Purpose: The purpose was to examine the existence of divine proportions among the Indian faces in Moradabad population. Materials and Methods: Totally, 100 patients (50 males; 50 females) aged 25-45 years were selected for the study. All facial photographs were analyzed based on the method of Ricketts assessing the divine proportions in vertical and transverse facial planes. Six horizontal and seven vertical ratios were determined, which were then compared with the phi ratio. Results: The horizontal ratio results showed that three male and female ratios were not significantly different from each other (P > 0.05), and interchilion/nose width ratio was highly significant (P < 0.001). The horizontal mean ratios for females as well as males were highly significant from the phi ratio (P < 0.001) except for interchilion/interdacryon ratio, which was significant (P < 0.05) for females and not significant (P > 0.05) for males. The vertical ratio results showed that there was a highly significant difference (P < 0.001) for forehead height/stomion-soft menton ratio and no significant difference for two ratios between the mean ratios of males and females. All the vertical mean ratios for both the groups were highly significant (P < 0.001), except for the intereye-soft menton/intereye-stomion ratio, which was significant (P < 0.05) for female group and not significant (P > 0.05) for the male group. Conclusion: Although, the golden proportion is a prominent and recurring theme in esthetics, it should not be embraced as the only method by which human beauty is measured to the exclusion of others factors.

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Aim: The aim of the study is to analyze the effect of different materials and techniques in current use on peripheral shaping of complete denture impression. Methods: The present study was conducted to compare and evaluate the maxillary border morphology produced using tissue conditioner as control and low fusing impression compound, Polyether, Pattern resin and periphery wax as border molding materials. The study was carried out on 15 denture wearer patients with well formed, rounded edentulous maxillary arch with adequate width and height. On each patient, border moldings were done, with tissue conditioner which was loaded on the borders of previous maxillary denture of the patient (control group), low fusing impression compound (Group 1), polyether (Group 2), Pattern resin (Group 3) and Peripheral wax (Group 4), respectively on special tray made for the patient. Sulcus width height and area was then measured for each group using stereomicroscope. Results and Conclusions: Based on the study it is concluded that the polyether was the best material for border molding which will give most accurate borders to a denture.

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Statement of Problem: Selection of proper sized maxillary anterior teeth is one of the difficult clinical steps in complete denture esthetics. Several studies have been reported to establish methods of estimating the combined width of maxillary anterior teeth. Purpose: The aim of this study was to determine whether a relationship exists between the innercanthal distance (ICD) and interalar width (IAW) with the combined width of maxillary anterior teeth. Material and Methods: The maxillary anterior teeth of 600 adult subjects were examined. ICD was measured between the median angles of the palpebral fissure. IAW was measured between the ala of the nose at their widest point. The mean combined width of the maxillary anterior teeth was determined intraorally at their widest dimension. Pearson's correlation coefficients were calculated to determine the relationship between ICD, IAW and the combined width of maxillary anterior teeth (α =0.05). Results: Although the Pearson correlation coefficients were relatively small, a significant relationship existed between innercanthal dimension and IAW (P < 0001). Conclusion: Within the limitations of this study, the results suggest that ICD and IAW cannot be used as a preliminary method for determining the width of the maxillary anterior teeth for edentulous patients.

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Aim: To determine the effect of three different tooth preparation techniques had on operator's ability to appropriately and consistently prepare teeth for metal ceramic crowns. Materials and Methods: Ninety maxillary left central incisor typodont teeth were allocated to three equal groups (A, B and C) of thirty and mounted in standard working model one at a time. A freehand approach was used to prepare the teeth in Group A, which acted as a control. Groups B and C were prepared with the assistance of silicon index and suitable depth gauge burs, respectively. A silicon index of unprepared teeth, into which contrasting colored silicon injected to occupy the space created by tooth preparation, was sectioned in the midline. Images of sectioned index were captured with optical microscope attached to a personal computer. A calibrated image analysis software was used to measure the depth of preparation (in millimeters) at five points (labial-cervical, mid-labial, incisal, mid-palatal and palatal cervical) on two occasions. These results were pooled and averaged to give a mean labial, incisal and palatal preparation depths in mm. The data were analyzed by one-way analysis of variance and Scheffe's post-hoc statistical test. Results: The mean depth of labial and incisal preparation for Groups A, B and C was 1.23 and 1.72 mm, 1.45 and 1.96 mm, 1.47 and 1.95 mm, respectively. The difference between the groups' labial preparation depth was significant as well as the difference between groups' incisal preparation depth. The mean palatal preparation was 0.46 mm for Group A, 0.54 mm for Group B and 0.59 mm for Group C. Conclusion: Teeth preparation for metal ceramic crowns without any assistance can lead to under-preparation of labial and incisal surface. Clinical Significance: Whenever possible, considerable importance should be given to the use of index or depth gauge burs for preparing teeth for receiving metal ceramic crowns.

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Presence or absence of a minimal zone of keratinized tissue around dental implants has been a matter of controversy. However, a consensus exists that a thick zone of keratinized zone around implants provides a prosthetic friendly environment, facilitates precise prosthetic procedures, allows oral hygiene maintenance, resists recession, and enhances esthetic blending. The aim of the present case series was to increase the zone of keratinized soft tissue around dental implants supporting overdentures. Three different surgical techniques modified palatal roll technique with and without apical positioning and connective tissue graft (CTG) were used to achieve this goal. There was a significant gain of keratinized soft tissue with all the three techniques, which remained stable over a period of 6 months. Modified palatal roll technique with and without apical positioning and CTG are simpler surgical techniques, which can be successfully and predictably used for increasing the zone of keratinized tissue around implants.

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Aims: The aim was to evaluate if any correlation exists between variation in angulation of Po-Na-ANS angle and relative parallelism of the occlusal plane to the different tragal levels of the ear in dentulous subjects. Methodology: A total of 200 subjects were selected for the study. A custom made occlusal plane analyzer was used to determine the posterior point of the ala-tragal line. The lateral cephalogram was shot for each of the subjects. The points Porion, Nasion, and Anterior Nasal Spine were located and the angle formed between these points was measured. Statistical Analysis Used: Fischer's exact test was used to find the correlation between Po-Na-ANS angle and relative parallelism of the occlusal plane to the ala-tragal line at different tragal levels. Results: Statistical analysis showed no significant correlation between Po-Na-ANS angle and relative parallelism of an occlusal plane at different tragal levels, and an inferior point on the tragus was the most common. Conclusion: Irrespective of variations in the Po-Na-ANS angle, no correlation exists between the variation in the angulations of Po-Na-ANS angle and the relative parallelism of occlusal plane to the ala-tragal line at different tragal levels. Furthermore, in a large number of subjects (54%), the occlusal plane was found parallel to a line joining the inferior border of the ala of the nose and the inferior part of the tragus.

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Statement of Problem: Three main factors which determine the success of an All-ceramic restoration are esthetic value, resistance to fracture and third being the marginal fit. Marginal fit and internal adaptation are crucial factors in increasing the longevity of the restoration. Newer and economical CAD CAM systems have been introduced claiming better marginal fit and adaptation of All ceramic crowns. CAD CAM systems involves scanning of the die or the tooth preparation and milling of the restoration, which may have variations among the systems available. Aim of the Study: Our study intended to check the marginal fit and internal adaptation of commonly used CAD CAM systems namely CERAMILL and CEREC -In Lab MC XL. Materials and Methods: Two groups of typodont teeth (n = 10) were prepared using a standardized protocol to receive All ceramic copings. 10 samples of Group A were used for fabrication of copings using CERAMILL system and 10 samples of Group B were used for fabrication of copings using CEREC -In Lab MC XL system. They were then luted with glass ionomer cement under mild finger pressure. Samples were embedded in resin and sliced longitudinally. They were then viewed under stereomicroscope and readings were measured along 15 points using ImageScope software. The P value was set at 0.05 at 95% confidence interval with 80% power. The data were checked for normality and unpaired t-test was used to evaluate the results of the two groups. Results: The overall internal adaptation was 61.5 ± 5.2 μm for CERAMILL and 56.9 ± 5.7 μm for CEREC -In Lab MC XL (P < 0.05). The marginal fit for CERAMILL was 83 μm and for CEREC -In Lab MC XL was 68 μm (P < 0.05). Conclusion: The marginal adaptation of CEREC -In Lab MC XL (68 μm) was found to be superior to CERAMILL (83 μm) (P < 0.05). Both the CEREC -In Lab MC XL and CERAMILL copings demonstrated internal adaptation and marginal fit within acceptable discrepancy range. When corroborating both the internal adaptation and marginal fit, CEREC -In Lab MC XL was found to be better than CERAMILL.

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Purpose of the Study: The purpose was to investigate the differences in tooth shade value according to age, gender and skin color among a sample of the local population in Bengaluru, India. Methodology: The study comprised 100 subjects belonging to both gender between the age groups of 16 years to 55 years. Tooth shade values of permanent maxillary left or right central incisors were recorded using the Vitapan 3D-Master shade guide. Skin color was matched using the Radiance compact makeup shades as a guide. Results: Chi-square statistical test demonstrated that younger subjects have lighter tooth shade values. No statistically significant differences were recorded in tooth shade value according to gender or skin color. Conclusion: Within the limitations of the current study, it can be concluded that tooth shade value is significantly influenced by age. Gender and skin color appear not to have a significant relation to tooth shade value.

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Surgical resection of lips is a relatively rare procedure. A defective lip may cause the patient to feel socially vulnerable as well as functionally handicapped and the defect will influence the patient's self-esteem and body image. Patients with labial defects also experience speech problems along with drying and crusting of the tissues in the area of defect. The lip and cheek provide a valve mechanism for speech. Rehabilitation of patients with this type of surgery creates numerous challenges for both the surgical and the maxillofacial prosthetic teams. The goals of prosthetic treatment include regaining favorable speech and restoration of esthetics. This case report presents a 65-year-old woman who was referred for restoration of her lost lip. This case paper describes a quick and simple method of positioning magnets with lip prosthesis attached to maxillary denture and thus esthetics and speech of the patient is restored. Use of retention magnets simplify the clinical and laboratory phase retains the denture and makes it stable and comfortable for the patient. The advent of magnets has enhanced the dental practitioner's capabilities with a remarkably improved potential for increasing prosthesis stability and preserving tissue.

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Objectives: This study was planned to evaluate the dimensional stability of elastomers during cold sterilization or immersion disinfection and also to evaluate the same, along with acrylic resin trays which are used in clinical practice. Materials and Methods: A study mold according to revised American Dental Association. Specification no. 19 was used. Polyether, polyvinyl siloxane (PVS) (heavy body), PVS (regular body) and Hydrophilic addition reaction silicon (medium body) were selected for study. 2% glutaraldehyde and 0.525% sodium hypochlorite were the disinfectants used. The study was divided into group-I and group-II. In group-I study, 24 specimens of each impression material were prepared. Eight immersed in 2% glutaraldehyde, eight in 0.525% sodium hypochlorite and rest eight allowed to dry bench cure. After 16 h, the specimens measured under Leica WILD stereomicroscope and dimensions compared with master die. In group II study, 24 specimens of the material with the least dimensional changes were prepared and adhered to 24 acrylic resin disks using tray adhesive. Same immersion procedure was followed as in group I. The data were analyzed by one-way ANOVA and Tukey's multiple tests. Results: Of four impression materials used, PVS (heavy body) was the most dimensionally stable, and Polyether was the least dimensionally stable in both the groups. Interpretation and Conclusion: Within the limitation of the study, PVS (heavy body) was most stable, and polyether was least stable of all the impression materials.

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Background/Purpose of the Study: Psychological factors, particularly psychosocial stress, have been implicated as risk indicators for temporomandibular disorder (TMD). The aim of this study was to assess any differences in salivary cortisol concentration, scores of perceived stress scale (PSS), and scores of depression and distress between TMD patients and matched controls. Materials and Methods: This case-control study comprised two groups; the patient group consisted of 60 patients attending the Department of Fixed Prosthodontics at the Faculty of Dentistry who met the inclusion criteria (42 females and 18 males aged 19-44), whereas the control group was selected to match the patient group in number, age and sex. Two questionnaires were used for stress assessment: The PSS 10 and the psychosocial measure of Research Diagnostic Criteria (RDC) for TMD axis II. Salivary cortisol levels were measured by a competitive immunoenzymatic colorimetric method. Data were analyzed using SPSS 17. Descriptive statistics, one-way ANOVA test, and independent t-test were used. Results: This study showed statistically significant differences between the patient group and the control group at the three measures of psychosocial stress (P < 0.05). Increased occurrence of this disorder in women has been observed. Conclusion: Psychosocial stress plays an important role in the etiopathogenesis of TMD. Women are at increased risk of TMD when compared to men. Sub-types TMD patients approximately have the same level of stress. Muscle disorders were the most common.

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Statement of Problem: Surface of porcelain restoration is a matter of clinical concern because of its abrasive action on the opposing enamel. Purpose: This study comparatively evaluated wear of enamel when opposed by three different surface finishes of ceramic. Materials and Methods: A total of 60 metal-ceramic discs (10 mm × 2 mm) with different surface finishes were fabricated. They were divided into four groups of autoglazed ceramic surface, over glazed ceramic surface, ceramic surface polished with Shofu polishing kit and ceramic surface polished with DFS polishing wheels and paste. Each group comprised of 15 discs. Sixty human teeth samples were prepared from freshly extracted, unrestored, caries free, nonattrited maxillary first premolars. Each tooth sample was weighed before wear testing using AT200 Mettler Toledo electronic analytical balance of 0.0001 g accuracy. Occlusal surfaces of these teeth were then abraded against the substrates in a wear machine for a total of 10,000 cycles. Each tooth sample was weighed after 5000 cycles and after the total of 10,000 cycles, respectively, using the same balance. Differences in weight of tooth samples before and after wear testing were evaluated statistically using one-way analysis of variance and Bonferroni's correction for multiple group comparisons. Results: The values obtained for percentage weight loss after 10,000 cycles for over glazed ceramic surface were marginally higher than values obtained for autoglazed surface. It was observed that values obtained for percentage weight loss by polished ceramic after 10,000 cycles were statistically less as compared to the values obtained with autoglazed and over glazed ceramic surface (P < 0.001). There was no statistically significant difference between the values obtained by polished ceramic surfaces of two different groups. Conclusion: Enamel wear produced by polished porcelain is substantially less than autoglazed and over glazed porcelain. No significant difference was found in enamel wear when opposed by ceramic surfaces polished by two different methods. This study indicates the potential damage porcelain can inflict upon enamel and suggests that porcelain should be polished instead of over glazed.

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Purpose: In the authors' experience, the color of silicone elastomer following polymerization in molds made of gypsum products is slightly different from the color that was matched in the presence of the patient, before the silicone is packed. It is hypothesized that the investing materials and separating media have an effect on the color during the polymerization process of the silicone. Materials and Methods : This study compares and evaluates the change in color of silicone elastomer packed in three commonly used investing materials - Dental stone (white color), dental stone (green color), and die stone (orange color); coated with three different separating media - Alginate-based medium, soap solution and a resin-based die hardening material. Pigmented silicone samples of dimensions 1.5 cm × 2 cm × 0.5 cm were made from the elastomer in the above-mentioned mold materials using combinations of the mentioned separating media. These served as test group samples. Control group samples were made by packing a mix of the same pigmented elastomer in stainless steel molds. The L*, a*, b* values of the test and control group samples were determined using a spectrophotometer. The change in color (Delta E) was calculated between the control and test groups. Results: The mean L, a, b values for the control group were, 31.8, 26.2, and 36.3, respectively. Average values of change in color (Delta E) for samples packed utilizing alginate-based medium, die hardener, and soap solution, respectively in white dental stone (2.70, 2.74, and 2.88), green dental stone (2.19, 2.23, 2.42), and orange die stone (3.19, 2.72, 2.80) were tabulated. Conclusion: Among the investing materials studied, die stone showed the most color change (3.19), which was statistically significant. Among the separating media, die hardener showed the least color change (2.23). The best combination of an investing material and separating media as per this investigation is a dental stone (green) and alginate-based separating medium.

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Atrophia idiopathica mucosa oris is an oral fibrosing disease resulting in marked rigidity and an eventual inability to open the mouth or had limited mouth opening. Patients with limited mouth opening are a common occurrence in prosthodontic practice. The majority of these patients can be treated with exercise and stretching movements before impressions are made. Some will not respond to these procedures because of facial scarring and surgical manipulation of the facial muscles. This article presents an impression procedure for overcoming difficulties encountered in such reduced mouth opening patients that can be assembled intraorally, disassembled intraorally, and reassembled extraorally.

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Background: The interim restoration is an important phase in fixed prosthodontic therapy. It should provide sufficient durability to withstand the forces of mastication. A fractured interim restoration is damaging to the prosthodontic care and may lead to an unscheduled appointment for repair. Several attempts have been made to reinforce interim fixed partial dentures (FPDs). These have included the use of metal wire, a lingual cast metal reinforcement, a processed acrylic resin interim restoration, and different types of fibers, e.g., carbon, polyethylene, nylon and glass. These fibers can be placed in the occlusal, middle or cervical thirds in the FPD. There is no scientific data to evaluate the effect of fiber placement methods on the fracture resistance of clinical interim FPDs. Purpose of the Study: Hence this study was designed to evaluate fracture load values of interim FPDs with different locations of fiber reinforcement. Materials and Methods: 30 interim FPD samples with polymethyl methacrylate (PMMA) reinforced with fibers at three different locations mainly occlusal, cervical and middle (10 samples each) were fabricated using a metal FPD on a master die. They were tested for fracture resistance in universal testing machine. Results: The fracture resistance was recorded and is tabulated and analyzed statistically. The results showed that the placement of the reinforcement in the occlusal third of the pontic resulted in higher fracture resistance which was significantly higher (P < 0.05) than all other locations. Conclusion: The occlusal third of the pontic region from mesial to the distal end of the connector is the best site of placement of the fiber for reinforcing the PMMA interim restorative resin.

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Purpose: The purpose was to assess the outcome of improved staff supervision on the efficiency and quality of complete dentures delivered by clinical students. Materials and Methods: The audit was performed in two parts. In the first cycle, retrospective analysis for complete dentures delivered by clinical students was undertaken, and patient's satisfaction was graded using Geriatric/General Oral Health Assessment Index (GOHAI). All the impeding factors encountered in the first cycle were identified, and corrective measures were implemented. Subsequently, a prospective analysis for the dentures delivered under strict staff supervision was undertaken in the second cycle. Patient satisfaction was graded again using GOHAI. Results: Improved staff supervision increased the patient satisfaction significantly. Conclusions: The quality of care had improved in leaps and bounds compared to the first cycle due to increased level of supervision and strict adherence to the recommendations made at the end of the first cycle.

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Purpose: Best practice strategies for helping students learn the reasoning skills of problem solving and critical thinking (CT) remain a source of conjecture, particularly with regard to CT. The dental education literature is fundamentally devoid of research on the cognitive components of clinical decision-making. Aim: This study was aimed to develop and evaluate the impact of blended learning module on clinical decision-making skills of dental graduates for planning prosthodontics rehabilitation. Methodology: An interactive teaching module consisting of didactic lectures on clinical decision-making and a computer-assisted case-based treatment planning software was developed Its impact on cognitive knowledge gain in clinical decision-making was evaluated using an assessment involving problem-based multiple choice questions and paper-based case scenarios. Results: Mean test scores were: Pretest (17 ± 1), posttest 1 (21 ± 2) and posttest 2 (43 ± 3). Comparison of mean scores was done with one-way ANOVA test. There was overall significant difference in between mean scores at all the three points (P < 0.001). A pair-wise comparison of mean scores was done with Bonferroni test. The mean difference is significant at the 0.05 level. The pair-wise comparison shows that posttest 2 score is significantly higher than posttest 1 and posttest 1 is significantly higher than pretest that is, pretest 2 > posttest 1 > pretest. Conclusion: Blended teaching methods employing didactic lectures on the clinical decision-making as well as computer assisted case-based learning can be used to improve quality of clinical decision-making in prosthodontic rehabilitation for dental graduates.

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The failure of dental implant can occurs at the preoperative planning stage, at the surgical stage, and at the postoperative stage. The success of this treatment can be increased if the clinical implant practice guidelines are prepared based on the recommendations from the highest level of research evidence (i.e.,) from systematic review of randomized controlled trials (RCTs) with meta-analysis. The Cochrane reviews of interventions are basically systematic reviews of RCTs with meta-analysis but follow a systematic methodological approach following the guidelines from Cochrane handbook for Systematic Reviews of Intervention. They give the current best evidence as they are updated every 2 years which is being the minimum period for an update. This evidence summary recommends the use of antibiotics, single dose of 2 g of amoxicillin 1 h prior to implant surgery to prevent implant failure, based on the body of evidence from the Cochrane review that was first published in 2003, 2008, and then updated twice in 2010 and 2013. The included studies are not from our population for the research question asked in this updated Cochrane review; hence, the need to do primary research in our population to support the available evidence is mandatory.

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