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   Table of Contents - Current issue
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July-August 2019
Volume 30 | Issue 4
Page Nos. 483-646

Online since Monday, November 18, 2019

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GUEST EDITORIAL  

Global oral health: A proposal for a change of picture p. 483
Gerhard K Seeberger
DOI:10.4103/ijdr.IJDR_674_19  PMID:31745038
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EDITORIAL Top

Oral health, universal health coverage, and dental research p. 486
SM Balaji
DOI:10.4103/ijdr.IJDR_825_19  PMID:31745039
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Randomized clinical trial of four adhesion strategies: A 42 month study p. 487
Maristela Dutra-Correa, Vanessa Harumi Kiyan, Marcia Tonetti Ciaramicoli, Vanessa Pecorari, Flávia Pires Rodrigues, Cintia Helena Coury Saraceni
DOI:10.4103/ijdr.IJDR_466_16  PMID:31745040
Context: The adhesives clinical effectiveness has been extensively reported for noncarious cervical lesions (NCCLs). However, there is a lack of information about the adhesive systems strategies and their effect on NCCL restoration longevity. Aims: This study aims to evaluate a 42-month performance of four dentin adhesive systems used for the restorative treatment of NCCLs. Settings and Design: NCCLs were randomly divided into four groups: (1) Scotchbond multi-purpose (MP); 2: Single bond plus (SB); 3: Scotchbond SE (SE); and 4: Easy bond (EB). Subjects and Methods: NCCLs (125) were randomly distributed: (1) MP; (2) SB; (3) SE; and (4) EB and were restored with a nanofilled resin-composite, evaluated along 18-36-42 months. Statistical Analysis Used: Kruskal–Wallis test: Comparison among the adhesive systems in each period. Friedman analysis: Comparison along the periods. Kaplan–Meier: Survival analysis. Results: Baseline and 42-month retention (RET) rates (%) were 100/100 for MP; 100/94.74 for SB; 100/87.5 for SE; and 100/100 for EB. The cumulative failure percentage was 9.52% for MP, 9.52% SB, 15.8% SE, and 10% EB. Restorations survival was not dependent on the used adhesive type. Marginal adaptation (MA) was similar to each group, but EB presented noticeable marginal deterioration. Wear was noticed in the 3-step etch-and-rinse (MP) restorations evaluated after 42 months. For the EB, baseline and 18-month wear evaluation were statistically similar. After 36 and 42 months, wear was also similar for EB. Conclusions: Adhesive systems showed similar performance within most important adhesive bonding efficiency achievement parameters: RET, MA, interfacial staining, recurrent caries, and postoperative sensitivity evaluated during 42 months.
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The incisive papilla as a guide to maxillary anterior teeth position for complete dentures p. 496
Rosalin Kar, Niranjan Mishra, Debashish Pati, Krishna Gopal Birmiwal, Aparna Gupta, Subhrajit Raut
DOI:10.4103/ijdr.IJDR_620_18  PMID:31745041
Context: The incisive papilla as a guide for complete dentures. Aims: To evaluate incisive papilla as a guide to maxillary anterior teeth position for complete dentures. Settings and Design: To measure the linear distances from the incisive papilla to the maxillary central incisors in Odia population and compare it to other ethnic groups. Subjects and Methods: The subjects were selected following inclusion & exclusion criteria. The impressions of maxillary & mandibular arches were taken and poured with die stone to produce the cast. The incisive papilla & incisors were marked on casts with a pencil. The photographs of casts were traced on an acetate tracing paper. The anterior-most points of maxillary incisors, anterior, middle & posterior-most points of incisive papillae were marked on the tracing as A, I1,M, I2 respectively. The A to M and A to I2 distances were measured, analysed and compared with Caucasians, Southern Chinese, and Dravidians. Statistical Analysis: Independent sample “t” test and Analysis of Variance followed by the post-hoc Bonferroni test were used. Results: A sample of 100 subjects in the age group of 20 to 40 years with was selected. The A to M measurements of Odia population differed significantly from Caucasians but were similar to Southern Chinese population. The A to I2 measurements of Odia population differed significantly from Caucasians & Dravidians but were similar to Southern Chinese. Conclusion: The linear measurements from incisive papilla to maxillary incisors of the Odia population are similar to that of Southern Chinese but differ significantly from Caucasians and Dravidians.
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Prevalence of precancerous lesions in an adult population p. 500
Benley George, Shibu T Sebastian, Rino R Soman, Vinod M Mulamoottil, Minimol K Johny
DOI:10.4103/ijdr.IJDR_138_18  PMID:31745042
Objectives: The present study aimed to identify the prevalence of precancerous lesions among an adult population in Kerala, India. Materials and Methods: A dental screening camp was organized in each district at two locations for two consecutive days to draw maximum participation of the community. All adult subject's attending the camp were initially screened for precancerous lesions using conventional light. An initial oral screening was done by two public health dentists and suspected cases were subjected to Identafi Oral cancer screening device and followed by histopathological evaluation. Results: The prevalence of oral precancerous lesions in the adult population of Kerala was 4.4%. Most of the lesions were associated with the use of tobacco followed by alcohol and spicy foods. Conclusion: The oral cancer detection device is an aid in detection of oral precancerous lesions.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Efficacy of a mouthwash containing essential oils and curcumin as an adjunct to nonsurgical periodontal therapy among rheumatoid arthritis patients with chronic periodontitis: A randomized controlled trial p. 506
Divvi Anusha, Preetha Elizabeth Chaly, Mohammed Junaid, JE Nijesh, K Shivashankar, Shyam Sivasamy
DOI:10.4103/ijdr.IJDR_662_17  PMID:31745043
Purpose: The purpose of this study was to assess the efficacy of mouthwash containing essential oils and curcumin (MEC) as an adjunct to nonsurgical periodontal therapy on the disease activity of rheumatoid arthritis (RA) among RA patients with chronic periodontitis (CP). Materials and Methods: A triple-blinded controlled trial was conducted among 45 female RA patients with CP randomized into three treatment groups as follows: Group A: scaling and root planing (SRP) with 0.2% chlorhexidine mouthwash as an adjunct (n = 15), Group B: SRP with MEC as an adjunct (n = 15), and Group C: SRP alone (n = 15). RA disease activity was assessed using erythrocyte sedimentation rate, serum C-reactive protein, serum anti-citrullinated protein antibody, and serum rheumatoid factor. Periodontal disease activity was assessed using plaque index, clinical attachment level (CAL), and pocket depth (PD). All parameters were recorded at baseline and 6 weeks thereafter. Data were assessed using one-way ANOVA and paired t-test. Results: A significant reduction in periodontal and RA disease activity parameters was observed from baseline to 6 weeks following intervention (P < 0.05). The highest percentage of mean reduction in plaque index and RA parameters from baseline to 6 weeks was observed in Group B followed by Groups A and C. The highest percentage of mean reduction in PD and CAL was observed in Group A followed by Groups B and C (P < 0.001). Conclusion: This study reveals that MEC as an adjunct to SRP is effective in reducing the disease activity of RA and CP, thereby warranting the use of the same.
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Comparative efficacy of analgesic gel phonophoresis and ultrasound in the treatment of temporomandibular joint disorders p. 512
Sankar Narayanan Ramakrishnan, Nalini Aswath
DOI:10.4103/ijdr.IJDR_634_17  PMID:31745044
Aim: The aim of this study is to determine the efficacy of phonophoresis in patients with temporomandibular disorders. Objective: To prove that phonophoresis could be an effective treatment modality in in patients with temporomandibular disorders. Procedure: Fifty patients diagnosed clinically and radiographically as temporomandibular disorder were randomly assigned into either of the two groups, namely, (Group A) plain ultrasound and (Group B) phonophoresis. Acoustic gel containing no pharmacological agent was applied in the ultrasound group, whereas a gel containing aceclofenac was applied in the phonophoresis group. Each group was treated three times a week for 2 weeks. The assessment of pain and inflammation both before and after treatment were done using the visual analog scale (VAS) and Creactive protein (CRP). Results: Intergroup comparison was done and analyzed statistically using independent ttest. Intragroup comparison was done using paired ttest. A significant difference in VAS scores and CRP levels before and after treatment were seen within both ultrasound phonophoresis PH groups. No significant difference was noted statistically between ultrasound and phonophoresis group. Conclusion: The results of this study suggests that though plain ultrasound as well as phonophoresis with aceclofenac gel are effective in the management of temporomandibular disorders. Phonophoresis was found be slightly superior as evident in VAS scores and CRP levels though not statistically significant.
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Clinico-pathological correlations of odontogenic tumors: Some critical observations based on a 20 year institutional study and a comprehensive review of literature p. 516
Shaheen Syed, Karla M Carvalho, Anita Spadigam, Anita Dhupar
DOI:10.4103/ijdr.IJDR_579_17  PMID:31745045
Context: Odontogenic tumors (OTs) represent a rare subset of pathologies of the oral and maxillofacial region. The classification of OTs has undergone several changes over the years due to a lack of uniform international identification criteria. The histomorphological similarity and the many variations in behavioral patterns elaborated by these lesions warrant research. Aims: Using the update from the fourth edition of the World Health Organisation Classification of Head and Neck Tumors (2017), this dental institution carried out an epidemiological study on OTs in the state of Goa (India) and compared the data obtained with similar studies on OTs done within India. Materials and Methods: The clinical and pathological data of OTs from August 1996 to December 2016 was retrieved from the oral and maxillofacial pathology department archives, belonging to the lone dental college and hospital in the state of Goa, India. Demographic data such as frequency, age, gender, and site along with pathological subtype was analysed. Statistical Analysis Used: Descriptive analysis (i.e. frequency of age, gender, and location), Chi-Square Test and Fischer Exact test. Results: The relative frequency of OTs was 2.61% of all oral biopsied specimens. The most common OT encountered was ameloblastoma (57.9%). The posterior aspect of the mandible was the most favored site (77.2%). The frequency of OTs decreased after the fourth decade. An overall marginal male predilection (55%) was seen. Conclusions: This study contributes to the establishment of a comprehensive loco-regional epidemiological database on OTs in India, aiding research on their aetio-pathogenesis and diagnosis.
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Periodontal health status among HIV-seropositive pregnant women p. 521
Narendra Dev Jampani, Ravi Kiran Sunkavilli, Vajra Madhuri Songa, Lahari Buggapati, Srinivasa Reddy Pathagunti
DOI:10.4103/ijdr.IJDR_144_16  PMID:31745046
Aims and Objective: Routine oral health care is essential for those living with HIV (human immunodeficiency virus) infection, especially in pregnant women. Hormonal changes during pregnancy, immunosupression in HIV along with bacterial load in periodontal infections strongly influence the pregnancy outcomes. The aim of this study was to evaluate the periodontal health status in HIV seropositive pregnant women in Andhra Pradesh, India. Materials and Methods: This study includes a sample of 90 divided into three groups; HIV seropositive pregnant women (group PH; n = 30), HIV seropositive nonpregnant women (group H; n = 30), and healthy pregnant women without HIV infection (group P; n = 30). Clinical examination includes the recording of probing depths (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI), and periodontal screening and recording index (PSR) were assessed in three groups. Statistical analysis was done by Mann–Whitney U-test and Wilcoxon paired test using the software SPSS version 17. Results: Clinical parameters do not show any significant variation between the three groups. But slightly higher mean PD and CAL levels was observed in HIV seropositive pregnant and nonpregnant women compared with healthy pregnant women without HIV infection. About 13% of severe gingivitis cases were observed in HIV seropositive pregnant group compared with 6% in HIV seropositive and 3% in healthy pregnant group. Conclusions: Presence of slightly higher percentage of severe gingivitis in HIV seropositive pregnant women strengthens the fact of extra need for preventive oral health services during the prenatal period and provides recommendations for promoting maternal oral health in regional antiretroviral therapy centers in India.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Salivary flow rate, pH and buffering capacity in patients undergoing fixed orthodontic treatment – A prospective study p. 527
V Anu, PD Madan Kumar, M Shivakumar
DOI:10.4103/ijdr.IJDR_74_16  PMID:31745047
Background: Human saliva has got many important functions like lubrication of the oral tissues, making oral functions like speech, mastication and deglutition possible and also protecting teeth and oral mucosal surfaces in different ways. Dental Caries is one of the common complications in patients undergoing orthodontic treatment. Subjects with impaired saliva flow rate often show high caries incidence. A low flow rate combined with a low or moderate buffer effect clearly indicates poor salivary resistance against microbial attack. Aim: To investigate the changes in stimulated and unstimulated salivary flow rate, pH and buffer capacity in patients undergoing therapy with fixed orthodontic appliances. Materials and Methods: Salivary flow rate, pH and buffering capacity of 20 patients who underwent fixed orthodontic treatment at Department of Orthodontics, Ragas Dental College and Hospital, Chennai were examined using GC saliva check buffer kit. The procedure was carried out during the initiation of orthodontic treatment and subsequently, one month and six months after the placement of appliance. Results: Results showed there was a significant increase in the salivary flow rate one month and six months after placement of fixed appliance while pH and buffering capacity showed no significant changes. Conclusion: Salivary flow rate increases significantly during fixed orthodontic treatment. Salivary pH and buffering capacity showed no significant changes suggesting that they are not sole factors for demineralization in orthodontic patients.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Smile changes after intrusion of maxillary incisors with temporary anchorage devices (TADs) or accentuated compensating curve arch wire p. 531
Nahla Elsayed Gomaa, Neveen Mohamad Fakhry, Ghada Abdelfattah Elmehy, Mona A Montasser
DOI:10.4103/ijdr.IJDR_332_17  PMID:31745048
Objective: The aim is to evaluate changes of smile and gingival line after intrusion of maxillary incisors using mini-implant anchorage system or conventional accentuated compensating curve archwire. Materials and Methods: Twenty participants having deep overbite with age ranged from 18 to 24 years were enrolled in this study and were divided into two groups of 10 each. Intrusion of maxillary incisors was performed using mini-implant anchorage system in group 1 and by conventional accentuated compensating curve archwire in group 2. For each participant, lip position, dental and skeletal measurements related to the gingival line were recorded from standardized photographs and cephalometric analyses. Statistical analyses including t-test and Chi-square were used to evaluate differences between groups. Results: There was an improvement of smile arc (consonance) from 30% smile consonance pretreatment to 90% consonance postintrusion in group 1, but the change was insignificant in Group 2. There was an increase in the outer intercommisural width in Group 2 compared to group 1 with a significant difference between both groups (P < 0.046). A significant decrease in the upper lip to upper incisal edge relationship in Group 1 and an insignificant decrease in Group 2 (P = 0.03 and P = 0.262, respectively) was detected. A significant decrease in overbite in Group 1and in Group 2 (P = 0.001) with an insignificant difference between both groups (P > 0.05) was also observed. Conclusion: Smile improvement in the mini-implant group was mainly the result of improved smile arc, increase in outer intercommisural width, decrease in upper lip to upper incisal edge relationship, and decrease in overbite. With the use of accentuated compensating archwires, the only significant change was increase in the interlabial gap.
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Immunohistochemical analysis of osteopontin expression in oral squamous cell carcinoma p. 539
Dhana Lakshmi Jeyasivanesan, Shameena Pazhaningal Mohamed, Deepak Pandiar, Shaini Basheer
DOI:10.4103/ijdr.IJDR_474_17  PMID:31745049
Background: Oral squamous cell carcinoma (OSCC) is the most common malignant neoplasm of the oral cavity. Osteopontin (OPN) has been proved as a biomarker in varying malignant tumors. Only limited studies detail the role of OPN in OSCC. Aims: This study aims to demonstrate the expression of OPN in OSCC and to correlate the expression of OPN with the histologic grades of OSCC. Settings and Design: This is a retrospective immunohistochemical study in Dravidian population (linguistically Malayalam). Materials and Methods: Thirty diagnosed cases of OSCC were subjected to immunohistochemistry using OPN antibody for detection of OPN expression. Ten normal oral mucosal specimens were also stained as controls. Statistical Analysis Used: Chi-square test and ANOVA followed by Bonferroni test. Results: OPN expression was significantly higher in OSCC patients than in controls. In normal oral mucosal specimens, none of them showed OPN immunoreactivity. A significant difference was observed between total scores and intensities of normal and varying grades of OSCC. A significant difference was also observed between the percentage of positive cells for OPN expression of normal and varying grades of OSCC. However, no significant difference was observed between the percentage of positive cells for OPN expression of well-, moderate-, poorly-differentiated carcinomas. Correlation of OPN expression with lymph node status, site, and sex was found to be statistically insignificant. Conclusion: Insights gained from this study may lead to research targeted at the treatment of OSCC.
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Referral pattern to a university-based oral and maxillofacial cone beam CT service p. 544
Fatima M Jadu, Ahmed M Jan
DOI:10.4103/ijdr.IJDR_295_18  PMID:31745050
Aim: Despite the rising popularity of cone-beam computed tomography (CBCT) imaging in the field of dentistry, very few studies have addressed the questions of which dental specialties most frequently request CBCT images and which CBCT indications are most popular. This study attempts to answer both of these questions. Methods and Materials: CBCT request forms spanning a 1-year period were analyzed for data. Collected data included the specialty of the referring dentist and the referral reason. Results: A total of 660 referral forms were analyzed. Oral and maxillofacial surgeons were the discipline to most commonly request CBCT examinations. Pretreatment evaluation of potential dental implant sites was the most common indication for requesting CBCT scans. Conclusions: All dental specialties refer patients for CBCT examinations but at different frequencies and for various reasons that pertain to their respective disciplines. Clinical significance: These findings should be the basis for customizing the availability and scope of imaging services and in developing and modifying educational programmes for dentists and dental specialists.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Evaluation and comparison of surface characteristics of commercially available TMA wires using scanning electron microscopy and optical profilometer p. 548
Lidhiya Alexander, Pradeep Babu Kommi, Nandakumar Arani, Anoop Mathew, Anirudh Yashwant, RS Senkutvan
DOI:10.4103/ijdr.IJDR_420_18  PMID:31745051
Aim: The aim of this study was to evaluate and compare the surface characteristics of colored titanium molybdenum alloy archwires (purple-coated TMA and honey dew-coated TMA) and the regular titanium molybdenum alloy archwires. Materials and Methods: The experiment comprised three groups, Group I – regular TMA archwires, Group II – purple-coated TMA archwires, Group III – honey dew-coated TMA wires involving 21 samples each. The surface characteristics were assessed using scanning electron microscopy and optical profilometer. Results: The results were statistically analyzed using analysis of variance wherein Group I regular TMA wires exhibited a root mean square value of 148.071 nm and a standard deviation of 9.0027 nm followed by group II (purple-coated TMA wires) which showed a root mean square value of 84.095 nm with a standard deviation of 2.6005 nm, while group III (honey dew-coated TMA wires) was found to have a root mean square value of 71.681 nm with a standard deviation of 1.4645 nm on subjecting to optical profilometry. Conclusion: The surface roughness is higher for regular TMA wire exhibiting superior characteristic of color-coated TMA wires, especially honey dew-coated TMA wires over the regular and purple-coated TMA wires. This property of the archwires details regarding its application in both sliding and frictionless mechanics in retraction phase of fixed orthodontic treatment.
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A comparison of antibacterial inhibitory effect on Streptococcus mutans and tensile strength between chitosan-based bonding adhesives and commercial products p. 553
Ida Bagus Narmada, Amalina Indah Cynthia, Ari Triwardhani
DOI:10.4103/ijdr.IJDR_236_18  PMID:31745052
Background: Adhesive bonding is the material used to attach a bracket to the enamel surface of the tooth. Streptococcus mutans contributes to enamel demineralization during orthodontic treatment. Objectives: To analyze the antimicrobial inhibitory effect of Streptococcus mutans bacteria and tensile strength of chitosan and CaCO3-based adhesive bonding material. Materials and Methods: The investigation constituted laboratory experimental research featuring analytical observation and a random sampling method. The antibacterial inhibitory effect of chitosan and CaCO3-based adhesive bonding against Streptococcus mutans involved six groups: two control groups using commercial light cure and self-cure adhesive bonding products and four groups using adhesive bonding consisting of 75% CaCO3 + 17.6% Bis-GMA + 22.4% MMA with various percentages of chitosan composition (A1: 25%, A2: 50%, A3: 75%, and A4: 100%) each group consisting of two samples (n = 12). A diametric test was conducted consisting of three samples (n = 15) to measure the tensile strength of each group. Data were analyzed by a combination of one-way analysis of variance and least significant difference tests. Result: The antibacterial inhibitory effect showed significant differences between groups (A1: 2.9467 ± 0.4163, A2: 3.6500 ± 0.6245, A3: 5.1267 ± 0.2517, A4: 4.7267 ± 0.9238; P = 0.0000; P < 0.05). A diametric tensile strength test confirmed significant differences between groups (A1: 7.2733 ± 5.0046, A2: 6.7667 ± 4.4346, A3: 6.4533 ± 2.9994, A4: 1.0058 ± 1.0058, K1: 15.6167 ± 3.1250; P = 0.009; P < 0.05). Conclusion: Chitosan-based adhesive bonding with good tensile strength has an antibacterial inhibitory effect against Streptococcus mutans.
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Calcium sulfate-based bioactive cement for periodontal regeneration: An In Vitro study p. 558
Eva C Das, TV Kumary, PR Anil Kumar, Manoj Komath
DOI:10.4103/ijdr.IJDR_12_18  PMID:31745053
Background and Objective: Various types of osteoconductive graft materials are used for the management of alveolar bone defects arising out of periodontal disease. Inorganic, self-setting, bioactive bone cements are suggested to be most appropriate because they can conformally fill the bone defect and resorb progressively along with the regeneration of the host site. A new calcium sulfate-based bioactive bone cement (BioCaS) is developed, having simplicity and effectiveness for bone grafting applications. The response of primary human periodontal ligament (hPDL) cells to this material is investigated through in vitro cell culture model so as to qualify it for the repair of periodontal infrabony defects. Method: The BioCaS was designed as powder-liquid combination with in-house synthesized high purity calcium sulfate hemihydrate incorporating hydrogen orthophosphate ions. hPDL cells were isolated, cultured and characterized using optimized primary cell culture techniques. The cytotoxicity and cytocompatibility of the BioCaS samples were evaluated using the hPDL cells, with hydroxyapatite ceramic material as control. Osteogenic differentiation of the hPDL cells in presence of BioCaS was also evaluated using Alizarin red staining, Alizarin red assay, Von Kossa staining and Masson's trichrome staining. Results: The primary cell culture techniques yielded a healthy population of periodontal ligament cells, with fibroblast morphology and characteristic marker expressions. The hPDL cells exhibited good viability, adhesion and spreading to the BioCaS cement in comparison to sintered hydroxyapatite. In addition, the cells differentiated to osteogenic lineage in the presence of the BioCaS cement, without extraneous osteogenic supplements, confirming the inherent bioactivity of the cement. Conclusion: The new BioCaS cement is a potential candidate for the repair of periodontal defects.
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Long-term color stability of orthodontic adhesives after exposure to different staining agents p. 568
Thiago Vinícius Pavelski, Daniel Gheur Tocolini, Gisele Maria Correr, Leonardo Fernandes da Cunha, Carla Castiglia Gonzaga
DOI:10.4103/ijdr.IJDR_422_17  PMID:31745054
Context: The aims of this study were (i) to evaluate the color stability of two orthodontic adhesives and (ii) to evaluate the color stability of enamel and ceramic brackets bonded with orthodontic adhesives after exposure to different staining agents. Materials and Methods: Disks were prepared with two orthodontic adhesives (Transbond and Enlight). Color stability evaluation was performed with a spectrophotometer using CIELab parameters. The specimens were divided into four groups and immersed in the following staining agents (n = 5): distilled water (control), coffee, red wine, and cola soft drink, for 1 h/day for 120 days. Twenty molar crowns were also used. The baseline color of enamel was obtained and ceramic brackets were bonded with the orthodontic adhesives. The enamel specimens were divided into four groups and immersed in the same staining agents. After 120 days, another color reading with the brackets in position was taken. The brackets were then removed and the enamel color was again evaluated. Color difference (ΔE) in different time periods was determined and the data were analyzed by ANOVA and Tukey's test (α = 5%). Results: Transbond showed lower ΔE than Enlight. Water, cola, and coffee had the lowest ΔE values. Immersion in wine showed the highest ΔE values. For time, the lower ΔE values were found for 24 h and 7 days. Storage times of 60, 90, and 120 days showed the highest ΔE values. ΔE for enamel showed significant differences only for time. Conclusion: Adhesive, staining agents, and storage time influenced the color stability of orthodontic adhesives.
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Comparative evaluation of sealing ability of calcium sulfate with self-etch adhesive, mineral trioxide aggregate plus, and bone cement as furcal perforation repair materials: An In vitro dye extraction study p. 573
Siddharth Shah, Ritika De, Karkala Venkappa Kishan, Manikandan Ravinathanan, Nimisha Shah, Nidhi Solanki
DOI:10.4103/ijdr.IJDR_788_16  PMID:31745055
Aim: The aim of this study was to determine the sealing ability of three different materials mineral trioxide aggregate (MTA) Plus, bone cement, and calcium sulfate with self-etch adhesive (SEA) for the repair of furcal perforation, using dye extraction method. Materials and Methods: Forty-eight extracted human permanent first and second molars were included and randomly divided into four groups: Group 1, n = 12, negative control, perforation not repaired with any material, Group 2, n = 12, perforation repair material used, MTA Plus, Group 3, n = 12, perforation repair material used, calcium sulfate with SEA, Group 4, n = 12, perforation repair material used, bone cement. The teeth were then coated with two coats of clear nail varnish immersed in methylene blue dye for 24 h, kept in 65% concentrated nitric acid for 3 days. Dye leakage was measured with the dye extraction method using a spectrophotometer at 550 nm. Results: The negative control showed the highest mean values of dye absorbance (1.45). Bone cement (0.94) came second. Calcium sulfate with SEA (0.58) and MTA Plus (0.32) had no significant difference in their dye absorbance values. Conclusion: Within the limitations of the study, MTA Plus showed the least microleakage followed by calcium sulfate with SEA which has shown promising results and can be used as an alternative followed by bone cement which showed the highest microleakage.
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Detection and characterization of Streptococcus downei, a rare bacterial species of mutans streptococci from caries-active patients p. 579
Hamzah Abdulrahman Salman, R Senthilkumar, Bassam Shaker Mahmood, Khalid Imran
DOI:10.4103/ijdr.IJDR_400_17  PMID:31745056
Background: The oral bacteria, mutans streptococci (MS), are an etiological agent of dental caries. Of MS, Streptococcus downei are rarely isolated bacteria. Aim: The aim of this study was to isolate and characterize S. downei from caries-active subjects. Materials and Methods: In all, 65 dental plaque samples were collected from dental caries-active subjects. All the isolates were further identified and characterized using 16S rDNA sequencing, biochemical tests, antibiogram, and minimum inhibitory concentration (MIC). Results: Five isolates have been identified as S. downei using 16S rDNA sequencing. Phylogenetic analysis showed that S. downei was closely related to S. sobrinus. The biotype traits of these five isolates were IV (n = 3), V (n = 1), and variants (n = 2). The study proposed one new biotype, classified as biotype VIII for the variant strain. The antibiogram tests revealed that all the strains of S. downei were susceptible to all the antibiotics used in the study with higher sensitivity to penicillin and ampicillin. The MIC of ampicillin and erythromycin against S. downei was 0.047 and 0.39 μg/mL, respectively. Conclusion: The study reports the prevalence of S. downei in caries-active subjects and recommends further investigations to determine its role in the disease.
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Evaluation and comparison of different polymerization techniques, curing cycles, and thicknesses of two denture base materials p. 583
Jayant N Palaskar, Sunint Singh, Sanjeev Mittal
DOI:10.4103/ijdr.IJDR_170_16  PMID:31745057
Purpose: The study aimed to compare the effect of different materials, thicknesses, and polymerization methods and cycles, on the surface porosity of acrylic denture base resins. Materials and Methods: Conventional heat-polymerized polymethyl methacrylate (PMMA) and specially designed acrylic resin (Acron MC) were used to make 84 rectangular samples. They were divided into three groups to evaluate and compare the polymerization techniques, curing cycles, and thicknesses of the two denture base materials (28 samples each). Group A contained PMMA samples polymerized using water bath method (control group); Group B contained Acron MC samples polymerized by microwave method, and Group C contained PMMA samples polymerized by microwave method. Each group was further divided based on sample thickness and polymerization cycles. Each sample was scanned for surface porosity and area of each pore was measured using optical microscope. Data was analyzed using ANOVA, Bonferroni, and student t-tests. Unpaired student t-test was performed to compare the means of surface porosity with polymerization cycles and thicknesses among the groups. The power of study was kept at 80%. Results: Group C showed highest mean % of porosity depending on method of polymerization, different polymerization cycles (short and long) and polymerization cycles within the group. Group B showed the highest mean % of porosity depending on thickness and thickness within the groups. Conclusions: Microwavable acrylic resin polymerized by microwave energy exhibited statistically insignificant increase in porosity when compared to conventional heat cured acrylic resin by water bath method. Conventional acrylic resin polymerized by microwave energy exhibited high statistically significant porosity irrespective of sample thickness. There was statistically insignificant increase in porosity depending on sample thickness irrespective of material and method of polymerization.
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In Vitro evaluation of remineralization potential of novamin on artificially induced carious lesions in primary teeth using scanning electron microscope and vickers hardness p. 590
Anshul Gangwar, Kaushal Kishor Jha, Jyoti Thakur, Madhuri Nath
DOI:10.4103/ijdr.IJDR_326_16  PMID:31745058
Aims: The objective of this in vitro study was to find out the efficacy of Novamin in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using Vickers Hardness Testing Machine and Scanning electron microscope (SEM). Settings and Design: A total of 40 primary teeth were selected and divided into two groups: Control group and SHY NM (Novamin). All the samples were subjected to ph cycle protocol and assessed using Vickers Hardness Testing Machine and Scanning electron microscope. Each demineralized sample was randomly divided into two groups: Gp I –Control group, Gp II – Novamin (SHY NM). After 10-day period of ph cycle, the obtained data was analyzed statistically. Statistical Analysis Used: Pre and post groups were compared by paired t test. The significance of mean difference between the groups was done by Tukey's post hoc test after ascertaining normality by Shapiro-Wilk (W) test and homogeneity of variance by Levene's test. A two-tailed P value less than 0.05 (P < 0.05) was considered statistically significant. All analyses were performed on SPSS software (Windows version 17.0). Results: Statistical analysis showed that bioactive glass (novamin) remineralizes artificially induced carious lesion in primary teeth. Conclusions: SHY NM (Novamin) exhibited superior remineralization potential.
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A crude method of DNA extraction and identification from exfoliated human buccal mucosa cells p. 595
Priyanka Kardam, Monica Mehendiratta, Shweta Rehani, Rashi Sharma, Khushboo Sahay
DOI:10.4103/ijdr.IJDR_67_16  PMID:31745059
Background: DNA analysis has a key role in forensic dentistry. However, techniques of DNA extraction and analysis are far from the reach of majority of medical professionals owing to its expensive set up. Aim: The present study was aimed at formulating a crude method of extracting DNA from human buccal mucosa cells using materials commonly available in the laboratory so that the medical professionals could get more exposure to molecular biology techniques. The objectives were to identify the DNA and to assess its purity. Methods: Buccal mucosa cells from 10 healthy volunteers were taken for DNA extraction following the protocol of cell lysis, purification, and precipitation. DNA was identified using standardized techniques like Diphenylamine test and its purity was assessed using a spectrophotometer. A gel electrophoresis apparatus was also constructed using readily available materials. Results: DNA was extracted from human buccal mucosa cells using a crude method. The standardized tests confirmed the presence of DNA contaminated with proteins. The locally made Gel electrophoresis model exhibited a faint halo around the wells instead of DNA bands. Conclusion: DNA extraction from human buccal mucosa cells was made possible using locally available materials and a crude method, but it was not of high purity.
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SYSTEMATIC REVIEWS Top

Survival rate of dental implant placement by conventional or flapless surgery in controlled type 2 diabetes mellitus patients: A systematic review p. 600
Kalpana Singh, Jitendra Rao, Tuba Afsheen, Bhawna Tiwari
DOI:10.4103/ijdr.IJDR_606_17  PMID:31745060
Introduction: Dental implant may serve as a choice of treatment for replacement of missing tooth in diabetic patients with their well-controlled glycemic index. To minimize postoperative complications, dental surgical procedures comprises mainly two types, namely conventional and flapless surgery. Objective: The aim of this review is to find the survival rate of the dental implant when placed with either of the technique, that is, conventional or flapless in patients with controlled Type 2 diabetes mellitus from published studies. Materials and Methods: A total of 14 studies were included from PubMed database related to the survival rate of dental implant placement by conventional or flapless surgery among patients with controlled diabetes mellitus. The cumulative mean of dental implant survival rate by conventional and flapless techniques calculated from included studies is 94.2% and 92.3%, respectively. Conclusion: The survival rate of dental implant placement by conventional and flapless techniques is similar. As few studies on flapless technique are available, therefore researchers in future should explore its advantages and disadvantages.
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REVIEWS SECTION: GAPS IN POLICIES, PROTOCOLS AND PRACTICE Top

Areca nut use disorder: A dynamic model map Highly accessed article p. 612
Rooban Thavarajah, Kannan Ranganathan, Elizabeth Joshua, Umadevi Krishnamohan Rao
DOI:10.4103/ijdr.IJDR_947_18  PMID:31745061
Problem: Areca nut (AN) chewing is common among Southeast Asian population. Use of AN products (with or without tobacco) have a multifaceted effect on physical health, especially on cardiovascular, nervous, gastrointestinal, metabolic, respiratory, and reproductive systems. AN is a known group 1 carcinogen and carries addictive potential. Varying degrees of AN-related substance use disorder (SUD) have been reported among AN chewers. There is a lacuna in awareness of the health risk of AN use, prevention, and cessation programs among AN users, particularly in those who have developed SUD. Existing Lacunae: The dynamic interaction of factors that promote AN use and later the risk of developing SUD at individual and community level has not been studied in depth. Understanding of the bio-psycho-socio-economic-cultural factors is necessary to identify the factors that prelude, promote, and reinforce AN usage. For managing AN-related conditions, including the several systemic disorders, there is a knowledge lacunae, among health care providers with respect to the pathophysiology of AN-related health issues, SUD, and nonavailability of structured, evidence-based cessation protocols. Solutions/Recommendations: This manuscript presents a model-map to study the dynamics of AN use and the impact of AN on health and health care system at individual as well as community level. The model proposed can help the health policymakers to create evidence-based awareness and cessation protocols for AN.
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SHORT COMMUNICATION Top

Kedo file system for root canal preparation in primary teeth p. 622
Ganesh Jeevanandan, Sagareeka Ganesh, Arthilakshmi
DOI:10.4103/ijdr.IJDR_238_18  PMID:31745062
Endodontic instruments play a vital role during root canal preparation. Biomechanical preparation in primary teeth is performed using the adult endodontic files. There are various disadvantages during use of adult endodontic files in primary teeth namely the length and taper of the files. Recently, an exclusive paediatric endodontic file system has been introduced for cleaning and shaping of primary root canals. This short communication describes the use of exclusive Kedo-SH manual and Kedo-S rotary file system in primary teeth.
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CASE REPORTS Top

Tracheostomy and mandibular distraction in acute sleep apnea p. 625
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_626_19  PMID:31745063
Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.
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Proliferative fasciitis of the chin: A report of the rare case and review of literature p. 630
H Jyothi, S Sudha, Resmi G Nair, K Remya
DOI:10.4103/ijdr.IJDR_8_18  PMID:31745064
Proliferative fasciitis is a pseudo-sarcomatous myofibroblastic proliferation characterized by the presence of unusual giant cells resembling ganglion cells, which usually occurs in the adult population with a mean age of 54 years. It usually affects the upper extremities and is rare in head and neck region with only 11 cases described in the literature so far. Because of rapid growth and histological similarity to various malignant tumors such as rhabdomyosarcoma, recognition of this benign condition is a matter of utmost importance when a pathologist is concerned. In this study, we report a case of a 11-year-old boy presented with a lesion on the right side of chin, along with a literature review involving those cases reported in the head and neck region.
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Traumatic myositis chondro-ossificans of masseter muscle associated with TGF-β1, Indian Hegdehog, BMP2, osteopontin and osteocalcin upregulation: Case report p. 634
Allan Fernando Giovanini, Katheleen Miranda, Aline Fernanda Costa Vaz, Rafael Correia Cavalcante, Paola Fernanda Cotait de Lucas Corso, Leandro Eduardo Klüppel, Rafaela Scariot
DOI:10.4103/ijdr.IJDR_627_17  PMID:31745065
Masseter traumatic myositis chondro-ossificans (TMCO) is a rare pathological condition that causes severe mandibular function restriction. The aim of the present study is to report a TMCO case after direct masseter muscle injury and correlate it to bone and cartilage biomarkers up-regulation. Caucasian male patient, 38 years old, seeks treatment nine days after trauma with severe mouth opening limitation. Physical examination revealed a circumscribed hardened area connected to masseter muscle on the left side. Cone beam tomography and ultrasonography of masseter region were requested. There was incomplete fracture between the posterior board of inferior jaw and coronoid process as well as calcification within masseter muscle. The proposed treatment was excisional biopsy of calcification, coronoid process removal to enhance mouth opening as well as incomplete condyle fracture monitoring. Material removed was sent for histological analysis in order to confirm diagnosis. Immuhistochemistry was conducted and it was found that chondro-ossification biomarkers such as TGF-b1, Indian Hegdehog (IHH), BMP2, osteopontin (OP) and osteocalcin (OC) were up-regulated. One-year follow-up showed that the patient is stable with increased mouth opening and satisfactory jaw movements. Pathologists and maxillofacial surgeons must be aware of differential diagnosis of TMCO. Understanding cellular mechanisms of muscle tissue after trauma is also important once cellular pathway modifications leads to clinical features that differ from previously described in literature.
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Transient diplopia: A loco regional complication of inferior alveolar nerve block p. 639
Emmanuel Dhiravia Sargunam, Anuradha Ganesan, Deepak Chandrasekaran, Pearlcid A Siroraj
DOI:10.4103/ijdr.IJDR_427_17  PMID:31745066
A 34-year-old female patient required surgical removal of lower left third molar under local anesthesia. Two percent lignocaine with 1:80000 adrenaline was used for administrating inferior alveolar nerve block at dental clinic. Twenty five minutes after the surgical removal, patient developed diplopia on the left eye. This transient diplopia could be due to retro flow of local anesthetic agent through the inferior alveolar artery and indirectly to the ophthalmic artery paralyzing the lateral rectus muscle. Patient recovered after 60 minutes. This article discusses the possible etiologies of diplopia, the mechanism behind this ophthalmic complication, and the review of various reported literature.
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A histological continuum between dentinogenesis imperfecta and dentin dysplasia: A case report with literature review p. 643
Nikita Gulati, Saurabh Juneja, Akriti Singh, Iqbal Singh
DOI:10.4103/ijdr.IJDR_318_18  PMID:31745067
Dentinogenesis Imperfecta and dentin dysplasia are genetic oral diseases inherited in a simple autosomal dominant mode, with high penetrance and a low mutation rate. Both of them are present with bulbous crowns, marked cervical constrictions, severe attritions, few periapical radiolucencies, and premature tooth loss. The diagnosis is based on family history, and detailed clinical examination, while genetic diagnosis may become useful in the future once sufficient disease-causing mutations have been discovered. Here, we present a case with overlapping features of both dentinogenesis imperfecta and dentin dysplasia asserting both the anomalies to be part of the same continuum of the genetic event.
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