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   Table of Contents - Current issue
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January-February 2020
Volume 31 | Issue 1
Page Nos. 1-166

Online since Thursday, April 2, 2020

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GUEST EDITORIAL  

Peri-implantitis: Is it the surface or the alloy that's important? p. 1
Ajay Sharma, Lavanya A Sharma
DOI:10.4103/ijdr.IJDR_50_20  
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EDITORIAL Top

Centenary celebration of dental research p. 3
SM Balaji
DOI:10.4103/ijdr.IJDR_188_20  
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ORIGINAL RESEARCH-EVALUATIVE STUDY Top

Beak and bumper – Physics forceps: Evaluation of new technique in extraction Highly accessed article p. 4
K Raghu, SR Selvakumar, Ramsay Muthukumar, A Thangavelu, R Sathyanarayanan, Murali Mani, Murali Balasubramaniam
DOI:10.4103/ijdr.IJDR_433_18  
Purpose: The history of dentistry is not short; it started from ancient Egypt to ancient Romans and ancient Greeks. When it comes to extraction, all of them have made their own discoveries and progress. The progress they made also helped dentistry to move ahead in evolution of new extraction technique – the Physics Forceps. We have assessed the viability in using the Physics Forceps for routine dental extraction in our study for a period of 1 year. Materials and Methods: The study was conducted on 241 patients indicated for extraction based on our inclusion criteria using Physics Forceps after obtaining informed consent and University Ethics Committee approval. Tooth fracture, buccal alveolar bone fracture, and soft tissue injury around the tooth to be extracted were studied. Results: In our present study of 241 patients, 57.67% were females and 42.32% were males, out of which 93.77% had no tooth fracture, 3.32% had crown fracture, 1.65% had root fracture, and 1.24% had apex fracture. Further, 85.47% had no buccal alveolar bone fracture and 14.53% had buccal alveolar bone fracture. Using proper technique, 96.26% of patients had no soft tissue damage, and minimal damage was seen in 3.73% of patients. Discussion: Extraction by Physics Forceps is a very good technique of extraction. No or very minimal tooth fracture and soft tissue injury were noted. Though the forceps is costly, it represents a valuable addition to regular armamentarium for a general dentist for routine extraction. Physics Forceps is a dental extractor rather than a forceps.
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Factors affecting empathy among indian dentists p. 14
Soni Rajput, Manjunath P Puranik, Namita Shanbhag, Amit Kumar
DOI:10.4103/ijdr.IJDR_365_18  
Background: Empathy is one of the major essential elements in patient and dentist relationship. Interpersonal Reactivity Index (IRI) has been used extensively to measure empathy among medical and other health professions. However, its validity in dental profession remains to be explored. Aims: To examine the psychometric properties of IRI and also to assess the factors influencing the dental students' empathy. Setting and Design: A cross-sectional questionnaire study was carried out among 100 dental interns and postgraduates using IRI. Materials and Methods: Patients were selected randomly from six dental colleges in Bangalore. Internal consistency of items was evaluated by Cronbach's alpha and construct validity was assessed by confirmatory factor analysis with an orthogonal varimax rotation of factors. Statistical Analysis Used: The data were evaluated using SPSS 22. Descriptive and inferential statistics were performed with significance set at 5%. Results: Internal consistency of IRI (Cronbach's alpha: perspective taking = 0.76, fantasy = 0.80, empathic concern = 0.72, and personal distress = 0.79) was good. A four-factor solution emerged, accounting for 52% of total variance. The mean age of the participants was 24.25 ± 1.95 years. The mean for empathic concern domain was highest (20.75 ± 1.64). Gender, career choice, academic performance, and work satisfaction were associated with increased empathy scores, whereas depression and stress were associated with decreased empathy scores (P < 0.05). Conclusion: This study confirms the construct validity and reliability of the IRI for assessing empathy in dental students. Empathy scores among students varied depending on professional/personal factors.
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Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes p. 22
Sinduja Palati, Pratibha Ramani, Herald J Shrelin, Gheena Sukumaran, Abilasha Ramasubramanian, KR Don, Gifrina Jayaraj, Archana Santhanam
DOI:10.4103/ijdr.IJDR_195_18  
Aim: The aim of the study is to analyse the knowledge about oral lesions, the symptoms of such lesions and their attitude towards the treatment of these problems faced by institutionalised geriatric individuals. Methods and Materials: This questionnaire-based survey was conducted among 103 institutionalised elders residing at various institutions. The questionnaire consisted of questions that addressed the medical and dental issues faced by the institutionalised elders and assessed their knowledge and attitude towards dental health. All the received responses were tabulated and the results were represented graphically. Results: The results of the study showed that 44.66% of the elders underwent medical check-up once yearly and 72.82% of them visited the dentist. Of all 103 elders, none of them used dentures in spite of being edentulous and only 29.13% had any knowledge about oral lesions while the rest had no knowledge of the oral lesion and considered these lesions to be normal changes with increasing age. Conclusions: The findings of the present study demonstrate the need to improve access to oral healthcare and dental health education for the institutionalised elder population. In spite of the limitations of the study, we were able to record the obvious lack of dental hygiene practises, neglect and lack of motivation for proper dental care.
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Assessment of knowledge and awareness about biomedical waste management among health care personnel in a tertiary care dental facility in Delhi p. 26
Meera Choudhary, Mahesh Verma, Sujoy Ghosh, Jatinder Kaur Dhillon
DOI:10.4103/ijdr.IJDR_528_18  
Aim: The study was conducted to assess knowledge and awareness of biomedical waste management (BMWM) among undergraduate students, residents, and nursing staff in a tertiary care dental facility in Delhi. Materials and Methods: A questionnaire survey (using ten close ended questions) was conducted regarding various aspects of BMWM among undergraduate students, residents, and nursing staff in a tertiary care dental facility. In each group, scores were determined depending upon the correct responses, the participants marked. The data were compiled and subjected to statistical analysis. Results: Only 33.3% undergraduate students gave over 70% correct answers as compared to nursing staff (100%) and residents (62.2%). Undergraduate students showed various lacunae in terms of knowledge regarding BMWM. The difference between the knowledge of the 3 groups i.e., nursing staff, residents, and undergraduate students was statistically significant (P = 0.001). Residents exhibited better awareness regarding BMWM as compared to undergraduate students (P = 0.003). Conclusion: The pertinence of the issue of BMWM and lack of adequate preparation of the trainee dentists at undergraduate level reflects the urgent need to fill the lacunae in the dental undergraduate curriculum.
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Age estimation by assessment of dentin translucency in permanent teeth p. 31
Jigna S Shah, Ashish F Ranghani, Piyush G Limdiwala
DOI:10.4103/ijdr.IJDR_428_18  
Aim: To estimate the age by evaluating the length of dentin translucency in ground sections of extracted teeth using digital scanner and tools of GIMP 2.8 software for dental age estimation. Materials and Methods: Fifty extracted single-rooted permanent teeth from 50 different individuals and their 0.25-mm thick sections were prepared. Each tooth section was scanned and the length of dentin translucency was measured in GIMP 2.8 software. Results: A linear relationship was observed between dentin translucency and age in the regression analysis. Pearson's correlation analysis showed that there was positive correlation (r = 0.93, P = 0.001) between dentin translucency and age, and the difference between the chronologic age and real age is ± 4.88 years. Conclusion: Dentin translucency in the apical part of the tooth can be used for estimating the age of an individual. A method to digitally select and measure translucent root dentin length was used here. This software method is easy to use and less time-consuming. The measurements obtained using this method are more precise and thus help in more accurate age estimation. Considering these benefits, this study recommends the use of digital method to assess translucency for forensic purpose.
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ORIGINAL RESEARCH-COMPARATIVE STUDY Top

In Vitro comparison of the microbial leakage of obturation systems: Epiphany with resilon, guttaflow, and ah plus with gutta percha p. 37
KJ Prithviraj, Sreegowri , RK Manjunatha, Priya Horatti, Nageshwar Rao, S Gokul
DOI:10.4103/ijdr.IJDR_98_18  
Aim: To compare the microbial leakage of three root canal filling materials: AH Plus with Gutta-percha, Epiphany with Resilon, and Guttaflow using Enterococcus faecalis as the bacterial marker. Materials and Methods: In total, 30 caries free, human maxillary incisors with straight roots were used. The teeth were de-coronated with a diamond disc and the length was standardized for all specimens. Access opening was done through the coronal portion and the working length was determined. All the teeth were prepared to a standardized size apically and coronally. The teeth were then randomly divided into three experimental groups each. After obturation of the root canals, the outer surfaces of the teeth were coated with two layers of nail enamel except the apical 2 mm. The teeth were then subjected for bacterial leakage test using E. faecalis as a bacterial marker in dual chamber bacterial leakage model for a period of 30 days. Statistical Analysis Used: Chi-square test. Results: Results showed that Resilon/Epiphany (Group-2) demonstrated less leakage and Gutta-percha/AH Plus (Group-1) showed maximum leakage with the statistically significant difference between the two (P < 0.05). Guttaflow (Group-3) also showed less leakage than Gutta-percha/AH Plus (Group-1) with the statistically significant difference between the two (P < 0.05). There was no statistically significant difference between Resilon/Epiphany (Group-2) and Guttaflow (Group-3). Conclusion: Resilon/Epiphany and Guttaflow groups demonstrated less microbial leakage than Gutta-percha/AH Plus group.
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Comparative efficacy of low-Level laser and TENS in the symptomatic relief of temporomandibular joint disorders: A randomized clinical trial p. 42
Deepika Chellappa, Manigandan Thirupathy
DOI:10.4103/ijdr.IJDR_735_18  
Aim: Temporomandibular disorders (TMDs) comprise a number of signs and symptoms affecting the masticatory muscles, temporomandibular joint (TMJ), or both. Because of the multifactorial etiology of such problems, the treatment usually involves more than one modality. Objectives: Therefore, the aim of this study was to compare the effectiveness of transcutaneous electric nerve stimulation (TENS) and low-level laser therapy for the treatment of patients with TMD. Materials and Methods: The clinical trial was performed with 60 patients diagnosed with TMD of multiple causes. All the patients received both methods of treatment in 6 consecutive weeks. A paired t-test was applied to verify the significance of the results. Results: A significant improvement in the range of motion and pain relief for both the therapies was observed. Conclusions: Comparatively after analyzing the two methods, the values obtained after LLLT were significantly higher than those obtained after TENS therapy (P < 0.01).
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Comparison of routine teaching with fishbowl and 1-min preceptor for dental undergraduate students: An interventional study p. 48
Shefalika Priyam, Roopali M Sankeshwari, Supriya Vyavahare, Anil V Ankola
DOI:10.4103/ijdr.IJDR_231_18  
Aim: To compare routine teaching method with fishbowl and a one-minute preceptor for undergraduate students. Objectives: 1. Evaluation of theoretical knowledge for WHO dentition status and treatment need by fish bowl and routine teaching. 2. Effectiveness of the combination of fish bowl and one-minute preceptor in understanding WHO dentition status and treatment need. Materials and Methods: This study was conducted on 38 third year undergraduate students, which was divided into two groups (Group A: Fishbowl, Group B: One-minute preceptor). Routine lecture for WHO dentition status and treatment need was taken, followed by baseline evaluation which was done by giving 10 sets of clinical images to students and asked them to give WHO score. Furthermore, fish bowl and one-minute preceptor method were performed and students were subjected with the same set of clinical images again. At the end of the session, feedback was taken from the students by means of five open-ended questions about their views on fish bowl and one-minute preceptor. Data were analyzed with SPSS version 20 (Chicago IL). Wilcoxon Sign Rank test and Mann Whitney 'U' test was performed for intragroup and intergroup comparison respectively. Results: Combination of fishbowl and one-minute preceptor shows statistically significant result over routine teaching method with P value of .000. Conclusion: Combination of Fish Bowl and OMP could be used for better teaching method for students, as the students are actively involved and more learning takes place; the deficiencies of one method would be compensated by the other.
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The efficacy of transdermal and oral diclofenac for post-endodontic pain control: A randomised controlled trial p. 53
Shivani Mangal, Sylvia Mathew, B V Sreenivasa Murthy, Swaroop Hegde, K Dinesh, Poornima Ramesh
DOI:10.4103/ijdr.IJDR_167_17  
Objective: The aim of the present study was to compare the effect of transdermal diclofenac patch against oral diclofenac for post-endodontic pain control. Materials and Methods: Thirty-two patients with symptomatic irreversible pulpitis in single-rooted premolar teeth of either arch were treated endodontically in a single visit by a single endodontist. Oral diclofenac (50 mg twice daily) for group I and transdermal diclofenac patch (100 mg once daily) for group II were administered as post-endodontic analgesics for two days. Visual analogue scale (VAS) chart was used to record pain intensity scores preoperatively and at intervals of 4, 8, 12 and 24 h postoperatively for 2 days. Paracetamol 650 mg tablets were provided as rescue medication. Results: There was a significant decrease in the postoperative pain intensity scores for both groups. The postoperative scores gradually decreased from day 1 to day 2 in both groups. Twelve out of sixteen patients who had received diclofenac tablets complained of gastric discomfort. Conclusion: Transdermal diclofenac patch was as effective as an oral diclofenac tablet and can be used as an alternative and effective analgesic for post-endodontic pain management, especially in patients with gastric discomfort.
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Dental hygienist job autonomy depends on the period of dental hygiene education p. 57
Young-Eun Jang, Nam-Hee Kim
DOI:10.4103/ijdr.IJDR_212_18  
Context: Independent dental hygiene practice is critical in regions with low accessibility to dental services, as well as for preventing and managing oral diseases among children and the elderly from low-income families, as these individuals are highly vulnerable to oral diseases. Aims: We investigated whether the job autonomy of dental hygienists has been maintained, in accordance with the guidelines of the International Federation of Dental Hygienists (IFDH). Settings and Design: This study comprised a cross-sectional literature review. Subjects and Methods: We reviewed national reports and articles published in 23 countries selected for analysis to determine the degree of dental hygienist job autonomy, based on the extent of dental hygiene education. We divided the countries into two groups, based on the historical length of dental hygienist education. Statistical Analysis Used: We classified education as direct access, indirect supervision, and direct supervision. Two researchers reviewed and revised the classification results to ensure reliability. The Kappa value was 0.96 points. Statistical analysis was performed by PASW statistics 23.0 program (SPSS Inc., Chicago, IL, USA.). Results: Countries with >40 years of educating dental hygienists exhibited more independent dental hygienist practices than those with less than 40 years of educating dental hygienists. Conclusions: Countries with >40 years of experience in educating dental hygienists largely guarantee independent dental hygiene practice for dental hygienists, in accordance with IFDH guidelines. The society's need for dental hygienists is fulfilled and professional competency is maintained in these contexts; thus, it should be required for dental hygienists to maintain independent dental hygiene practices.
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Work-related musculoskeletal symptoms and coping strategies among dental auxiliaries at hospital universiti Sains Malaysia p. 61
Normastura Abd Rahman, Munirah Mohd Adnan, Azizah Yusoff, Joel Moh Heng Shu, Khadijah Rustam
DOI:10.4103/ijdr.IJDR_430_18  
Background: Dental personnel are vulnerable to work-related musculoskeletal symptoms (WMSS) due to the nature of their profession. Aim: To determine WMSS experienced by dental auxiliaries and their coping strategies toward these symptoms. Setting and Design: A cross-sectional study was conducted on 82 dental auxiliaries at a university dental hospital in Malaysia. Materials and Methods: Nordic musculoskeletal questionnaire and the Brief COPE questionnaire were used to measure the musculoskeletal symptoms and coping strategies of the respondents, respectively. Data were analyzed using IBM SPSS version 22.0. Results: Dental auxiliaries consisted of dental staff nurses (30.5%), dental surgery assistants (40.2%), dental technologists (18.3%), and healthcare assistants (11.0%). Their mean [standard deviation (SD)] age was 33.4 (7.60) years. Most of the respondents had been troubled with ache, pain, and discomfort at the neck, 54.9% (95% confidence interval 44.0%, 66.0%]. In addition, they were troubled mainly with distress at the low back (34.1%) and the ankle or feet (34.1%) which had prevented the respondents from doing their regular job over the past 12 months. The most common areas that had troubled the respondents over the past 7 days were the neck (36.6%), low back (36.6%), and ankle or feet (36.6%). The coping strategy most commonly practiced by the respondents was religion with a mean (SD) score of 3.70 (2.15), followed by active coping [3.13 (0.68)] and acceptance [3.13 (0.69)]. Conclusion: The prevalence of WMSS was high in the dental auxiliaries particularly in the neck region. The most common coping strategy used was religion. Awareness programs on the prevention of WMSS among the dental auxiliaries should be increased.
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Is platelet rich fibrin a viable alternative to subepithelial connective tissue graft for gingival root coverage? p. 67
Aniruddha Joshi, Girish Suragimath, Siddhartha Varma, Sameer A Zope, Apurva Pisal
DOI:10.4103/ijdr.IJDR_434_18  
Introduction: One of the most common aesthetic concerns associated with the periodontal tissue is gingival recession. Covering the root surface exposed during the disease process with soft and hard tissue surgeries may decrease these problems. The aim of the study was to compare the clinical outcome of coronally advanced flap (CAF) procedure in root coverage with platelet-rich fibrin (PRF) or subepithelial connective tissue graft (SCTG) for the treatment of Miller's Class-I gingival recession. Materials and Methods: The split mouth design consisted of 15 patients with a total of 30 sites with bilateral Miller's Class-I recession on anterior teeth. They were randomly assigned into PRF group (test) or SCTG group (control). Statistical Analysis: The values obtained were tabulated and analyzed using Mann--Whitney U-test and repeated measure ANOVA test. All the statistical tests were carried out using SPSS software. Results: It was observed that both the autogenous grafts healed without any complications and at the end of 6 months the grafts were stable and recession coverage between 88-100% was achieved. Conclusion: CAF procedure with either PRF or SCTG were both effective in the treatment of Miller's Class-I gingival recessions. CAF with SCTG showed better root coverage than CAF with PRF. Use of PRF offered additional benefit of avoiding second surgical site. Therefore, PRF can be considered as a viable alternative to SCTG in certain cases.
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Correlation of streptococcus mutans and streptococcus sobrinus colonization with and without caries experience in preschool children p. 73
RL Veena, C Nagarathna
DOI:10.4103/ijdr.IJDR_432_18  
Background and Objectives: The aciduric mutans streptococci (MS) group, including Streptococcus mutans (SM) and Streptococcus sobrinus (SS), is highly cariogenic. Relationship between increments in dental caries and the presence of these species is not yet clarified. It is of great importance to separately determine the presence of these two species for understanding their role in dental caries, accurate prediction, and effective prevention. Hence, this study was undertaken to detect the presence of SM and SS in plaque samples of caries-free (CF), early childhood caries (ECC), and severe early childhood caries (S-ECC) and also to compare the possible relationship between these species with the occurrence of ECC. Materials and Method: In all, 120 healthy children between 3 and 6 years of age were randomly allocated into three groups: Group A (n = 40) CF, Group B (n = 40) ECC, and Group C (n = 40) S-ECC. Plaque samples were collected from all approximal surface and gingivobuccal surfaces of teeth using a sterile universal scaler and dmft/dmfs scores were taken. The presence of SM and SS was evaluated using real-time polymerase chain reaction. Results: The presence of SM in CF, ECC, and S-ECC was 10.0%, 27.5%, and 42.5%, respectively, and SS was 5.0%, 40.0%, and 47.5% in CF, ECC, and S-ECC, respectively. Comparison of mean relative quantification (RQ) values of SM between three study groups showed significant results between CF and S-ECC at P value 0.003. Comparison of mean RQ values of SS showed significant results between CF to ECC and CF to S-ECC at P value <0.001. This study showed significant results between the mean dmft/dmfs scores in three study groups and the presence of high levels of SM and SS in ECC and S-ECC groups. However, the study showed weak positive correlation between dmfs scores and both SM and SS species in ECC and S-ECC. Interpretations and Conclusion: Higher levels of SS were more closely related to the caries-active lesions leading to severity of dental disease, that is, both in ECC and S-ECC. There was significant difference between mean dmft/dmfs scores in three study groups and it also showed positive correlation between dmfs scores and SM and SS colonization in ECC and S-ECC status.
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ORIGINAL RESEARCH-RETROSPECTIVE STUDY Top

Pericoronal follicles revealing unsuspected odontogenic cysts and inflammatory lesions: A retrospective microscopy study p. 80
Viviane Palmeira da Silva, Gabriela de Luca Meyer, Natália Batista Daroit, Bruna Jalfim Maraschin, Márcia Gaiger de Oliveira, Fernanda Visioli, Pantelis Varvaki Rados
DOI:10.4103/ijdr.IJDR_459_18  
Aim: This study aimed to analyze the prevalence of diseases related to pericoronal follicles, and assess the rate of concordance between clinical and histopathological diagnoses. Methods: Histologically, we analyzed 1,298 tissue samples surrounding the crowns of teeth that were diagnosed clinically as pericoronal follicles. In addition, we determined associations among histopathological diagnosis, patients' age and sex, tissue site, presence of nests of odontogenic epithelium, presence of reduced enamel epithelium, and presence of diffuse inflammation. Results: Odontogenic pathologies were present in 35% of the samples, and rate of concordance between clinical and histopathological diagnoses was 0.54. Probability of developing odontogenic pathologies was high in the mandibular molars (odds ratio: 2.13) and in the tissues with odontogenic epithelial remnants (odds ratio: 1.2), reduced enamel epithelium (odds ratio: 1.3), and diffuse inflammation. (odds ratio: 10.5). Conclusions: The findings of this study highlight the clinical relevance of histopathological examination of the pericoronal tissue in unerupted and partially erupted teeth for early diagnosis of pathologies because this study demonstrated the odontogenic cysts and inflammatory lesions in tissues clinically diagnosed as pericoronal follicles.
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Validation of cone beam computed tomography-based classification method for individual assessment of mid-palatal suture with respect to clinical application among Indian children p. 85
HP Chanchala, B Nandlal, Nagaraj Murthy, Raghavendra Shanbhog
DOI:10.4103/ijdr.IJDR_517_18  
Aim: The aim of this study is to validate the Fernanda Angelieri classification method for the individual assessment of mid-palatal suture among Indian children using multi-slice computed tomography (CT) with respect to clinical application in rapid maxillary expansion. Material and Methods: Present study was conducted utilizing 760 existing head and neck CT image records. CT images were stratified into three categories based on growth spurts: Group I – 6–10 years (n = 210), Group II – 11–14 years (n = 270), and Group III – 15–18 years (n = 280). The CT images were analyzed for stages of mid-palatal suture maturation, according to age and sex. The recorded data were subjected for statistical analysis. Results: Indian children, up to age of 10 years, were distributed in stage A and B. After 11 years, up to 14 years girls showed varied distribution and spread equally among stage B, C, and D. After 15 years, more number of girls were distributed in stage D and E, whereas boys remained distributed variedly in stage B, C, and D. Mid- palatal suture maturational stages correlated to chronological age among both the genders using Fisher exact test and expected contingency table showed statistically significant variation among both the gender independently and collectively (P < 0.001). Conclusion: Cone beam computed tomography (CBCT)-based prediction of stages of mid- palatal suture maturation by Fernanda Angelieri is valid among the Indian population. During treatment plan of maxillary expansion among children above 10 years, it is better to have a diagnostic CBCT image analysis of mid-palate suture for predicable prognosis.
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Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation p. 91
Purv Shashank Patel, Jigna S Shah, Bhavin B Dudhia, Purva Bharat Butala, Yesha V Jani, Roseline S Macwan
DOI:10.4103/ijdr.IJDR_540_18  
Objectives: This study was aimed at determining the specific signs of close relationship between impacted mandibular third molar (IMTM) root and inferior alveolar nerve (IAN) canal as visualised on digital panoramic radiograph or orthopantomograph (OPG) which should indicate as well as contraindicate the need for cone beam computed tomography (CBCT) imaging based on hierarchical model of Fryback and Thornbury. Materials and Methods: The sample consisted of 120 individuals (200 IMTM) who had undergone OPG as well as CBCT imaging as preoperative radiographic evaluation before surgical extraction. On panoramic radiographs; Rood and Sheehab's radiographic signs of IMTM root and IAN canal, impacted third molar position based on Winter's classification and depth of impaction based on Pell and Gregory's classification were evaluated. On CBCT; presence/absence of corticalization and the status of the buccal and lingual cortices (thinning/perforation) were evaluated. These findings of OPG were compared to CBCT findings to determine the better modality based on hierarchical model of Fryback and Thornbury. Results: Statistically significant association was found between radiographic signs of Rood and Sheehab such as 'no relation' and 'superimposition' on OPG and presence of corticalization between IMTM root and IAN canal on CBCT. Statistically significant association was also found between 'mesioangular' and 'vertical' positions of Winter's classification as well as 'class 1A' of Pell and Gregory's classification of IMTM on OPG and presence of corticalization on CBCT. CBCT was found to be having lesser variance and greater F value as compared to OPG for evaluation of IMTM. Conclusions: On OPG; Rood and Sheehab's radiographic signs such as 'no relation' and 'superimposition', Winter's 'mesioangular' and 'vertical' and Pell and Gregory's 'Class 1A' are not indicative for CBCT examination before surgical extraction is attempted. On OPG; Rood and Sheehab's radiographic signs such as interruption of white line, darkening of root, darkening of canal, deflection of root, narrowing of canal as well as diversion of canal are all frequently associated with absence of corticalization between IMTM root and IAN canal and hence require CBCT examination before surgical extraction is attempted so that post-operative neurological complications can be minimised. Also, Winter's horizontal, distoangular and others as well Pell and Gregory's classes 1B,1C,2A,2B,2C,3A,3B,3C are indicative for CBCT examination before surgical extraction is attempted. Fryback and Thornbury model-based comparison proves that CBCT is a better radiographic modality as compared to OPG for evaluation of IMTM relation with IAN canal.
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Sexual dimorphism of mental foramen position in peruvian subjects: A cone-beam-computed tomography study p. 103
Yalil Augusto Rodríguez-Cárdenas, Manuel Casas-Campana, Luis Ernesto Arriola-Guillén, Aron Aliaga-Del Castillo, Gustavo Armando Ruiz-Mora, Maria Eugenia Guerrero
DOI:10.4103/ijdr.IJDR_557_18  
Background: The position of the mental foramen (MF) is particularly relevant in dentistry. The incorporation of new imaging techniques, such as cone-beam-computed tomography (CBCT), can be used to identify anatomic dimorphic traits. Aims: This study evaluated the sexual dimorphism of MF position by CBCT among a selected population. Methods: Fifty CBCT images from 20 to 40-year-old subjects (25 men and 25 women) were evaluated. The horizontal position was evaluated using the al Jasser-Nwoku classification to identify the position of the MF in the mandible. Two measurements were obtained on coronal sections to evaluate the vertical position of the MF: the distance from the uppermost alveolar ridge to the upper edge of the foramen and the distance from the inferior edge of the foramen to the lower border of the mandible. Statistical Analysis Used: Comparisons between sexes and sides were performed with Student's t-test and Chi-square tests. Results: The most frequent location of the MF was in line and below of the second premolar tooth in both men and women (P > 0.05). Additionally, significant differences were found between sexes for the distance from the inferior edge of the foramen to the lower border of the mandible in each side (P < 0.001 for the right and left sides). Conclusions: Horizontal position of the MF is not a sexually dimorphic feature and it is predominantly in line and below the second premolar tooth. Women present the MF in a more caudal position, closer to the mandibular base when compared to men.
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Factors involved in the treatment sought immediately after traumatic dental injuries in Brazilian children p. 109
Daniele Lucca Longo, Sara S Oliveira, Erika Calvano Küchler, Francisco W G Paula-Silva, Marília P Lucisano, Paulo Nelson-Filho, Alexandra M de Queiroz, Raquel Assed Bezerra Silva
DOI:10.4103/ijdr.IJDR_19_17  
Aim: The aim of this study was to evaluate demographic and clinical factors involved in the immediate seeking of care after traumatic dental injury (TDI) in Brazilian children. Materials and Methods: Records from 74 patients, age ranged 1–11 years, who sought treatment at the School of Dentistry of Ribeirão Preto at University of São Paulo, Brazil, were collected. Data was analyzed using the Epi Info 7.0 software by t-test, odds ratio calculation, Chi-square, or Fisher's exact tests. Results: Twenty-three (31.1%) sought dental treatment immediately and 51 (68.9%) did not seek dental treatment immediately. The most common type of trauma was lateral luxation (44.6%). In primary teeth, 31 cases (60.78%) involved the soft tissue and 16 (39.2%) involved hard tissue injuries. While in permanent teeth, 20 cases (40%) involved soft tissue and 24 (60%) involved hard tissue injuries had more traumas in the hard tissue (P = 0.04). The type of injury and dentition was not associated with the time that the guardians sought dental treatment (P > 0.05). None of the factors were involved in immediately seeking care after TDI. Conclusion: Moreover, the majority of parents/caregivers did not immediately seek dental treatment after TDI, regardless of the type of injury.
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Age- and sex-related mandibular dimensional changes: A radiomorphometric analysis on panoramic radiographs p. 113
Palak H Shah, Rashmi Venkatesh, Chandramani B More, V Vaishnavee
DOI:10.4103/ijdr.IJDR_327_18  
Introduction: Mandible undergoes age- and sex-related structural changes similar to other bones of the body. Thus, morphometric analysis of the mandible helps in age and sex determination. Aim: To investigate the influence of age and sex on the mandible by measuring three parameters, i.e. gonial angle, ramus height and bigonial width. Materials and Methods: A retrospective radiomorphometric analysis was conducted in the department of Oral Medicine and Radiology. A total of 300 panoramic radiographs (150 males and 150 females) equally distributed in six study groups according to the age were analysed. The measurements were performed using DIGORA 2.8 software for Windows. The acquired data was statistically analysed by one way ANOVA test and Student's t-test using SPSS (v. 19.0). Results: Statistically significant differences according to age were found in gonial angle dimensions. Ramus height and bigonial width did not demonstrate statistically significant co-relation with age. According to sex, all the three study parameters showed statistically highly significant differences. Conclusion: The morphometric analysis of the mandible is a useful tool for age estimation and sex determination.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Comparison of autogenous bone graft and tissue-engineered bone graft in alveolar cleft defects in canine animal models using digital radiography p. 118
Shirin Shahnaseri, Mahnaz Sheikhi, Batool Hashemibeni, Seyed Amir Mousavi, Parisa Soltani
DOI:10.4103/ijdr.IJDR_156_18  
Background: Autogenous bone graft is the gold standard for repair of bone defects. However, osteoprogenitor stem cells are suggested as an alternative treatment. Aims: To quantitatively compare bone formation in autogenous bone graft and tissue-engineered graft using digital radiography densitometry software in canine alveolar cleft model. Setting and Design: This experimental study on animal models was conducted in Isfahan University of Medical Sciences. Methods: Mesenchymal stem cells (MSCs) were obtained from subcutaneous adipose tissue of 4 dogs. Undifferentiated cells were incubated with a hydroxyapatite/beta-tricalcium phosphate scaffold in an osteogenic medium for 21 days. A maxillary defect simulating human alveolar cleft was created from the alveolar crest to nasal floor with 15 mm width bilaterally. Two months later, the defect was filled with autogenous bone graft harvested from tibia on one side and tissue-engineered graft from MSCs on the other side. Digital radiography was performed on days 15, 30, 45, 60, 75, and 90 after grafting. Radiographic density was calculated by the mean numeric value of pixels of the desired area ranging from 0 (darkest) to 255 (lightest) by associated software. Statistical Analysis Used: The data were analyzed by Statistical Package for the Social Sciences using descriptive statistics and two-way repeated-measure analysis of variance test (α = 0.05). Results: Mean density measured for autogenous bone graft group was 110.72, 82.70, 75.76, 93.57, 100.22, and 100.32 in days 15, 30, 45, 60, 75, 90, respectively and 120.7, 87.62, 83.72, 92.02, 92.30, and 93.77 in stem cell group. Although the time lapse was a significant factor in two groups (P = 0.01), the results indicated that the difference between two groups was not statistically significant (P = 0.942). Conclusion: Tissue-engineering can be used as an alternative method in reconstruction of bony defects with predictable clinical outcomes.
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Comparison of antibacterial efficacy of cinnamon extract, neem extract as irrigant and sodium hypochlorite against Enterococcus fecalis: An in vitro study p. 124
Veerale Panchal, Deepa Gurunathan, NP Muralidharan
DOI:10.4103/ijdr.IJDR_177_18  
Aim: The aim of the study is to compare the antibacterial effectiveness between cinnamon extract as irrigant with neem extract irrigant and sodium hypochlorite against E. fecalis. Materials and Methods: The present study is a randomized controlled in vitro study conducted on 60 extracted permanent single rooted teeth. The teeth were divided into three groups- Group 1 was irrigated with cinnamon extract, Group 2 was irrigated with neem extract irrigant and Group 3 with 3% sodium hypochlorite. The colonies in the reduction of E. feacalis was noted as CFU values per ml. Wilcoxon signed ranked test was used to compare in between the three groups. Mann- Whitney's test was used for inter group comparison between the three groups. Results: Cinnamon extract had the maximum reduction in the CFU colonies followed by sodium hypochlorite. Neem extract irrigant had the least reduction in the colonies of E. feacalis. (P < 0.05). Conclusion: Cinnamon extract irrigant show better reduction in E. fecalis as compared to 3% sodium hypochlorite and neem extract irrigant.
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Erosive effect of milk, honey, cereal porridge, and millet porridge on enamel of primary teeth: An in vitro study p. 129
Theresa Sam Cherian, Priya Subramaniam, Megha Gupta
DOI:10.4103/ijdr.IJDR_224_18  
Context: Enamel erosion is manifested as partial demineralization occurring at the enamel surface leading to increased surface roughness. Diets comprising milk, cereals, and millets are frequently fed to infants and toddlers. These foods are prepared so as to make them soft in texture, palatable, and easy to ingest. Aim: To determine the erosive effect of milk, honey, and porridges made from cereal and millet on primary tooth enamel. Settings and Design: Exfoliated caries-free primary teeth were collected, and a total of 50 longitudinal sections were prepared. They were equally divided into five groups of 10 samples each. Materials and Methods: Each group was incubated in milk, honey, cereal porridge, millet porridge, or saliva for 30 min. Subsequently the samples were washed and incubated at 37°C in saliva for 2 h. This cycle was repeated five times. The samples were gold sputter coated, and surface roughness was measured using optical profilometry. Saliva samples were evaluated for calcium release using dry chemistry method. The pH of foods and titratable acidity were also estimated. Statistical Analysis Used: One way analysis of variance and Tukey's post hoc test. Results: The mean surface roughness value, Ra (μm), obtained with millet porridge was 6.0175 ± 0.54 μm, which was significantly higher than cereal porridge, honey, and milk (P < 0.05). Calcium release in saliva was highest with honey (>14 mg/dL) and it also exhibited the lowest pH (4.33). Conclusion: Porridges prepared from millet and brown rice cereals were seen to have an erosive effect on the enamel of primary teeth.
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Comparative evaluation of 2D miniplates and 3D miniplates fixation in mandibular angle fracture - A clinical study p. 134
Rohit Singh, Konark, Anju Singh, DK Singh, Jazib Nazeer, Supriya Singh
DOI:10.4103/ijdr.IJDR_885_19  
Introduction: Mandibular angle fracture is common in road traffic accidents. This study was conducted to compare 3D miniplate system with 2D plates for treatment of mandibular angle fractures. Materials and Methods: The study was conducted on 120 patients with mandibular angle fracture of both genders. After selecting patients, patients were divided into 2 groups of 60 each. In group I, patients were treated with 3D, 2.0-mm titanium plates, and in group II, patients were treated with 2D, 2.0-mm titanium miniplate in mandibular angle fracture. Patients were evaluated regularly after 1, 3, and 6 months for outcome of treatment. Results: In group I, males were 22 and females were 38. In group II, males were 40 and females were 20. Right angle fracture was seen in 32 patients in group I and 26 in group II. Left angle fracture was seen in 24 in group I and 28 in group II. Right angle and left parasymphysis fracture was seen in 3 in group I and 4 in group II. Left angle and right parasymphysis fracture was seen in 1 in group I and 2 in group II. [Table 3], [Graph 1] shows that in group I, after 1 month sensory deficit was present in 5 patients and in group II in 12 patients. After 3 months, there were no patients with sensory deficit in group I and 2 in group II. Preoperatively in group I, mouth opening was 24 mm and in group II patients was 25.80 mm, which increased to 31.20 mm in group I and 28.20 mm in group II at 1 month, 32 mm in group I and 30 mm in group II at 3 months, and 37.20 and 32.12 mm in groups I and II, respectively, at 6 months. The difference was significant (P < 0.05). Conclusion: 3D miniplate system is reliable and effective treatment modality for mandibular angle fractures as compared with traditional 2D miniplates.[INLINE:1]
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Evaluating the fracture resistance of fiber reinforced composite restorations - An in vitro analysis p. 138
Arun Kumar Patnana, Narasimha Rao V. Vanga, Rajasekhar Vabbalareddy, Srinivas Kumar Chandrabhatla
DOI:10.4103/ijdr.IJDR_465_18  
Background: Laboratory reports show that fiber-reinforced composites have improved fracture resistance over traditional composites. However, limitations in the biomechanics of tests to evaluate the fracture resistance of fiber-reinforced composites need to be considered for accurate clinical applications. Aim: To assess the fracture resistance of particulate filler composites, glass fiber-reinforced composites, and polyethylene-fiber reinforced composites by analyzing the different fracture types and failure patterns. Materials and Methods: A standardized incisal (Group I) and mesioincisal fractures (Group II) were prepared on human maxillary central incisors. The test samples were further subdivided according to the restorative material used; particulate filler composites (Filtek Z 250), glass fiber-reinforced composites (fibre splint), and polyethylene-reinforced composites (Ribbond). The type of fractures was evaluated under the stereomicroscope and the failure patterns were analyzed using the graphical output from Universal Testing Machine. Statistical Analysis: The Chi-square test of association was used to test the association between fiber-reinforced composites and fracture resistance of tooth restoration complex. Results: No statistical association was observed between fiber-reinforced composites to the type of fractures in both incisal (P = 0.29) and mesioincisal restoration (P = 0.27). A significant association was observed between the fiber-reinforced composites to the failure patterns in both the incisal (P = 0.005) and mesioincisal restoration (P = 0.007). Conclusion: The glass and polyethylene fiber-reinforced composites showed improved fracture resistance properties than the traditional particulate filler composites in both incisal and mesioincisal restorations.
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Variable antifungal activity of curcumin against planktonic and biofilm phase of different candida species p. 145
Veena S Narayanan, Sunil Muddaiah, R Shashidara, US Sudheendra, NC Deepthi, Lakshman Samaranayake
DOI:10.4103/ijdr.IJDR_521_17  
Objective: To evaluate the in vitro antifungal activity of curcumin against 2 strains of Candida albicans (ATCC 90028 and a clinical isolate – JY strain) and 1 isolate each of 3 nonalbicans – Candida species [Candida parapsilosis (ATCC 22019), C. glabrata (ATCC 90030), and C. dublieniensis (MYA 646)]. Materials and Methods: Planktonic MIC of the 4 Candida species was determined using micro broth dilution assay according to CLSI M27-A3 criteria. The biofilm development and sensitivity assay were performed with the 2 C. albicans strains. Results: Curcumin at high concentrations (0.1–2 mg/mL) was effective in inhibiting planktonic organisms of all the 5 tested Candida strains. The planktonic phase and the biofilm phase of C. albicans ATCC 90028 exhibited similar MIC values for curcumin (0.5 mg/mL). Both curcumin and fluconazole were ineffective against the mature biofilms of JY strain. Conclusion: Our results reported here for the first time, in particular for the biofilm state of C. albicans, imply that curcumin a natural product could be used as a therapeutic alternative to conventional antifungals although further investigations are required to evaluate its potential.
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CASE REPORTS Top

Degloving injury of the mandible among different age groups p. 149
Nagesh Lakshminarayan, RB Savithramma, NG Bhuvaneshwari, Denzy Lawrence
DOI:10.4103/ijdr.IJDR_111_18  
Degloving injuries of the oral cavity are characterised by separation of periosteum and soft tissue of the anterior floor of the mouth from the inner cortex of the anterior segment. The higher incidence of the degloving injuries of mandible are seen in children and young adults due to higher involvement in contact sports. In elders, degloving injury of mandible are rare as compared to that of the limbs which are common. Here, we describe the case report of an elderly female with an apparent soft tissue abrasion with encrustation along the left side of the lower lip due to fall. Thorough intra oral examination revealed the presence of degloving injury along the lower anterior region of mandible which was debrided and sutured. Without a high level of suspicion, such lesions existing in the gingivobuccal sulcus may be missed, leading to increased risk of secondary infection and obligate healing in turn leading to increased morbidity.
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Reconstruction of moustache and ala of the nose with a single forehead flap p. 153
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_100_20  
Reconstruction of critical-sized defects of composite facial units is a challenging one. This is amplified when facial hair-bearing areas are included. A case of reconstruction of multiple midfacial defects is presented. Initially, defective jaws were addressed. Later, appropriate modification of existing extended paramedical forehead flap to sequentially reconstruct defective lip, moustache, and parts of alae are described. The flap design was such that hair-bearing areas were used to reconstruct moustache while the nasal alar defect was reconstructed using the non-hair-beating forehead skin. Finally, dental implants were also placed. The technique was reliable, giving minimal donor site deformity but with maximum result. However, it is a multi-stage procedure. The paper also describes the challenges of midfacial unit reconstruction as handled in this case.
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Postoperative maxillary cyst p. 157
Pooja Siwach, Tabita Joy, Shuddhodhan Gaikwad, Vikas Meshram
DOI:10.4103/ijdr.IJDR_259_18  
Cysts of the oral cavity are among the most commonly encountered biopsy specimen in histopathology. Shear categorized the cysts associated with maxillary antrum under four subheadings – mucocoele, retention cyst, pseudocyst, and postoperative maxillary cyst (PMC). PMC is also known as surgical ciliated cyst, postoperative paranasal cyst, or respiratory implantation cyst. Although it constitutes 20% of oral cysts in Japan, it is quite rare in the other parts of the world. Herewith, we report a case of a 65-year-old female who presented with the complaint of palatal swelling and having a history of maxillary sinus surgery 30 years ago.
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Cone beam computed tomography aided endodontic and aesthetic management of fused mandibular incisors with communicating canals p. 160
Chellaswamy Savrimalai Karumaran, Anil Ramachandran Kumar, Kiran Kumar Neelakantappa, Rajasekaran Meenakshi Sundaran, Remya Venkatesan, Savitha Bhasker Naik
DOI:10.4103/ijdr.IJDR_811_18  
Endodontic treatment of fused teeth needs special care and attention due to its complex anatomy. The aim of this article is to highlight the problems encountered and the strategy in treating such cases. We report a case of unilateral fusion of the left mandibular central incisor and lateral incisor, with a single pulp chamber. The single pulp chamber separates into two root canals and a large communication exists at the apical third of the root canals. This is the first time fused teeth with a large communication is reported. CBCT analysis was effective in confirming the morphological aberrations and aided in accurate planning and treatment. Chemomechanical preparation with manual dynamic irrigation coupled with passive ultrasonic activation of the irrigant and obturation with thermoplasticised gutta percha helped in successful outcome of the case.
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Arteriovenous malformation of the parotid gland: Diagnostic perspective- A case report p. 164
Hima John, S Padmashree, Padma Pandeshwar, Sayyad Zohabhasan Innus
DOI:10.4103/ijdr.IJDR_296_18  
Arteriovenous malformation (AVM) of the parotid gland is an extremely rare condition with very few cases reported in the literature. Majority of the swellings in the parotid region are usually due to sialadenitis, tumour etc., therefore making the initial diagnosis of vascular malformation may be difficult if there is no evident Turkey-wattle sign. Here, we present a case of AVM of parotid gland with its clinical features, radiographic features and its management. The lesion, being a high flow one, was managed with sclerosing agents to regress its size.
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