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   Table of Contents - Current issue
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May-June 2017
Volume 28 | Issue 3
Page Nos. 239-351

Online since Friday, July 14, 2017

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GUEST EDITORIAL  

Current status and future perspectives of sentinel lymph node biopsy in oral cancers Highly accessed article p. 239
Arvind Krishnamurthy
DOI:10.4103/ijdr.IJDR_213_17  
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EDITORIAL Top

Redefining and reinventing dentistry p. 241
SM Balaji
DOI:10.4103/ijdr.IJDR_357_17  
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Prevalence of dental caries and periodontal disease in a rural area of Faridabad District, Haryana, India p. 242
Naseem Shah, Vijay Prakash Mathur, Shashi Kant, Arpit Gupta, Vartika Kathuria, Partha Haldar, Ravindra Mohan Pandey
DOI:10.4103/ijdr.IJDR_370_16  
An oral health survey was conducted in 829 individuals in different age groups in Ballabhgarh, Haryana, India, to estimate the prevalence of Dental caries and Periodontal diseases. A survey tool was modified from WHO's STEPwise approach to surveillance and Oral Health Assessment form 2013 from recently released WHO Oral Health Survey: Basic Methods (5th Edition) keeping in mind the South East Asian region. Out of 28 villages, six villages were randomly selected. A random list of study participants (Age-sex specific) was generated from the pooled list of these 6 villages. Local health workes helped in inviting the specific subjects to one centralized location within each village/ locality. The subjects were examined by trained dental surgeons and recordings were done by trained assistants. The prevalence of dental caries in 5-7 year, 12-15 year, 35-44 year and 65-74 year was 33.2%, 31.3%, 64.9% and 50.1% respectively. The prevalence of Periodontal Disease in 35-44 year and 65-74 year found to be 65.2% and 90.4% respectively. Only 37 participants had mucosal lesions, of which leukoplakia and tobacco pouch keratosis was seen in majority. Using the adopted tool, the prevalence of dental caries was found to be highest in 35-44 year (64.9%) age group and the prevalence of periodontal disease was found to be high in 35-44 year (65.2%) age group and highest in 65-74 year (90.4%) age group. Oral health promotion efforts are required to prevent oro-dental diseases in the studied population.
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Evaluation of analgesic and anti-inflammatory activity of a combination of tramadol-ibuprofen in experimental animals p. 248
Chidambarann Suthakaran, Muniyagounder K Kayalvizhi, Karnam Nithya, Thozhudalangudy AR Raja
DOI:10.4103/ijdr.IJDR_731_16  
Background: Pain is the major concern of patients attending dental clinics, and satisfactory pain relief has always been difficult to achieve. Since the pathophysiology of pain is a complex, central and peripheral nervous system process, combined analgesic regimens with different mechanisms of action as a multimodal approach are becoming popular among the clinicians and dentists. Objectives: The aim of the present study was to evaluate the analgesic and anti-inflammatory activity of ibuprofen and tramadol when used alone or in combination in animal models of pain and inflammation. Animals and Methods: The animals were divided into six groups with six animals in each group. Analgesic activity was assessed by hot plate method in rats and by acetic acid-induced writhing test in mice. Paw edema model in rats after induction with 0.1 mL of 1% carrageenan was used to assess the anti-inflammatory activity. Statistical Analysis: Analysis of variance followed by Tukey's honestly significant difference post hoc test was used for statistical analysis. Results and Conclusion: Combined use of tramadol and ibuprofen provided enhanced analgesic and anti-inflammatory effects in animal models of pain and inflammation.
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Evaluation of occlusal groove patterns of mandibular first and second molars in an Indian population: A forensic anthropological study p. 252
Rashmi GS Phulari, Rajendrasinh Rathore, Mili D Takvani, Shivani Jain
DOI:10.4103/ijdr.IJDR_559_15  
Background: The study of dental morphological characteristics is important in anthropological research as it can provide information on the phylogenetic relationship between species, as well as variations and diversities within a population. Aims and Objectives: To determine the prevalence of six types of mandibular second molars in Gujarat state and the results can be used in both forensic anthropological researches and clinical aspects of dental sciences. Materials and Methods: This descriptive investigation was undertaken among 1000 students (13–25 years old) in high schools and dental institutes of Gujarat state. The students were selected by cluster sampling method and screened for the number of cusps and groove patterns of mandibular first and second molars. Gender and religion of the students were recorded on prepared forms. Statistical Analysis: It was done with the help of STATAIC-13 software. Descriptive statistics were used to summarize the data and Pearson's Chi-square test was used to check association between variables. Throughout the discussion, level of significance was set at 5%. Results and Conclusion: The high percentage of “+-”shaped groove pattern and low percentage of primitive “y-”shaped pattern in our study shows a tremendous evolutionary trend persisting in this population. The analysis of dental morphological traits is crucial in anthropological research as it can provide data on the phylogenetic relationship between species, as well as variations and diversities within a population.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Attitude of bachelor of dental surgery students and interns toward teaching-learning process in Government Dental College, Kottayam, Kerala, India p. 256
Sandhya Gopalakrishnan, Philip Mathew, Kannan Vaidyanathan
DOI:10.4103/ijdr.IJDR_121_16  
Introduction: The educational environment affects the academic performance of students. One of the most widely utilized tools for measuring the educational environment is Dundee Ready Education Environment Measure (DREEM). The objective of the study was to assess the attitude toward study environment, as measured using DREEM questionnaire, and to find out the differences in perception of various batches of dental students. Materials and Methods: All Bachelor of Dental Surgery students from Government Dental College, Kottayam, Kerala, India, were included in the study. They were given the well-established DREEM questionnaire. A total of 234 students took part in the study, belonging to 2009, 2010, 2011, 2012, 2013, and 2014 batches. DREEM subcategories were analyzed for significance using analysis of variance. The significance of DREEM score across the different batches was further analyzed using post hoc test. Results: Overall, DREEM score was positive (111.14), but there is need for improvement. Individual questions also were given positive score for most questions. The maximum score was obtained for 3rd year students. Similar results are obtained for three of the five subcategories of DREEM. Conclusion: The total DREEM score was positive (111.14). The total score as well as the scores for the subcategories was highest in 3rd year dental students. The increase might be due to the excitement of clinical exposure for the first time in 3rd year students.
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Oral changes in patients undergoing chemotherapy for breast cancer p. 261
Shruthi Acharya, Keerthilatha Murlidhar Pai, Sujatha Bhat, Ballal Mamatha, Vadhiraj M Bejadi, Shashidhar Acharya
DOI:10.4103/ijdr.IJDR_379_16  
Background: Breast cancer is one of the most common cancers in India. Most of the patients with breast cancer are treated with chemotherapy which has multiple oral complications. Aims: The objectives of this study were to describe the occurrence of taste disturbances, xerostomia, oral mucositis, oral pigmentation, and candidal and salivary changes among patients receiving chemotherapy for breast cancer. Methods: Fifty-two women with newly diagnosed breast cancer (without distant metastasis), eligible for adjuvant/neoadjuvant chemotherapy (cyclophosphamide and adriamycin, 4 cycles × 3 weeks), were included in this study. All the observations were noted before, during (after 6 weeks of starting chemotherapy), and after the completion of chemotherapy (after 12 weeks of starting chemotherapy). Statistical Analysis Used: Variables such as mucositis, salivary flow rate, salivary pH, and candidal carriage rate were compared at baseline, and at 1st and 2nd follow-ups using Wilcoxon signed-rank test (P value corrected for α for pair-wise comparisons). Results: Mean unstimulated whole salivary flow rate reduced from 0.5 ml/min to 0.3 ml/min, and the mean colony-forming units of Candida reduced from 32.3 × 103 cells/ml to 13.1 × 103 cells/ml at the end of the study period. Xerostomia, taste disturbances, and oral mucosal pigmentation increased from 28.8% to 50%. Conclusions: There was a discernible change in oral mucosal, salivary, and candidal status during the course of the study.
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Neocondyle distraction osteogenesis in the management of temporomandibular joint ankylosis: Report of five cases with review of literature p. 269
Ravi Sharma, R Manikandhan, P Sneha, Anantanarayanan Parameswaran, J Naveen Kumar, Hermann F Sailer
DOI:10.4103/ijdr.IJDR_292_13  
Introduction and Objectives: Management of temporomandibular joint (TMJ) ankylosis is a challenging and rather daunting task owing to complex abnormal anatomy and its sequel to craniofacial structures. Various autogenous grafts and alloplastic materials have been tried with variable success for creation of a near-normal joint. In recent years, neocondyle distraction has added a new dimension to the management of TMJ ankylosis. The aim of this paper is to describe the role of neocondyle distraction in TMJ ankylosis. Materials and Methods: Neocondyle distraction was carried out in five patients with TMJ ankylosis following gap arthroplasty. Computed tomogram scans were taken before surgery and 1-year postdistraction for surgical planning and postoperative assessment, respectively. The intraoral distractors (KLS Martin, Jacksonville, FL, USA) were used in this study. Results: All five patients reported with adequate mouth opening and functional jaw movements. The procedure was well tolerated by all the patients. None of the patients underwent reankylosis following neocondyle distraction. Conclusion: With proper surgical planning and distraction protocol, neocondyle distraction is an effective and safe technique for TMJ reconstruction and preventing reankylosis.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Angiogenesis concept in odontogenic keratocyst: A comparative study p. 275
Donia Sadri, Fatemeh Shahsavari, Sareh Farhadi, Zahra Shahabi, Zahra Mehran
DOI:10.4103/ijdr.IJDR_521_16  
Context: Recent reports have indicated that angiogenesis possibly affects the biologic behavior of the lesions. Aim: Given the different clinical behaviors of odontogenic keratocyst (OKC), the present study was undertaken to evaluate the concept of angiogenesis in pathogenesis and clinical behavior of OKC. Setting and Design: This experimental study was carried out on 22 and 24 samples of OKCs and dentigerous cysts (DCs), respectively. Methods: Immunohistochemical staining was approached using CD34 and vascular endothelial growth factor (VEGF) antibodies. The expression of VEGF was first reported by determining the counts of stained cells, including epithelial cells, fibroblasts, and endothelial cells, followed by the percentage of stained cells in each sample based on a 0–2 scoring system. The counts of CD34+ cells were reported in each group in the form of means ± standard deviations. In addition, the patterns of blood vessels in the samples prepared from the walls of both cysts were evaluated. Statistical Analysis Used: Mann–Whitney U-test, Chi-squared test, and t-test were used for analysis of data, and statistical significance was defined at p < 0.05. Results: The expression percentage and scores of VEGF and the mean expression rate of CD34 were significantly higher in OKCs than DCs (p = 0.045, 0.000, and <0.001). No significant difference was detected in the vascular patterns of these lesions (p = 0.58). Finally, there was a strong correlation between the expressions of the two markers in the samples (Correlation coefficient = 0.766). Conclusion: The present results indicate the angiogenesis may play an important role in the pathogenesis and the unique clinical behavior of OKC.
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Comparative evaluation of effectiveness of intra-pocket anesthetic gel and injected local anesthesia during scaling and root planing – A split-mouth clinical trial p. 281
Kalyan Chintala, Sandhya Pavan Kumar, K Raja V Murthy
DOI:10.4103/ijdr.IJDR_489_16  
Background and Aim: Pain control is an important outcome measure for successful periodontal therapy. Injected local anesthesia has been used to secure anesthesia for scaling and root planing (SRP) and continues to be the anesthetic of choice for pain control. Alternatively, intra-pocket anesthetic gel has been used as an anesthetic during SRP. Hence, this clinical trial was done to compare the effectiveness of intra-pocket anesthetic gel and injected local anesthesia during SRP and also to assess the influence of intra-pocket anesthetic gel on treatment outcomes in chronic periodontitis patients. Materials and Methods: Fifteen systemically healthy chronic periodontitis patients were recruited. The dental quadrants on right side received either intra-pocket 20% benzocaine gel (Gel group) or infiltration/block by 2% lidocaine with 1:80,000 adrenaline (injection group). Quadrants on the left side received the alternative. Pain perception and patients preference for the type of anesthesia was recorded. Clinical parameters: plaque index, modified gingival index, modified sulcular bleeding index, probing pocket depth, and clinical attachment level were recorded at baseline and 1 month after treatment. Results: No difference was observed in visual analog scale (P > 0.05) and verbal rating scale (P > 0.05) pain perception between gel group and injection group. A slightly increased preference to gel as anesthesia (53% vs. 47%) was observed. The treatment outcome after SRP did not show a significant difference between gel and injection group (P > 0.05). Conclusion: Intra-pocket administration of 20% benzocaine gel may be effective for pain control during SRP and may offer an alternative to conventional injection anesthesia.
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Honey and olive oil as bio-friendly substitutes for formalin and xylene in routine histopathology p. 286
Keerthi Muddana, Jaya Nagendra Krishna Muppala, Shyam Prasad Reddy Dorankula, Aruna Kumari Maloth, Pavan G Kulkarni, Deepsagar Thadudari
DOI:10.4103/ijdr.IJDR_246_16  
Background: Formalin has long been the standard fixative and xylene has been the clearing agent for routine histopathology and immunohistochemistry worldwide. In recent years, as a result of increasing concerns about the potential carcinogenicity of formaldehyde and xylene, attempts have been made to find safer alternatives. In the present study, we considered honey as better alternative for formalin and olive oil as safer substitute for xylene. Aims: The aim of this study was to know whether honey could be a possible substitute for formalin and olive oil could be a possible substitute for xylene. Materials and Methods: Thirty routine biopsy tissues of 1–2 cm were taken. The study group was divided into Group A and Group B. Group A were subjected to normal processing. Group B were fixed into honey for 24 h after which it was taken through routine processing, and then immersed in olive oil instead of xylene. All the sections will be stained with routine hematoxylin and eosin staining. Compare the sections of both the methods. Results and Conclusion: The preservation of tissue by honey giving superior result when compared to that of formalin. Olive oil was found to be effective clearing agent compared to xylene.
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Evaluation of marginal and internal gaps of metal ceramic crowns obtained from conventional impressions and casting techniques with those obtained from digital techniques p. 291
Rathika Rai, S Arun Kumar, R Prabhu, Ranjani Thillai Govindan, Faiz Mohamed Tanveer
DOI:10.4103/ijdr.IJDR_81_17  
Background: Accuracy in fit of cast metal restoration has always remained as one of the primary factors in determining the success of the restoration. A well-fitting restoration needs to be accurate both along its margin and with regard to its internal surface. Aim: The aim of the study is to evaluate the marginal fit of metal ceramic crowns obtained by conventional inlay casting wax pattern using conventional impression with the metal ceramic crowns obtained by computer-aided design and computer-aided manufacturing (CAD/CAM) technique using direct and indirect optical scanning. Materials and Methods: This in vitro study on preformed custom-made stainless steel models with former assembly that resembles prepared tooth surfaces of standardized dimensions comprised three groups: the first group included ten samples of metal ceramic crowns fabricated with conventional technique, the second group included CAD/CAM-milled direct metal laser sintering (DMLS) crowns using indirect scanning, and the third group included DMLS crowns fabricated by direct scanning of the stainless steel model. The vertical marginal gap and the internal gap were evaluated with the stereomicroscope (Zoomstar 4); post hoc Turkey's test was used for statistical analysis. One-way analysis of variance method was used to compare the mean values. Results and Conclusion: Metal ceramic crowns obtained from direct optical scanning showed the least marginal and internal gap when compared to the castings obtained from inlay casting wax and indirect optical scanning. Indirect and direct optical scanning had yielded results within clinically acceptable range.
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Comparative evaluation of laser-microtextured implant versus machined collar implant for soft and hard tissue attachment: A clinical and radiological study p. 298
Saroj Kumar Rath, Manab Kosala, Ankit Gupta
DOI:10.4103/ijdr.IJDR_578_15  
Background: Various mechanical modifications in the collar region of endosseous implants is a challenge for better performance and osseointegration. Here is a comparative evaluation being carried out to find out the effect of the machined collar (MC) and Laser-Lok (LL)-modified titanium implants on the success of implants being commonly advocated in partially edentulous among serving personnel and their families. Materials and Methods: Twenty-four patients with appropriate inclusion and exclusion criteria were selected for placement of Biohorizons MC and LL implants in 12 cases each. Aseptic surgical procedure was followed for implant surgery, and clinical parameters such as clinical attachment loss, pocket depth (PD), bleeding on probing, and plaque index (PI), mobility parameters estimated by Periotest value, and radiographic assessment of crestal bone loss (CBL) at interval of 6 months and 1 year were recorded and compared by statistical analysis. Results: Intragroup comparison at 6 and 12 months period for all the parameters were nonsignificant except CBL in Group A (CBL-MC) with 12 cases shows a mean of 0.917 and 1.500, respectively, standard deviation difference = 0.477 (significant) with P < 0.05. Similar significant difference in CBL was observed with superior result in LL implants. Conclusion: The presence of LASER textured with microgrooves on the collar of the implants did not increase the PI and sulcular bleeding index. The probing PD was much less as observed in the group of LASER-treated implants in comparison with that of MC group. LL implant had an edge over MC proving success of the laser treatment on collars of implants.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Open reduction and internal fixation: Screw injury - Retrospective study p. 304
Preetha Balaji, SM Balaji
DOI:10.4103/ijdr.IJDR_272_17  
Background/Aims: Open reduction and internal fixation (ORIF) is a standard surgical procedure in jaw trauma and in orthognathic surgery. Insertion of screws is a significant risk for accidental tooth root injury with varying outcomes. Contrary evidences are found in literature due to a variety of study designs. This study was undertaken to address the lacunae and possibly estimate the difference in occurrence of tooth damage during or after ORIF between trauma and planned osteotomies. Materials and Methods: In this retrospective study, the data of ORIF in either trauma or orthognathic surgery fulfilling inclusion and exclusion criteria were collected and analyzed. Results: There were 1632 patients fulfilling the inclusion and exclusion criteria and formed the study group, of which 663 were in orthognathic surgery, of whom 210 had bimaxillary orthognathic surgery. In the trauma group, 358 patients had fractures involving both jaws whereas 272 had maxilla alone and 339 had mandibular fractures alone. On comparing the outcome, of the 9073 screws studied, 93.40% were not involved in any contact with the teeth, 6.3% were in category of potential hits (near apices or the root surfaces), and only 0.28% had evidence of root damage with the screws. It is observed that molar and premolar had a significant difference in terms of the type of surgery (P ≤ 0.05) whereas canine (P = 0.75) and incisor (P = 0.67) showed no statistical difference. Conclusion: ORIF when used as mentioned is a safe way for the management of fractures. The incidence of root injury is not uncommon but can be avoided with careful planning and execution.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Selection of dental implants based on masticatory load of the patient: A novel approach p. 309
Sindhu Sudhakar Kumararama, Ramesh Chowdhary
DOI:10.4103/ijdr.IJDR_124_16  
Purpose: Masticatory load and efficiency vary from one individual to other. Maximum load of one person may be the least load of another. Hence, optimization of dental implants based on the load dissipation of an individual is essential for a better prognosis of implant-supported prosthesis. The aim of the study was to find the appropriate implant dimensions for the particular region based on the masticatory efficiency of the individual. Materials and Methods: A two-dimensional-threaded implant model was designed, which was duplicated in total 28 models with varying dimensions starting from 3 mm × 8 mm till 6 mm × 14 mm, with an incremental increase of 2 mm in length and 0.5 mm in diameter. All these implant models were surrounded in cancellous bone. Each implant model was loaded from 50 Newtons (N) to 700 N with an incremental increase of 50 N in load in vertical direction to the static model complex. Results: Von Mises stresses were calculated for all the models with different amount of load. The analysis showed that, with an increase in applied masticatory load the smaller dimensional implants showed more stress in the bone, with more stress concentration toward the crest of the implants, and in the apical bone, with respect to the ultimate stress capacity of bone. Conclusion: Thus, based on the numerical analysis results, a classification was designed, which will indicate that for a particular amount of masticatory load, a particular dimension of implant has to be selected, rather than just selecting the implant based on the available bone and its dimensions without knowing the load the implant is going to take once it is loaded.
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In vitro effect of chlorhexidine gel on torque and detorque values of implant abutment screw p. 314
Hamid Neshandar Asli, Bardia Vadiati Saberi, Arezoo Sadat Fatemi
DOI:10.4103/ijdr.IJDR_459_16  
Purpose: Use of chlorhexidine (CHX) gel to eliminate the malodor of implant cavity may decrease the friction coefficient and effective preload and result in abutment screw loosening. This study aimed to assess the effect of CHX gel on the preload, torque, and detorque values. Materials and Methods: This in vitro experimental study was conducted on three groups of five implants. Group A (G1) was the control group and no material was applied to the implant cavity. In Group B (G2), implant cavity was filled with saliva before abutment screw tightening. In Group C (G3), implant cavity was first filled with saliva and then with CHX gel. The abutments were torqued to 24 N/cm2 according to the manufacturer's instructions and were then loosened. These processes were repeated five times. The ratio of the mean percentage of detorque to torque values was measured in all groups. The collected data were analyzed using ANOVA and post hoc Tukey's test. Results: No significant difference was noted between G1 and G2. Group G2 had significantly higher detorque value (p < 0.05). ANOVA detected a significant difference in the mean torque (p < 0.05) and detorque (p < 0.001) values among the three groups. G3 showed maximum difference between torque and detorque values; the minimum difference was noted in G2. Conclusion: Application of CHX gel (to decrease the malodor of the implant cavity) decreases the detorque and preload values and increases the risk of screw loosening.
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Distance M-Me: A novel parameter having significant potential as a predictor of mandibular growth p. 320
Parul Jain, Rahul Kaul, Santanu Mukhopadhyay, Subrata Saha, Subir Sarkar
DOI:10.4103/ijdr.IJDR_87_17  
Objectives: The purpose of the present study was to investigate the relationship of the measured distance between two mandibular points (distance M-Me) to chronological age and to find out whether the absolute values of distance M-Me could be classified age-wise into a unique range, which could be directly read for predicting the stage of mandibular growth. Methods and Materials: The study sample consists of lateral cephalometric records of 65 patients (34 females and 31 males; age range: 6–21 years). Chronological age was calculated in decimal years. Lateral cephalograms were assessed by two independent examiners. Points M and Me were located on the lateral cephalograms, and linear distance between them was measured. Results: Pearson product-moment correlation coefficients showed a high correlation between chronological age and distance M-Me (0.746 for females and 0.869 for males, p < 0.01). When the values of distance M-Me were compared with chronological age, it was possible to make four age groups (for females and males separately), where each group showed a unique range of value for distance M-Me. The values increased with increasing age. Conclusions: Increase in value of distance M-Me with age, showing reduced individual variation, depicts a well-conserved linear dimension. Values of distance M-Me can be directly read for predicting the stage of mandibular growth and can be used as a valuable adjunct or substitute to chronological age.
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Comparative evaluation of shear bond strength of zirconia restorations cleansed various cleansing protocols bonded with two different resin cements: An In vitro study p. 325
Sriram Sankar, Vijay Venkatesh Kondas, Sihi Vahanan Dhanasekaran, Prem Kumar Elavarasu
DOI:10.4103/ijdr.IJDR_274_16  
Context: Yttria partially stabilized tetragonal zirconia polycrystalline restorations have gained widespread use because of its enhanced strength and esthetics. During the try-in process, zirconia is likely to be contaminated with saliva. This contamination leads to a clear weakening of the bond between restorative material and cement. For this reason, zirconia surface should be cleaned before cementation. Hence, the purpose of this study is to compare the shear bond strength of zirconia restorations cleansed with various surface cleansing protocols bonded with two different resin cements. Materials and Methods: Eighty samples of zirconia discs were prepared in the dimensions 2.5 mm diameter and 4.5 mm thickness. They were divided into two groups of each forty samples based on luting cement used. Each group was further subdivided into four subgroups of each (n = 10): Group 1: uncontaminated zirconia blocks, Group 2: saliva-contaminated zirconia blocks and cleaned only with distilled water, Group 3: saliva-contaminated zirconia blocks treated with Ivoclean, and Group 4: saliva-contaminated zirconia blocks were air abraded. Eighty human maxillary premolars were then sectioned to expose dentin and were mounted on an acrylic block. A jig was fabricated to bond zirconia with the tooth using two self-adhesive resin cements. The samples were subjected to shear bond strength testing. The data were analyzed using one-way analysis of variance and Tukey's honest significance difference test with a level of significance set at p < 0.05. Results: The mean shear bond strength values of Group 1 and 2 - subgroup B are 10.3 ± 0.4 and 9.80 ± 0.7 (saliva-contaminated zirconia, cleansed with distilled water only), respectively, were lowest among all test subgroups and were significantly less than mean values of subgroup C, Group 1 - 20.45 ± 0.6 and Group 2 - 20.75 ± 0.4 (Ivoclean group) and subgroup D, Group 1 - 20.90 ± 0.3 and Group 2 - 20.60 ± 0.5 (air abrasion group) (p < 0.05) for both test groups. Conclusions: In a clinical practice, a simple application of Ivoclean can be an effective alternative to air abrasion in removing salivary contaminants and improve resin-zirconia bonding.
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SYSTEMATIC REVIEW Top

Enamel color changes following orthodontic treatment p. 330
Akshaya Pandian, Sukanya Ranganathan, Sridevi Padmanabhan
DOI:10.4103/ijdr.IJDR_404_15  
Objective: To evaluate and compare the effect of various orthodontic bonding systems and clean up procedures on quantitative enamel colour change. Materials and Methods: A literature search was done to identify the studies that assessed the quantitative enamel colour change associated with the various bonding systems and cleanup procedures. Electronic database (Pub Med, Cochrane and Google Scholar) were searched. First stage screening was performed and the abstracts were selected according to the initial selection criteria. Full text articles were retrieved and analyzed during second stage screening. The bibliographies were reviewed to identify additional relevant studies. Results: Sixteen full text articles were retrieved. Six were rejected because the methodology was different. There was significant enamel colour change following orthodontic bonding, debonding and clean up procedures. Conclusion: Self–etching primers produce less enamel colour change compared to conventional etching. Resin Modified GIC produces least colour change compared to other light cure and chemical cure systems. Polishing following the clean-up procedure reduces the colour change of the enamel.
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CASE REPORTS Top

Report of occurrence and endodontic management of three-rooted maxillary first and second premolars in the same individual p. 337
Kothandaraman Sathyanarayanan, Manali Ramakrishnan Srinivasan, Sundaresan Balagopal, Lingeswaran Poornima
DOI:10.4103/ijdr.IJDR_65_16  
Anatomical variations should be kept in mind in clinical and carefully looked for in radiographic evaluation during endodontic treatment of maxillary premolars. These teeth have highly variable root canal morphology. Although three separate roots in the maxillary first premolars have been reported, it is a rarity to find both the first and second premolars possessing three separate roots. This case report describes the diagnosis and endodontic management of maxillary first and second premolars with three canals and three separate roots. Access cavity refinements were required for stress-free entry to the complex anatomy.
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Severe unintentional extrusion of mineral trioxide aggregate during apexification p. 341
Levent Demiriz, Ebru Hazar Bodrumlu
DOI:10.4103/ijdr.IJDR_365_16  
The aim of this report was to present the long-term clinical and radiographic outcomes of a case including severe unintentional extrusion of mineral trioxide aggregate (MTA). An 11-year-old boy was referred with a previously traumatized permanent central incisor which was temporarily treated by using calcium hydroxide root canal filling material. Since having an open apex and a large periapical lesion, root canal treatment with MTA apexification was planned. During the apexification process, a huge amount of MTA was unintentionally extruded into periapical tissues. The parents were informed about the complication, and the obturation of the remaining root canal was completed. Clinical and radiographic follow-up was performed for 4 years. Complete healing of periapical lesion was confirmed by the radiographic follow-up at the 48th month. Patients should be followed-up for giving a chance to observe periapical healing without any surgical removal if the MTA is unintentionally extruded.
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Oral gingival metastasis: A diagnostic dilemma p. 344
Nalini Aswath, Chandrakanth Balakrishnan, Vidyarani Shyamsundar, Sarumathi Thirrugnanamurthy
DOI:10.4103/ijdr.IJDR_261_16  
Oral cavity is a rare target for metastasis with an incidence of 1% among all oral cancers. In 24% of such cases, oral metastasis is the first indication of an undiagnosed primary. Metastatic oral malignancies have been reported in the mandible, tongue, and gingiva. Although gingival metastasis has been reported from lung, prostate, rectal carcinoma in men and carcinoma of breast, adrenal glands, and genitalia in females, gingival metastasis from carcinoma of the penis has not been reported. Herein, a case of metastatic gingival carcinoma that developed after extraction of teeth from primary carcinoma of the penis is presented. An extensive literature search revealed no such similar case reports.
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A conservative management of iatrogenically damaged distal root of the mandibular second molar p. 348
Rashmi Bansal, Sonali Roy, Praveen Chandra, Anuraag Gurtu, Rahul Pandey
DOI:10.4103/ijdr.IJDR_642_16  
Trauma to the adjacent hard and soft tissue is the most common iatrogenic injury during extraction of the mandibular third molar. As every functional component of the dental arch is of prime importance in contemporary dental practice, the major concern must be in conserving the tooth and its structure as much as possible. The present case discusses the application of this conservative approach for management of iatrogenically damaged distal root of the mandibular second molar during extraction of impacted third molar, in which excessive guttering of alveolar bone and fractured apical third of distal root of 37 was observed radiographically. A conservative and noninvasive approach was successfully achieved to restore the damaged root by the bioactive material. Sealing of the remaining root with mineral trioxide aggregate allowed regeneration of soft and hard tissue around it.
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