Purpose: The purpose of this in vivo study was to compare the relative efficacy of two different chemical irrigants in achieving the same objective of bacteria decrease in deciduous teeth. The classic needle irrigation system and the EndoVac system were chemical irrigants. Materials and methods: In this comparative study, 80 deciduous molars in patients aged 3–9 years were chosen according to the selection criteria. The teeth were divided randomly into four groups based on the irrigation system and irrigant used, namely, the group I [2.5% sodium hypochlorite (NaOCl) + conventional needle], group II (2.5% NaOCl + EndoVac), group III [2% chlorhexidine (CHX) + conventional needle], and group IV (2% CHX + EndoVac). Pre and postirrigation microbial samples were collected and transferred for microbial assay. Thereafter, pre and postoperative observations were recorded and a mean reduction of bacterial colony-forming units (CFU)/mL was obtained. The statistical analysis was then performed. Results: In the intragroup comparison, EndoVac and the conventional system showed a statistically significant (p > 0.05) reduction in mean CFU/mL. In the intergroup comparison, EndoVac showed better results than the conventional needle irrigation system (p > 0.05). There was more reduction in CFU in 2% CHX than in 2.5% NaOCl in both the conventional needle system (p = 0.3056) and the EndoVac system (p = 0.4573), with no significant difference. Conclusion: In this in vivo study, the efficacy of EndoVac was found to be better among all the tested groups. Around 2% CHX was found superior as compared to 2.5% NaOCl with no significant difference. Clinical significance: The EndoVac apical negative pressure irrigant system eliminates optimum bacterial load. It significantly cleans more debris from mechanically inaccessible regions of root canals. The use of 2% CHX has shown promising results due to its property of substantivity and acceptability by children.

Background: Anxiety toward dental treatment may be the reason for not only young children but also secondary school children to postpone dental treatment despite having severe pain. Hence this study was undertaken to recognize such anxious secondary school children prior to the treatment and tried to manage them with the retraining technique. Materials and methodology: The present interventional study comprised 100 participants with highly anxious about dental treatment and were selected randomly within the secondary school age group of 11–16 years visiting the dental hospital. These selected participants were randomly allocated into two groups with 50 members in each group. Group I participants were managed with the retraining behavior management technique and in group II subjects retraining behavior management technique was not employed. Preinterventional and postinterventional dental anxiety (DA) scores were assessed using a Modified Dental Anxiety Scale (MDAS). The data obtained was statistically analyzed with Statistical Package for the Social Sciences (SPSS) version 22 using the Wilcoxon sign ranked test. Results: There was a significant difference in preinterventional and postinterventional mean DA scores in group I treated with the retraining technique with no significant difference in group II. Conclusion: The retraining technique can be used in managing highly anxious secondary school children during dental procedures.

Aim: To evaluate the thickness of the root canal dentin wall in the cervical, middle, and apical third of primary first molars. Materials and methods: Cross-sectional study consisting of 30 cone-beam computed tomography (CBCT) images of primary maxillary and mandibular first molars, with crown, and root integrity. The wall dentin thickness of each canal was measured in three axial views, divided into distal (D), mesial, lingual/palatine, and buccal surfaces. Results: The smallest dentin wall thickness of the maxillary molar was located on the mesial surface of the mesiobuccal (MB) canal apical third (mean 0.55 ± 0.04 mm). The buccal and palatal (P) surfaces of the distobuccal (DB) and P canals showed the smallest dentin thickness on the cervical third (0.62 ± 0.02 mm). On the mandibular molar, we found the smallest dentin thickness on the apical third [lingual surface of the MB canal and buccal surface of the mesiolingual (ML) canal] with a mean of 0.41 ± 0.07 mm. Additionally, the dentin thickness is average of the D canal was about 0.67 ± 0.11 mm. Conclusion: It is essential to understand the primary first molar's anatomy to reduce possible complications in pediatric patients from instrumentation during root canal treatments. Clinical significance: Pulpectomy is among the most challenging procedures in pediatric dentistry and the knowledge of the root anatomy of primary teeth allows the professional to make better clinical decisions and reduce possible risks during root canal treatment.

Aim: To assess and compare the antibacterial efficacy of methylene blue (MB) and red laser (660 nm) antimicrobial photodynamic therapy (aPDT), indocyanine green (ICG) and infrared laser (810 nm) aPDT, and dual-dye (MB and ICG) and dual light (red and infrared) aPDT on oral biofilms of Enterococcus faecalis (E. faecalis), Prevotella intermedia (P. intermedia), and Streptococcus mutans (S. mutans). Materials and methods: Biofilms of E. faecalis, S. mutans, and P. intermedia were grown at 36°C and 5% CO₂ for 7 days in a 96-well plate in a brain heart infusion (BHI) growth medium. Before aPDT, a total of 27 inoculums were collected from culture wells and grown on culture plates to assess baseline colony forming units (CFU). The microbial wells were treated with MBaPDT (group I), ICGaPDT (group II), and MBICGaPDT (group III). Post-aPDT, inoculums were collected from wells to be cultured to assess CFU. One-way analysis of variance (ANOVA) and student paired t-tests were used for statistical analysis. The significance level was fixed at p ≤ 0.05. Results: Methylene blue antimicrobial photodynamic therapy (MBaPDT) caused a significant reduction in E. faecalis counts compared to other groups (f = 11.15, p = 0.01). aPDT on S. mutans resulted in a significant (p = 0.04) reduction of bacterial counts in the ICGaPDT group. aPDT on P. intermedia resulted in a significant reduction in bacterial counts (p ≤ 0.05) in MBaPDT and ICGaPDT groups. Conclusion: Dual-dye and dual light aPDT showed an antibacterial effect against E. faecalis. It was ineffective against S. mutans and P. intermedia. Clinical significance: Dual-dye aPDT may effectively reduce E. faecalis counts in infected root canals and improve the outcomes of root canal treatment.

Objective: To assess salivary nitric oxide (NO) levels in children with caries at baseline before treatment and compare salivary NO levels before treatment and after 15 and 30 days of the treatment. Study design: The saliva sample was collected from a total of 31 children with caries aged between 6 and 12 years. NO levels were estimated in children with caries before and after treatment using Griess reaction. Decayed teeth in permanent dentition (DT) and and decayed teeth in primary dentition (dt) scores, pretreatment NO levels were recorded at the baseline. After completing the treatment, posttreatment NO levels were compared at 15 and 30 days using paired t-tests. Mann–Whitney U test was used for comparing NO levels with both genders. Further, the correlation of NO with age and dental caries was estimated using the Spearman correlation test. Results: A significant increase in salivary NO levels was found in children after treatment (p < 0.001). No significant correlation was found between NO, age, gender, and DT and dt scores. Conclusion: Higher levels of NO were associated with low caries experience. Clinical significance: The salivary NO in children is of higher diagnostic values as it can be used in caries risk assessment.

Aim: To check the reliability and validity of International Caries Detection and Assessment System (ICDAS) II coding in occlusal caries detection under unaided visual and enhanced visual examination. Materials and methods: This study included 100 extracted premolars and molars. Two examiners independently scored occlusal caries using ICDAS II criteria without magnification and under 6x magnification in the dental operating microscope. The examination was repeated after one month to check the intraexaminer reliability. The examined samples were sectioned and the carious lesions were scored using Ekstrand–Ricketts–Kidd (ERK) histological criteria under 20x magnification in stereomicroscope. The ICDAS II scores given by the examiners were compared with the histological scores. Results: The κ values for interexaminer reproducibility of unaided and enhanced visual examinations were 0.695 and 0.626, respectively (substantial agreement), and 0.984 (almost perfect agreement) for histological examination. Intraexaminer reproducibility for unaided and enhanced visual examinations were 0.835 and 0.910, respectively (almost perfect agreement). Spearman's correlation coefficients of ICDAS II unaided visual and enhanced visual examinations to ERK histological scores were 0.724 and 0.689, respectively, which infers that there is a strong correlation between unaided visual and histological examination and a moderate correlation between enhanced visual and histological examination. For unaided visual examination, specificity is 100% and sensitivity is 92%, whereas for enhanced visual examination, specificity is 50%, and sensitivity is 100%. Conclusion: Unaided visual examination demonstrated good reliability and validity for ICDAS II coding, whereas enhanced visual examination exhibited good reliability but relatively lower validity. Clinical significance: This study reveals that magnification did not have any added benefits in occlusal caries diagnosis using ICDAS II coding compared to unaided visual examination. The use of magnification did not improve the validity and led to a drop in the specificity, which indicates higher chances of false positive results.

Background: Premature loss of primary teeth results in space loss, thus affecting the integrity of the oral tissues. According to the American Academy of Pediatric Dentistry, the treatment for a carious primary molar with pulpal involvement is pulpectomy. The success of this procedure depends on the elimination of bacteria, the most common being Enterococcus faecalis (E. faecalis), by cleaning and shaping the root canals with rotary or hand instrumentation. Aims and objectives: Evaluating and comparing the cleaning efficacy and obturation quality using Kedo-SH hand files and rotary Kedo-SG (blue) and Pro AF Baby Gold files in primary molar teeth. Materials and methods: A total of 51 extracted primary molar teeth were selected and divided into three equal groups. Group I, the control group, was instrumented with Kedo-SH hand files. Groups II and III were instrumented with Kedo-SG (blue) and Pro AF Baby Gold files, respectively. Baseline data and postinstrumentation data were sent for microbiological analysis to check microbial levels of bacteria E. faecalis. Obturation quality was then scored using Barrieshi-Nusair criteria and the T-scoring system by Robia. Results: Associating obturating length between each group, maximum samples in group I showed adequate fill. Relating to density, maximum samples in group III showed no voids present in the obturation. Distribution of the T-scoring system shows maximum samples in group III having all three qualities of ideal obturation. On comparing microbiological analysis among the groups, group I showed higher colony counts of E. faecalis compared to groups II and III. Conclusion: In the present study, rotary instrumentation in the canals showed more consistent results than hand instrumentation. Among the rotary files, Pro AF Baby Gold files show a greater reduction in E. faecalis, with a good obturation quality. Thus, the use of nickel-titanium (Ni-Ti) files is a good option for root canal instrumentation in primary teeth.

Aim: To compare and evaluate the regenerative potential of blood clots and platelet-rich fibrin (PRF) in IYNPT based on the revised American Academy of Endodontics (AAE) clinical considerations for regenerative endodontics 2016. Materials and methods: A total of 20 patients (7–12 years) with immature young necrotic permanent teeth were included and irrigation and disinfection were done using the revised AAE protocol. Teeth were randomly categorized into PRF scaffolding and conventional bleeding technique. The cases were followed up for 1, 3, and 6 months for clinical and radiographic evaluation. Result: At 6 months there was no significant difference between the groups in terms of clinical healing and periapical healing. A significant statistical difference was noted at the end of 6 months with respect to apical closure within the PRF group. A significant difference was seen in the increase in dentin thickness between groups with PRF showing more increase. Conclusion: The PRF scaffold can be used as it induces the regenerative potential of stem cells at the apex.

Aim: To assess the clinical and radiographic success of conventional pulpectomy and pulpectomy done under an endodontic microscope over a period of 12 months. Materials and methods: The study was conducted as a single-blinded, parallel-group prospective, randomized, and controlled clinical trial. The enrollment of the study involved the assessment of 258 deciduous molars for eligibility as per the inclusion criteria. A total of 104 teeth were allocated to each group, that is, group I (conventional pulpectomy) and group II (pulpectomy under microscope). However, due to unavoidable circumstances during the coronavirus disease 2019 (COVID-19) pandemic, 98 and 90 teeth were treated in each group, respectively. Pulpectomy in both groups was done using standard protocol except for the use of an endodontic microscope in group II. The clinical and radiographic outcomes were assessed by an independent blinded observer and analyzed using appropriate statistical tests. Results: The clinical success at 6 months is 95.7 and 96.5%, and at 12 months is 96.6 and 97.7% in groups I and II, respectively. The radiographic success at 6 months is 93.5 and 95.4%, and at 12 months is 95.5 and 98.8% in groups I and II, respectively. The overall success rates of both groups with statistically no significant differences. Conclusion: The present study concludes comparable results are achieved using an endodontic microscope to conventional pulpectomy without magnification.

Introduction: Microorganisms induce a variety of infections and diseases in the human body and are largely ubiquitous in the nature of the contamination, directly, or indirectly leading to transmission of infectious agents. A substantial number of bacterial species have been identified as inhabitants of the oral cavity. Infection control is a major topic of concern in medical and dental healthcare settings. Aim: To evaluate the disinfecting ability of various herbal extracts on sterilization of endodontic files against endodontic pathogens. Materials and methods: The study was conducted in three phases to evaluate the disinfecting ability of tea tree, neem, eucalyptus, and ajwain oil on sterilization of endodontic files against Staphylococcus aureus, Streptococcus β-hemolyticus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Peptostreptococcus species, and Bacteroides fragilis. Results: Colony-forming units (CFU) of all tested bacteria among group I (tea tree oil) were found to be significantly lower than that among group II (ajwain oil), group III (eucalyptus oil), and group IV (neem oil), respectively. Conclusion: The antimicrobial activity among all the essential oils was found to be maximum for tea tree oil, followed in descending order by ajwain, eucalyptus, and neem oils. Hence, the incorporation of these herbs in dental practice will prove to be a valuable adjunct in dental treatment. Clinical significance: Herbs have also been long used in various endodontic medicaments and dressings with obtundent and soothing effects and exhibited a great microbial inhibition potential against the tested endodontic pathogens.

Aim and objective: To evaluate and compare the cytotoxicity and antimicrobial activity of various inorganic metal oxide nanoparticles along with vehicles when used as intracanal medicaments in the root canal system. Materials and methods: The study included triplicates (n = 36 times) that were subjected to n calcium oxide (CaO), n zinc oxide (ZnO), n magnesium oxide (MgO), and metapaste as intracanal medicaments. The efficacy of novel intracanal medicaments was evaluated for biocompatibility assay using 3-(4,5-dimethylthiazol-2-yl)—2,5-diphenyl tetrazolium bromide (MTT) reagent following antimicrobial efficacy against Enterococcus faecalis (E. faecalis) was evaluated using zone of inhibition (ZOI) and minimum inhibitory concentration (MIC). The statistical analysis Kruskal–Wallis test, student t-test, and analysis of variance (ANOVA) using Statistical Package for the Social Sciences (SPSS) software (v.20.0). Results: The order of proliferative activity of experimental groups on L929 mouse fibroblast cells using MTT assay was: metapaste > nCaO > nMgO > nZnO). After evaluation of antimicrobial efficacy, group I: nCaO showed maximum ZOI and MIC against E. faecalis, which showed high statistically significant differences between all four groups after ANOVA (p < 0.0001*). Conclusion: n calcium oxide (CaO) mixed with propylene glycol (PPG) 400 has a potential role as an intracanal medicament with minimum cytotoxic effect and maximum antimicrobial activity against endodontic pathogens. Clinical significance: Nanoparticles-based intracanal medicament can provide a promising future in reducing endodontic flareups when used as intracanal medicament.

Purpose: The aim of present study was to assess the frequency, severity, and distribution of developmental defects of tooth enamel and correlate the etiology with the type of defect in 11–13-year-old Indian children. Materials and methods: The present study included examination of permanent maxillary incisors in 500 children in the age-group of 11–13 years to examine the occurrence of distribution of developmental defects of tooth enamel. Materials and methods: Only the buccal surface of four permanent maxillary incisors was examined for enamel defects using modified developmental defects of enamel (DDE) index by Clarkson which recognized three basic types of enamel defects; namely demarcated opacities, diffuse opacities, and hyploplsia. Personnel details, dental history which included dental infection, extraction, trauma, lifetime fluoride, fluoride in water, and medical history were also recorded. Data was coded and analyzed for distribution of developmental defects of tooth enamel by tooth type and gender using Statistical Package for the Social Sciences. Result: Out of 500, 114 (22.8%) children showed defective enamel in permanent maxillary incisors. Of all enamel defects, diffuse opacities were most prevalent with 48.25% occurrence followed by demarcated opacities 38.5%, hypoplasia 10.52%, and any other defects 1.75%. No significant difference was observed in males and females for the occurrence of developmental enamel defects. The occurrence of dental enamel defect significantly correlated with dental history as well as with medical history (Chi-squared statistical test, p-value = 0.001**). Conclusion: (1) High fluoride in water accounts for most prevalent diffuse opacity. (2) Demarcated opacities are associated mainly with positive dental history. (3) Hypoplasia of incisors was found to be least prevalent associated with trauma, periapical infections.

Background: Full-coverage restorations are commonly employed choice of treatment in treating multisurface carious lesions in primary teeth. Aim: To assess the amount of Streptococcus mutans (S. mutans) colonization and oral hygiene status in deciduous molars restored with preformed zirconia and stainless steel crowns (SSC). Materials and methods: A total of 21 children aged between 4 and 7 years with bilateral carious primary molars were randomly divided into two groups of zirconia and SSC. Plaque collection was done using sterile swabs at baseline and 1-month intervals. S. mutans was cultured on mitis salivarius-bacitracin agar (MSBA). The microorganisms were then counted and expressed as colony-forming units. The plaque and gingival indices were recorded during the follow-up visits. All data were tabulated and subjected to statistical analysis, with the level of significance set at 5%. Results: A total of 21 children with 42 teeth were randomized into group I—SSC and group II—zirconia crowns using the split-mouth technique, respectively. The zirconia group showed a statistically significant reduction in the adhesion of S. mutans (p < 0.001). On comparing the plaque and gingival indices between the groups, plaque index (PI) and gingival index (GI) scores were significantly low in the zirconia group as compared with the SSC, with a mean difference of 0.08 at 3 months in group II (p < 0.001). Conclusion: Streptococcus mutans (S. mutans) adhesion to zirconia crowns was significantly less when compared with SSC, with better gingival health and oral hygiene.

Context: The smear layer produced during the instrumentation of the root canal contains both organic and inorganic components, and it is recommended to be removed as it has a mixture of bacteria and their byproducts. Irrigants like sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), endodontic irrigant, citric acid, etc., possess the ability to remove the smear layer. Considering the antimicrobial effect, antiinflammatory, cavity disinfectant, nontoxicity, better taste, and aroma of herbal products, a novel approach has been introduced in the field of endodontics. Aims: To assess the efficacy of passion fruit juice in removing the smear layer and its erosive potential in root canals after instrumentation by scanning electron microscopy. Materials and methods: About 35 single-rooted premolars were divided into five groups—30% passion fruit extract (PFE), 17% EDTA, 17% EDTA + 5.25% NaOCl, 30% PFE + 17% EDTA, and saline. Following irrigation with the above irrigants, each tooth was split into two halves and examined and scored for smear layer removal (modified Torabinejad's criteria) using a scanning electron microscope. Statistical analysis: Overall comparison of the irrigant's action on removing the smear layer and their erosive potential was done using the Kruskal–Wallis test, and intergroup comparison of the irrigant action was done using the Mann–Whitney U test. All the statistical analyses were set with a significance level of p < 0.05. Results: A total of 30% PFE produced less erosion and statistically significant smear layer removal in the coronal and middle third of the root. When combined with 17% EDTA, it effectively removed the smear layer in all three-thirds of the root. Around 30% PFE + 17% EDTA is less erosive when compared to 17% EDTA + 5.25% NaOCl. Conclusion: This study revealed that 30% PFE and 30% PFE + 17% EDTA are promising irrigants as root canal disinfectants in endodontics.

Aim: To evaluate the clinical and radiographic efficacy of Nigella sativa and Aloe vera as pulp medicaments in primary molars in comparison to formocresol. Materials and methods: This randomized controlled trial is a three-arm, parallel-group study. This research included 66 vital, carious primary molars that required pulpotomy treatment in 4–7-year-old children. Teeth were randomly assigned to one of the three groups: groups (1–3) Nigella sativa, Aloe vera, and formocresol, respectively. All teeth were covered with stainless steel crowns (SSC) after the pulpotomy procedure was done and were assessed clinically and radiographically at 3, 6, and 12 months following Zurn and Seale criteria. Results: After 12 months, the clinical success rate was found to be 40, 90, and 72.7% for Nigella sativa, Aloe vera, and formocresol groups, respectively. While the radiographic assessment showed a success rate of 20, 72.7, and 81.8%, respectively. Conclusion: Aloe vera can be considered as an alternative pulpotomy medicament to formocresol. On the other hand, Nigella sativa is not recommended to be used in pulpotomy procedures. Further long-term follow-up clinical studies and histological studies are recommended. Clinical significance: Although formocresol is the most popular used material in pulp therapy, concerns were raised regarding its toxicity and carcinogenicity by the International Agency for Research on Cancer (IARC). Consequently, herbal medicine is expanding rapidly worldwide nowadays and herbal extracts are suggested as an alternative to formocresol for their proposed antibacterial and anti-inflammatory properties.

Aim: Various surveys aimed at gathering the knowledge and awareness of health practitioners as well as students, both medical and dental, regarding the link between oral health and systemic diseases have been published. However, relatively few studies have attempted to examine the awareness of such knowledge among the general population. Therefore, the current study aimed to explore the public perception regarding the oro-systemic link. Materials and methods: The present study was designed as a cross-sectional survey to be carried out in the Department of Periodontology and Oral Implantology, PGIDS, Rohtak. All survey participants were provided with a written questionnaire which was required to be completed by each participant independently. The study questionnaire was designed to collect demographic data followed by specific questions targeting the awareness and knowledge of the participants regarding the relationship between oral and systemic health. Results: A total of 240 completed questionnaires were available for analysis. Only about a quarter of the total participants (27.5 %) believed that oral health status has any effect on the rest of the body. A positive response (YES) of 25% was observed for effect of diabetes and physician prescribed medicines on systemic health. Regarding the effect of pregnancy, smoking, stress, and obesity on systemic health, less than 20% positive response was recorded. Conclusion: The findings indicate a very poor awareness regarding the impact of systemic conditions on oral status and vice versa, among the studied population. Clinical significance: Pedodontists should lay emphasis on imparting knowledge about oro-systemic connections to their patients as well accompanying guardians. This would go a long way in spreading much needed awareness among the general population as well as ensuring that children adopt healthy lifestyle habits right from childhood.

Aim: The purpose of this study is to present a framework for the potential implementation of children's anxiety levels and perspectives of their experiences receiving treatment from dental students through interviews and drawing into the clinical assessment of dental students. Materials and methods: A total of 51 patients between the ages of 5 and 8 years were included in the study. Pulp therapy and/or restorative treatment was performed during the first therapeutic session for all participants. Children were asked to draw about themselves at the dentist's and then verbally explain their drawings. Drawings were analyzed using Child Drawing: Hospital (CD: H) to determine the child's anxiety score. Interviews were analyzed using thematic analysis to establish the factors contributing to the patient having a positive/negative experience. The relationships between the children's level of anxiety and their experience were analyzed using correlation and regression analyses against the student clinical assessment data. Results: Most children in the study exhibited average levels of anxiety and had an overall positive perception of the dentist. The correlation and regression analyses determined that when children presented higher levels of anxiety, the students received statistically significant higher scores in evidence-informed practice (EIP), skills, and their tolerance for error during procedures. No other rubric item was related to the children's anxiety or whether their experience was positive/negative. Conclusion: Although this study provided a framework for exploring children's anxiety levels and perspectives of their experiences in teaching clinical settings, more research is needed to refine the method for student evaluation. Clinical significance: This study will enable dental students to meet the needs of child patients, which consequently increases treatment motivation and adherence to dental services as well as reduces the likelihood of patient anxiety and improves patient self-care skills over time.

Introduction: This study was performed to evaluate the clinical and radiographic effectiveness of TheraCal light cured (LC) comparison to mineral trioxide aggregate (MTA) and calcium hydroxide in direct pulp capping of primary molars over a period of 9 months. Materials and methods: A total of 90 primary molars from children aged between 5 and 8 years were included in this randomized clinical study based on inclusion and exclusion criteria and were randomly divided into three groups—group I, TheraCal LC; group II, MTA; and group III, calcium hydroxide. Direct pulp capping (DPC) was performed in noncontaminated pulpal exposure with hemostasis achieved within 2–3 minutes followed by restoring the tooth using glass ionomer cement (GIC). Subjects were followed up at 3, 6, and 9 months for clinical and radiographic evaluations. Results: At 9 months of follow-up, the overall success rate of direct pulp capping in groups I, II, and III were 60%, 72.41%, and 48.14%, respectively. Intergroup comparison showed nonsignificant differences (p >0.05). Conclusion: The outcomes of this study suggest the limited success of direct pulp capping in primary molars. However, among the three materials used in this study, MTA comparatively had better results.

Aim: The purpose of this case report is to provide a simple, efficient, and novel technique for fabricating a nasal stent utilizing a multisegmental cast to rehabilitate the anatomic and functional dynamicity of the upper airway following primary cleft lip and primary rhinoplasty surgery. Background: Nasal deformity is often associated with congenital unilateral or bilateral cleft lip and palate. Despite primary nasal reconstruction at the time of definitive lip repair, the long-term postoperative outcome of the nasal correction frequently falls short of the surgeon's or patient's expectations. This condition is more prevalent in the Asian population due to undeveloped, thin alar cartilage and thick skin. Case description: A 4-month-old female infant was referred from the Department of Plastic Surgery for the fabrication of a nasal stent after surgical cleft lip repair with nasal reconstruction. A customized nasal stent using a multisegmental cast followed by relining with tissue conditioner was planned to minimize relapse of the nasal defect. Conclusion: The technique described in the present case for nasal stent fabrication is simple, cost-efficient and innovative. Postoperative use of this nasal stent helps to maintain the corrected position of the nose after primary lip and nasal correction, resulting in significantly improved esthetic results. Clinical significance: Nasal surgical correction deteriorates over time, especially within the 1st year of surgery due to tissue memory and contraction of the scar tissue. Hence a nasal stent should be worn after the surgery to maintain the corrected nasal form.

Anatomical variations in root morphology have been frequently encountered in pediatric endodontic practice. Due to insufficient knowledge of canal anatomy in primary teeth, having unusual canal morphologies is possibly more prone to endodontic treatment failures. Advanced investigations have given the clinician an open handed chance to recognize those variations and thus effectively manage them to achieve desired results. This paper describes the mandibular primary second molar requiring pulp therapy having three separate and distant canals in the mesial and distal root. Such additional canals were labeled as the middle mesial (MM) canal in the mesial root and the middle distal (MD) canal in the distal root. Additional canals were identified on clinical examination and multiangled radiographs and verified with the help of cone-beam computed tomography (CBCT) imaging. In primary second molars such additional canals are bizarre. This paper describes the bizarre variations that were seen on second deciduous molars.