Dental fluorosis is a specific condition due to chronic ingestion of excessive fluoride during enamel formation. The cleavage and removal of enamel proteins are disturbed. Retention of the proteins and water results in varying degrees of subsurface porosities related to the severity of fluorosis. The porosities may attract extrinsic stains, causing enamel discoloration. Posteruptively, occlusal trauma may cause detachment of surface enamel weakened by the subsurface porosities. The therapeutic management options include bleaching, microabrasion, veneering and crowning. The bleaching agents break down the chromogens into smaller molecules, resulting in teeth with lighter and brighter shades. The microabrasion is aimed at removing the superficial microporous zone together with the entrapped extrinsic stains, while laminate veneers and crowns provide esthetic masking of the discolored fluorosed enamel. It is suggested that mild-to-moderate fluorosis be treated by microabrasion and bleaching, while severe fluorosis, with loss of some surface enamel, is managed by veneering and crowning, depending on the extent of surface enamel loss. Long-term clinical trials are needed to evaluate the appropriateness of the various management options for fluorosis of varying severity.

Immediate implant placement in the esthetic zone is a topic that has recently received a lot of attention in the literature. Successful implant placement at the time of extraction in the esthetic zone is a challenge, requiring management of soft-tissue, atraumatic extraction placement of the implant and later the prosthetic stage. This article looks reviews recent literature on the topic of immediate implant placement in the esthetic zone and the clinical steps involved. The article also looks at recent evidence on patient satisfaction and discusses the merits, demerits of such a procedure and precautions to be taken by the practitioner to minimize failure.

Aim: This study evaluated the distortion and fracture mode of ProTaper and Mtwo rotary instruments following their use in severely curved root canals in extracted human teeth. Materials and Methods: A total of 30 mesial canals of mandibular molars were allocated into two groups that were balanced in terms of angle and radius of curvature. Canals were prepared by either ProTaper or Mtwo systems. Each set of instruments was changed after the third canal. Longitudinal and fractographic examinations of the instruments were carried out by scanning electron microscopy. Images were evaluated according to distortion and mode of fracture. Chi-square analysis and Fisher's exact test were carried out at a significance level of P < 0.05. Results: No significant difference was found between fracture and distortion percentage of ProTaper and Mtwo rotary instruments (P > 0.05). Fractographic analysis revealed that all of the Mtwo instruments demonstrated torsional failure and all but one of the ProTaper instruments (S1) showed torsional failure. Conclusion: Fractographic examination of the fractured surface revealed shear fracture was the predominant mode of failure. Root canal curvature was an essential parameter influencing the susceptibility of instruments to fracture.

Aim: Aim of the present study was to evaluate the oral health attitudes and behavior of female undergraduate dental students in Kingdom of Saudi Arabia, according to age and level of dental education. Materials and Methods: A self-administered questionnaire based on the Hiroshima University - Dental Behavior Inventory (HU-DBI) was distributed among 351 dental students at Riyadh colleges of dentistry and pharmacy. Results: A response rate of 88% was obtained. The mean HU-DBI score did not show any significant relationship (P < 0.05) with age and academic level dental education by one way-analysis of variance (ANOVA). The students were considerably concerned about the appearance of their teeth and gums and halitosis. The total mean score was not markedly higher in the clinical levels (level 7 to level 12) than in the non-clinical levels (level 1 to level 6), indicating that the students were almost equally aware. The present study showed that dental students in Saudi Arabia had poor oral health awareness. Conclusion: The oral health behavior of Saudi dental students needs to be improved in order to serve as a positive model for their patients and the community.

Aim: The aim of this study was to tabulate the factors effecting Saudi dental students' selection of a posterior restorative dental material and compare those factors between a private and a government dental school in Riyadh. Materials and Methods: The sample comprised of 267 students studying in both the private dental college (67 males, 75 females) and the government dental college (55 males, 70 females) in their last 3 years of clinical training. The students were administered a structured questionnaire specifically designed for the purpose after obtaining informed consent. Responses were compared between the students of each school using the chi-square and Mann-Whitney U test. Each student's responses to amalgam and composite were measured using the Wilcoxon signed rank test. Results: Overall composite resin was the material preferred by a majority of the students regardless of the type of school. Students in both the private and the government college were likely to give higher scores for composite than amalgam. A majority of students in both schools felt that amalgam could not be completely replaced with composite. When asked to list the main drawbacks of amalgam and composite most of the respondents answered lack of esthetics for amalgam, while they listed micro-leakage as the greatest drawback of composites. Conclusion: The findings of our study suggest that dental students in the Kingdom of Saudi Arabia seem to possess the ability to work confidently with posterior composite resins and seem to be comfortable in doing so; however, there is a significant difference in the factors influencing their choice of material.

Aim: The purpose of the following study is to measure the amount and frequency of iatrogenic damage to inter-proximal surfaces of adjacent teeth, following crown preparation, among undergraduate dental students in Riyadh Colleges of Dentistry and Pharmacy. Materials and Methods: Teeth surfaces were examined on master casts, using ×2.5 magnifying loupes. The damage depth of the injured teeth was measured, with - a modified digital micrometer caliper (Whitworth's 6 inch Digital Caliper). To ensure that examined teeth surfaces were intact pre-operatively, they were confirmed with pretreatment radiographs. Results: A sample of 180 teeth surfaces chosen randomly was examined of which only 111 samples done by undergraduate students with intact teeth surfaces were included. The 69 excluded samples either had carious or restored teeth surfaces or were done by practitioners other than dental students. Over Nearly 98% of examined teeth surfaces, adjacent to crown prepared teeth, were proximally injured. Through using specific measuring parameters, the most frequent type of damage was abrasion (58.7%). The most commonly damaged area found was the middle-third of the proximal surface. The damage extended to more than 50% of the proximal surface, in 63% of the total sample. The depth of the injury was more than 0.1 mm in 58% of the total sample. Damage was more frequent in maxillary teeth (60.4%), than mandibular teeth (39.6%). Conclusion: Conventional crown preparation methods appear to result in significant damage to adjacent teeth surfaces; increasing caries risk potential, thermal sensitivity and periodontal disease. Therefore, protection of these surfaces and selection of the most appropriate instruments and preparation techniques are important.

Background: Oral candidiasis continued to receive attention due to its evidenced association with its evidenced association with acquired immunodeficiency syndrome. In spite of considerable improvements in the laboratory diagnostic methods, there is still a need for more reliable, definitive and less time-consuming diagnostic techniques for Candida infection. Many of the studies were done utilizing acridine orange (AO) as a basic fluorescent dye for the demonstration of yeast in cultured Candida species and in histopathological sections. However, only very few studies report this technique to demonstrate Candida organisms in oral smears. The present study was carried out to assess the diagnostic reliability of detection of Candida by utilizing AO fluorescent dye in oral exfoliative smears of oral candidiasis. Materials and Methods: A total of 62 clinically diagnosed cases of oral candidiasis were studied. Two smears and a swab were collected from each suspected lesion. Each slide was stained with, periodic acid Schiff (PAS) reagent and AO. PAS stained smears were then evaluated for the presence of Candida species under light microscopy. AO stained smears were observed under fluorescent microscopy. After inoculation of swab on the saborouds agar plates, the growth of Candida species was evaluated by Gram stain and germ tube test. Each technique was evaluated for sensitivity, specificity, positive predictive value and negative predictive value. Results: It was found that the PAS stained smears were more reliable for detection of Candida species (sensitivity = 100%, specificity = 66.7%), than AO method (sensitivity = 87.5%; specificity = 0%). Conclusion: Acridine Orange fluorescent technique even though rapid lacks specificity for Candida.

Aim: Central giant cell granuloma (CGCG) of the jaws and giant cell tumor (GCT) of bone share a number of similarities and dissimilarities in respect of their histopathological, cytometric and immunohistochemical features. The aim of this study was to compare CGCG of the jaws and GCT of long bones from clinicopathology, cytometry and immunohistochemistry aspects. Materials and Methods: 18 CGCG and 22 GCT of bones were compared. Clinical data were obtained on the age, gender, diagnosis, clinical course, treatment and follow up. Histopatholgical features of mononuclear cell; stroma and giant cells were assessed. Computer-assisted image analysis was used to measure the mean number of giant cells, mean number of nuclei per giant cell, fractional surface area and relative size index. Expression of cell differentiation markers (vimentin, CD68, CD34, S-100P, alpha-smooth muscle actin [αSMA]) and cell cycle related markers (PCNA, P53, Ki-67, bcl-2) were evaluated. Results: CGCG of the jaw showed an early age of presentation (55.6% <25 years) and the mandible was the more common anatomical location (77.8), whereas the femur and tibia were equally affected by GCT (36.4%). GCT showed higher mean number of giant cells, higher number of nuclei per giant cell, greater fractional surface area and relative size index. Both diseases showed similar cellular phenotype in respect of Vimentin, S100 protein, CD68 and CD34. There was increased immunoreactivity of GCT to Ki-67, P53 and αSMA. Conclusion: The findings suggested that the GCT and the CGCG may be variants of the same disease entity with age and site-specific features.