutment screw fragment poses some risk to the implant which is varying from mild to severe. As the location of fracture is more gingival to the implant platform, difficulty of retrieval as well as risk to the implant increases. The proposed decisionmaking tree will be a useful tool in helping clinicians to manage abutment screw fracture.

Aim: The aim of the present study was to clinically assess the performance of BioHPP PEEK material when used for inlay restoration and to compare it with widely used zirconia inlays. This clinical study was undertaken to evaluate their performance in terms of retention, colour matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, wear-anatomic form, postoperative sensitivity and fracture resistance using the modified Ryge's criteria. Settings and Design: In vivo - prospective clinical study. Material and Methods: A total of 40 patients were selected based on inclusion and exclusion criteria requiring inlays. The patients were further divided in two groups: Group A - Consisted of 20 permanent maxillary and mandibular carious posterior teeth restored with BioHPP PEEK inlays and Group B - Consisted of 20 permanent maxillary and mandibular carious posterior teeth restored with CAD/CAM zirconia inlays (sintered monolithic zirconia, Zolid, Amann Girrbach AG, Koblach, Austria). Two prosthodontists, who were blinded to the study groups, evaluated the restorations. In cases of widely different scores, the observers re-evaluated the restorations and reached a consensus. Restorations were evaluated at the end of 1 week (base line), 3 months, 6 months, and 12 months, using modified Ryge's criteria. Statistical Analysis Used: Chi- square' test, 'Fisher's exact' test and 'z' test. Results: 90% of the BioHPP PEEK inlays were rated satisfactory in comparison to 95% of zirconia inlays. Sensitivity score was 10% in BioHPP PEEK inlays and 15% in zirconia inlays. No significant difference was encountered with other parameters in this study. Conclusion: The BioHPP PEEK when used as indirect aesthetic restorations was found to be satisfactory with relatively low rate of fracture over an observation period of one year in comparison to zirconia inlays in posterior teeth. The BioHPP PEEK can be a suitable alternative with high level of accuracy in terms of retention, marginal quality and aesthetics.

Aim: To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator. Settings and Design: Non-randomized controlled study. Materials and Methods: Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1–20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test. Statistical Analysis Used: One-way ANOVA, Post hoc Bonferroni and Chi square test. Results: SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004). Conclusion: SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.

Aims: This study aimed to evaluate the combined influence of condylar and incisal guidance in canine-guided and group function occlusal schemes. Settings and Design: In vivo - Cross sectional study. Materials and Methods: A total number of 88 subjects were selected and classified into two groups: 44 subjects with canine guided and 44 subjects with group function occlusal schemes. Condylar and incisal guidance tracings of both the groups were recorded using SAM AXIOQUICK RECORDER (School Articulator Munich) and evaluated. Statistical Analysis Used: Kolmogorov–Smirnov test and Shapiro–Wilk test were employed to test the normality of data. Independent sample t-test and Mann–Whitney U-test was performed for quantitative variables. Results: The condylar and incisal guidance among canine-guided individuals was 31.38 ± 12.01 and 55.83 ± 14.04, respectively, while in group function individuals, it was 29.44 ± 12.65 and 43.74 ± 20.27. Conclusions: Within the limitations of the present study, condylar guidance was similar in subjects with both schemes of occlusion, whereas steeper incisal guidance was noticed in canine-guided individuals as compared to group function.

Aim: This research was aimed to determine the potential for treating osteogenesis with a combination of zinc oxide and turmeric (ZOT) rhizome liquid extract. Setting and Design: In vivo, post test-control group design. Material and Methods: The mandibular incisors of Wistar rats were extracted and left untreated or received an application of zinc oxideeugenol (ZOE) 10% or ZOT rhizome liquid extract at various concentrations (10%, 20%, and 40%). The mandible was then subjected to immunohistochemical analysis to detect RUNX2 and alkaline phosphatase (ALP) activity. Statistical Analysis Used: One-way ANOVA and Tukey HSD using SPSS software. Results: All groups demonstrated increasing RUNX2 and ALP activity. ZOT 40% showed the highest activity in all groups on day 3 and day 7, although there were no significant differences with ZOE 10%. Conclusion: A combination of ZOT rhizome liquid extract can induce the osteogenic process in postextraction sockets. The results highlight the need for further investigation of the potential osteogenesis of curcumin in humans.

Aim: Assess the retention of endocrowns fabricated of different CAD/CAM materials. Settings and Design: In vitro - comparative study. Material and Methods: Root canal treated mandibular first molars were prepared in a standardized method. Standardized endocrowns were manufactured using four CAD-CAM blocks: resin infiltrated ceramic (Vita Enamic), partially stabilized tetragonal zirconia (Katana), lithium disilicate ceramic (IPS e.max CAD), and polyether-ether-keton (PEEK, BioHPP). After proper surface treatment, the restorations were cemented using a resin cement (Panavia F2.0) and were connected to a special attachment unit and secured to a universal testing machine. The amount of axial load required to dislodge the restoration from the tooth structure was measured (n = 12, α = 0.05). Failures were classified as adhesive debonding from the tooth structure without damaging the supporting tooth structure and cohesive fracture of the supporting tooth structure Statistical Analysis Used: One-way analysis of variance,Tukey's post hoc test. Results: The retention of Vita Enamic (61 ± 11 N) and IPS e.max CAD (58 ± 9 N) was significantly higher (F = 123, P < 0.01) than Katana (33 ± 13) and Peek restorations (23 ± 11). Vita Enamic and IPS e.max CAD were associated with fractured tooth segments during debonding while Katana and PEEK specimens were adhesively debonded from the remaining tooth structure. Conclusions: Within the limitations of this study, using lithium disilicate ceramics and resin infiltrated ceramics as restorative materials to fabricate endocrowns to restore severely damaged endodontically treated teeth, recorded significantly higher retention values. Meanwhile, using yttrium partially stabilized zirconia and polyether ether ketones for the same purpose recorded a favorable mode failure which avoided the possibility of tooth fracture.

Aim: The aim of this study was to evaluate and compare the shear bond strength between ceramic layered over titanium and ceramic layered over cobalt-chromium alloy, which are used in the fabrication of screw-retained implant prosthesis. Settings and Design: In-vitro – Comparative study. Materials and Method: A total of 40 samples (20 samples of Titanium in Group 1 and 20 samples of Cobalt-Chromium in Group 2) were fabricated. For all the samples bonding agent was applied on to the sand blasted surface and firing was done at a temperature of 980° C. A layer of opaque was applied using a brush and placed back in the furnace at a temperature of 910° C. Then ceramic was layered on to the surface with putty index as guide and firing was done in the ceramic furnace up to a temperature of 880° C followed by glazing. Shear bond strength was measured using a Universal Testing Machine. Statistical Analyses Used: One sample t-test and paired sample t-test. Results: Descriptive statistics were done to calculate mean differences between groups and samples. The mean bond strength of titanium- ceramic samples was more than those of cobalt-chromium-ceramic samples. Inferential statistics used in the study were one sample t-test for intra-group comparison and paired sample t-test for inter group comparison which showed no statistically significant difference between the two metal types (P value = 0.163). Conclusion: The shear bond strength of ceramic veneered over titanium meets the ISO requirements of minimum shear bond strength between metal-ceramic systems and has achieved the clinically acceptable values. The use of titanium super structure over titanium implants reduces the adverse effects and avoids undesirable effects.

Aim: This study assessed the validity and reliability of color selection by smartphone photography using two smartphone applications and Adobe Photoshop software. Settings and Design: In vitro comparative study. Materials and Methods: The validity and reliability of dental tooth shade recognition (DTSR), Chromatcher, and Adobe Photoshop were evaluated for color selection of shade tabs. The iPhone 7 camera in automatic mode was used for photography. Images were captured using Smile Lite with/without polarized filter and with camera flash. To assess the reliability, nine Vita Lumin Vacuum shade tabs were chosen and each was photographed for 10 times using Smile Lite. The reliability of DTSR, Chromatcher, and Photoshop in shade-taking was calculated. To assess their validity, 16 shade tabs of Vita Lumin Vacuum and 26 shade tabs of Vita 3D Master were photographed using the aforementioned lighting conditions. The color of photographs was calibrated and shade-taking was performed and compared with the shade suggested by SpectroShade as reference. Statistical Analysis Used: Data were analyzed using Two-way analysis of variance and Bonferroni post hoc test. Results: The reliability of Photoshop, DTSR, and Chromatcher was 98.88%, 63.3%, and 100%, respectively. The validity of Photoshop was significantly higher than other software programs (P < 0.05). Chromatcher had higher validity than DTSR (P < 0.05). Conclusion: Shade-taking by calibrated smartphone pictures and Adobe Photoshop has high validity and reliability.

Aim: The aim of this study was to evaluate and compare the peel bond strength of an autopolymerizing acrylic resin and a fiberreinforced composite (FRC) resin to a heat temperature vulcanizing maxillofacial silicone (M511) using two different primers. Settings and Design: In vitro - comparative study. Materials and Methods: Autopolymerizing acrylic resin and FRC resin specimens with a dimension of 75 mm (length) ×10 mm (width) × 3 mm (height) were fabricated. A total of 60 samples were split into six categories based on the substructure material and primers (A330G primer and Sofreliner tough primer) used to bond the maxillofacial silicone to the FRC and acrylic resin specimens. In a universal testing machine, the peel bond strength was conducted at a 10 mm/min crosshead speed until bonding failure occurred. Statistical Analysis Used: The t-test, one-way analysis of variance, and the Tukey's honest significant difference (post hoc test) tests were used to statistically assess the values. Results: The Sofreliner tough primer produced the greatest peel bond strength in both the acrylic resin (0.89690 N/mm) and the FRC resin groups (3.19860 N/mm). Adhesive failures predominated in the acrylic resin group regardless of the primer used. The FRC group showed predominantly cohesive failures with both the A330G primer and Sofreliner tough primer. Conclusion: This study suggests that FRC resin combined with Sofreliner tough primer can significantly enhance the peel bond strength.

Aims: The purpose of this study is to compare and evaluate the failure modes and load-bearing capacity of different surface-treated polyether ether ketone (PEEK) copings when veneered with lithium di-silicate with that of PEEK veneered with composite. Settings and Design: In vitro; comparative study. Materials and Methods: Congruently anatomically shaped single unit PEEK copings (n = 40) were fabricated by scanning a prepared typodont tooth. The PEEK copings were subdivided among four groups (n = 10/group). Among all, one group of PEEK coping was veneered with Urethane dimethacrylate (UDMA)-based composite and other groups were veneered with lithium-di-silicate after different surface treatment on peek copings, i.e., (i) composite veneered PEEK fixed dental prosthesis (FDP) (control group: Group PC), (ii) lithium di-silicate veneered PEEK FDP (no surface treatment: Group PCeN), (iii) lithium di-silicate veneered PEEK FDP (sandblasting with 50 μm alumina: Group PCeS), and (iv) lithium di-silicate veneered PEEK FDP (chemical etching with 98% sulfuric acid: Group PCeE). The load-bearing capacity of all specimens was assessed using a universal test machine. All the samples were loaded till the cracking point and load at that point and failure modes were noted down. Statistical Analysis Used: One-way ANOVA and post hoc Tukey tests. Results: The highest load-bearing capacity was recorded for lithium di-silicate veneered PEEK copings which were chemically etched with 98% sulfuric acid (Group PCeE: 1040.25 ± 77.46) followed by Group PCeS (1017.20 ± 53.70), then Group PC (965 ± 51.57) and least was for Group PCeN (933 ± 97.54). There was a significant reduction in mean load-bearing capacity in Group PCeN (P < 0.05). Conclusions: Veneering of PEEK with pressed lithium di-silicate seems to be a viable clinical option in terms of adequate load-bearing capacity. Lithium di-silicate veneered PEEK FDPs were successful against physiological occlusal forces and are a suitable material for FDPs.

Oligodontia is a developmental anomaly which represents the congenital absence of more than six teeth in primary, permanent, or both dentitions and may or may not be associated with a syndrome. These patients suffer from occlusal disharmony, problems in speech and esthetic appearance. A multidisciplinary approach becomes mandatory to manage such patients to rehabilitate their oral function. Therefore, early diagnosis and treatment become important. This is a case report of a 15-year-old female patient with oligodontia, who was rehabilitated with removable overlay prostheses fabricated digitally, without modifying her existing dentition, to restore mastication, phonetics, and esthetics. Such an approach is essential for children who have not completed their growth. The monolithic three-dimensional (3D) printed denture has increased fracture resistance and higher wear resistance compared to conventional denture. It can also be easily adjusted, repaired and if required, reproduced. This article highlights the methodology, pros and cons of fabricating 3D printed dentures for such patients.

Secondary trigeminal neuralgia might be very rarely preceded by trigeminal neuropathic pain. The patient, in this case, presented with paroxysmal pain in the left mandible and numbness of the lower lip and tongue. Sensory testing of these areas revealed cold and heat hyperalgesia and mechanical hyposensitivity in the mandibular region. Magnetic resonance imaging showed a mass in the left cerebellopontine angle. The patient was prescribed systemic mirogabalin (2.5 mg/day), which provided some relief until the tumor was removed. The histopathological diagnosis was an epidermoid tumor. This article discusses the clinical characteristics and sensory testing findings that distinguish secondary trigeminal neuralgia from trigeminal neuropathic pain based on the International Classification of Orofacial Pain.

Defects of the cranial vault can result from the decompressive craniectomy secondary to trauma, cerebral infections, resection of intracranial processes, or bone invading skin tumors. Reconstruction of the cranial vault not only provides protection and esthetic reasons but also maintains and restores physiological circulatory system of the cerebrum essential for the regulation of intracranial pressure. This paper presents prosthetic rehabilitation of two patients, who suffered head injury resulting in extensive frontoparieto temporal defects that induced symptoms such as headache, fatigue, loss of concentration, loss of memory, and depression. Along with the physical dysfunction and disfigurement, the injury resulted in a deep psychological impact on overall well-being and self-esteem of the patient as well as the close family members. The patients were prosthetically rehabilitated with custom-made heat polymerized polymethyl methacrylate cranial prosthesis and the assessment of postrehabilitation outcome was done using a specific measurement tool; key behaviors change inventory (KBCI) a 64-item questionnaire that evaluates executive, interpersonal, and emotional functioning behaviors following traumatic brain injury. Rehabilitation resulted in the restoration of form, function, and esthetics along with the improvement in psychological status and general health as reflected in KBCI scores posttreatment. Based on the posttreatment scores obtained in the cases under study, it is suggested that KBCI may serve as an important prognostic tool for the assessment of treatment outcomes.