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   Table of Contents - Current issue
November-December 2019
Volume 30 | Issue 6
Page Nos. 817-981

Online since Tuesday, January 14, 2020

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Translational research in dentistry: The need of the hour p. 817
Anil Kishen
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Mercury, dentistry, minamata convention and research opportunities p. 819
SM Balaji
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Effect of casein phosphopeptide–amorphous calcium phosphate as a remineralizing agent – An In Vivo study p. 820
Neelam Dewani, Nilotpol Kashyap, Alok Avinash, Brij Kumar, Manpreet Singh, Pallavi Pawar
Introduction: Demineralization and remineralization have a crucial impact on the hardness and strength of teeth. Casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) Trident white chewing gum has anticariogenic property and also stimulates saliva, which buffers the oral cavity and promotes remineralization. Trident sugar-free gum, therefore, is an excellent delivery vehicle for promoting enamel remineralization. Aims and Objectives: The aim of this study is to show that CPP-ACP-containing chewing gum would increase the level of calcium concentration of saliva, thereby supplying calcium and phosphorus to whole dentition for a prolonged period and aid in remineralization of tooth surfaces. Materials and Methods: An in vivo nonrandomized clinical trial study was carried among 60 children. Unstimulated saliva from each 60 selected participants was collected. Then each participant was given two pellets of chewing gum containing CPP-ACP and asked to chew for a period of 20 min, after which saliva samples were again collected from each participant. The study was carried out for 15 days, and at three intervals, calcium and phosphorus levels were assessed using affiliated reagent kits and spectrophotometer. Results: Significant difference was found in the calcium and phosphorus concentration of saliva before and after chewing CPP-ACP-containing chewing gum. When post calcium and phosphate levels were analyzed among different time intervals, a highly statistically significant difference was observed (P = 0.000). Conclusion: Clinical trial study shows that chewing sugar-free gum containing CPP-ACP can be regarded as an additional caries prevention tool.
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Development and initial validation of an oral health-related quality of life scale for older adolescents p. 826
Radhamoni Madhavan Pillai Baiju, Elbe Peter, Nettiyat Oommen Varghese, Jolly Mary Varughese, Remadevi Sivaram, Vivek Narayan
Background: Oral health-related quality of life (OHRQoL) perception is age-dependent and therefore different for children, adolescents, and adults. Adolescents are a critical age group with specific oral health needs. Oral health needs assessment is not complete without the estimation of OHRQoL. Objective: To develop and validate an OHRQoL scale for older adolescents considering their functional, social, emotional, academic, and economic situation. Methods: All steps in psychometric tool development including face, content, and translational validity, pretesting, piloting, and factor analysis were followed. Construct validity was further tested using a cross-sectional study on 400 senior secondary students. Sociodemographic data, Decayed Missing Filled Teeth, Dental Aesthetic Index, and Community Periodontal Index were used to test construct validity. Results: A 20-item tool with five domains (intraclass correlation of 0.857, Cronbach's alpha of 0.811, variance of 64.25%) was developed. Convergent validity was established with a single-item global question and discriminant validity with clinical indices. In the multivariate logistic regression model, malocclusion emerged as the most significant predictor for poor OHRQoL adjusting for socioeconomic status, dental caries, gingival bleeding, and last dental visit. Dental caries and last dental visit also significantly predicted poor OHRQoL in the adjusted regression model. Conclusion: The new tool has sound psychometric properties, is relatively short, culturally equivalent, age-specific, and can assess both positive and negative aspects of adolescent oral health. Further testing in longitudinal studies is required to determine its usefulness as an outcome measure.
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A survey on skills for cone beam computed tomography interpretation among endodontists for endodontic treatment procedure p. 834
Krishnamachari Janani, Raghu Sandhya
Introduction: Cone beam computed tomography (CBCT) is used as a diagnostic tool, which aids in deciding the treatment plan in various fields of dentistry. In endodontics, CBCT is a useful tool in diagnosing apical periodontitis, resorptions, perforation, root canal morphology, traumatic injuries, and voids. The objective of this study was to evaluate the knowledge attitude and practice in diagnosing and interpreting the endodontic treatment using CBCT among the endodontists. Materials and Methods: A cross-sectional questionnaire survey was conducted among endodontists. Overall, 97 participants were included in the survey and the questionnaire containing 15 closed-ended questions was administered to the participants. Descriptive statistics were used to analyze the data. Results: On analyzing the response to the questionnaire, it was found that out of 97 participants, 24 had professional experience of more than 10 years. About 57% of participants preferred using digital radiographic technique for diagnosis. Majority of them were aware that CBCT is used for identifying location, size, and extent of periapical lesions. About 46% of participants stated that in detecting voids, CBCT was thrice significant compared with periapical radiography. According to 31% of the endodontists, CBCT was not reliable to detect vertical root fracture. It was found that 63% of the endodontists said they have not undergone any training or workshop in CBCT. Conclusion: This research study revealed that adequate training and skills are required in interpreting CBCT in endodontic treatment procedure among endodontists.
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Tobacco use among school going children p. 839
Ankita Verma, Mridula Goswami, Jatinder Kaur Dhillon
Background: Despite increasing awareness of harmful effects of tobacco, its use in various forms continues to be significant health risk factors among children. Aim: To assess the prevalence, pattern, and age of initiation of tobacco consumption, various factors influencing the habit of tobacco consumption, correlation between the educational status of children and their habit of tobacco consumption, and evaluation of any tobacco-induced oral lesion among 8–14 years of school going children in Central Delhi zone. Methods and Materials: Total sample of 500 students aged 8–14 years from two schools in Central Delhi were studied using a structured, close ended, prevalidated questionnaire after taking prior permission and inform consent from the school authority. In the end, intraoral examination was done and health educational session was conducted to make students aware of health hazards of tobacco products. Results: Prevalence of tobacco consumption among students was 16.4%. Out of total 82 tobacco users, 89% were male, whereas 11% were female. Smokeless tobacco consumption was predominant with Gutka being most preferred. Mean age of initiation of smoking form of tobacco was 9.57 ± 1.13 year, whereas for smokeless form, it was 9.25 ± 1.16 years. Friends (78.04%) were most common influencing factors, followed by family member (12.2%) and media (9.7%). Conclusion: The rate of tobacco use was high, considering very young age group of this study. Consumption of tobacco among children is an emerging health problem in Central Delhi zone. Mandatory health education sessions against tobacco should be held regularly for students, teachers, and parents.
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Prevalence of oral diseases and risks to oral health in an urban community aged above 14 years p. 844
Chris Merin Varghese, JS Jesija, Jasmin Helan Prasad, Ruby Angeline Pricilla
Introduction: Oral health is a requisite to general health and quality of life. The public health problems associated with oral diseases are a serious burden in every nation around the globe. Aims: The aim of this study is to assess the prevalence of dental problems and the oral health seeking behavior of an urban south Indian population aged >14 years. Materials and Methods: In this population-based cross-sectional study, 101 households were selected through systematic random sampling. About 419 participants were interviewed and information on sociodemographic characteristics, personal, and dental history was obtained and a complete oral cavity examination was performed. Results: The prevalence of dental caries, periodontal problems, and tooth wear were 78.75%, 74.7%, and 72.3%, respectively. The mean number of overall affected teeth in the population by one dental problem is 16 ± 8.13. The mean Decayed, Missing and Filled Teeth (DMFT) score was 4.5. The risk factors that were significantly associated with the poor oral health status were age >31 years (Odds Ratio (OR), 2.88), education less than eighth grade (OR, 2.35), inadequate oral hygiene practices (OR, 1.61), use of any form of tobacco (OR, 2.08), and alcohol consumption (OR, 2.02). Only 185 (44.1%) participants perceived that they had a dental problem at the point of the survey and only 20 of them (10.81%) visited a dentist. Conclusion: This study showed a high prevalence of dental caries, periodontal problem, and tooth wear. This emphasizes the need for community-based awareness program on dental health and recommends periodic dental health screening program at the community level for early diagnosis and better treatment.
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Dental clinic: Potential source of high-risk screening for prediabetes and type 2 diabetes p. 851
Ajinath N Jadhav, Pooja R Tarte, Santosh K Puri
Background: It is predicted that by 2030 diabetes may affect 79.4 million individuals in India. Early diagnosis and prompt treatment of diabetes are essential to prevent or delay its acute or chronic complications. It is observed that the number of patients visiting dentists is significantly increased. This opportunity can be used for early identification of diabetes in dental office. This study assesses the feasibility of high-risk screening for diabetes and prediabetes in private dental care center. Materials and Methods: A cross-sectional study was conducted among patients reporting to the dental clinic. A total of 1150 patients above 40 years of age having one or more risk factors such as family history of diabetes, hypertension, smoking, loss of teeth, and periodontitis were included in the study. Patients were subjected to high-risk screening by random blood sugar (RBS) test. American Diabetes Association criteria indicating normal (RBS 79–140 mg/dL), prediabetic (RBS 140–200 mg/dL), and diabetic (RBS >200 mg/dL) was considered for screening. Results: Among 1150 participants, 64.69% had RBS level within normal range and 20.69% had prediabetic range while 14.60% had RBS level above 200 mg/dL, suggestive of having diabetes. A total of 35.29% patients had hyperglycemia based on random blood glucose level. Conclusion: The study concluded that patients who are unaware about their diabetic status visiting a dental clinic having one or more risk factors of diabetes can be used as potential sources for high-risk screening for diabetes using a simple RBS test and oral examination.
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Odontometric analysis of canines to establish sexual dimorphism in an urban population p. 855
Subraj J Shetty, Ishani Ratnaparkhi, Treville Pereira, Siddharth Acharya, Swati Gotmare, Pooja Kamath
Background: Teeth are the most durable part of the skeleton. Under most of the adverse conditions occurring in nature like putrefaction, mutilation, fire and prolonged immersion in water, teeth are the most indestructible part of the body and may survive all these challenges. Due to this, the use of dental morphology to determine sexual dimorphism is a procedure established in anthropological and biological studies. Among all teeth, canines are found to exhibit greatest sexual dimorphism. Aims and Objectives: This study aimed to determine the gender of an individual based on the bucco-lingual dimensions of the canines and the inter-canine arch width and analyse if any sexual variation existed in them. Setting and Design: It was a cross sectional study. Materials and Methods: In the present study, 50 male and 50 female volunteers residing in Navi Mumbai; in the age group of 18-60 years were selected to observe the sexual dimorphism in the bucco-lingual crown dimensions of the canine and difference in inter-canine width. The bucco-lingual dimensions were measured on the study casts as the greatest distance between the buccal and the lingual surfaces of the canine crown with a digital Vernier calliper. The inter-canine width was measured between the tips of the canines with the calliper beaks placed along the long axis of the teeth. Statistical Analysis used: Unpaired 't' test and ROC curve using SPSS 21.0 statistical programme for Windows. Results: It was found that the bucco-lingual dimension was significantly larger in males as compared to females and the difference was statistically significant. The difference in mandibular inter-canine arch width was statistically significant. Conclusion: The study defines that the bucco-lingual dimensions are more reliable criteria for sexual dimorphism in Navi Mumbai population than the inter-canine arch width. Thus, it is indicated that the dimorphism in canines can be of immense medico-legal use in identification and gender determination.
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Evaluation of the prevalence of comorbidities in patients reporting for dentoalveolar surgeries p. 860
Srivalli Natarajan, Taher Abbas Mistry, Usha Asnani
Background: Medical comorbidities have varied effects on the management of a patient for dentoalveolar surgeries. Prior diagnosis and prudence in such conditions is of utmost importance for avoidance of complications and overall welfare of the patient. There is a dilemma on the extent of investigations required to evidently ascertain the medical status and fitness of a patient for a dental procedure. The objective of this study was to evaluate the prevalence of medical comorbidities in patients reporting for dentoalveolar surgeries, which would help provide data to establish an evidence-based protocol for perioperative workup of all dental surgeries. Methodology: A total of 2872 patients were included in this study age ranging from 13 years to 84 years. Detailed case history of the patient and baseline blood investigations were recorded. Physician's consultation was acquired to identify any medical comorbidity the patient may be suffering from. Results: It was observed that 17.8% of the patients were detected with medical co-morbidities. Hypertension and Diabetes being the most prevalent (Hypertension: 9.1% and Diabetes: 6.2%). This study has shown that 8.8% of all patients in our study were either newly diagnosed with comorbidities or were inappropriately treated for a prediagnosed comorbidity. Conclusion: We conclude that only relying on the medical history provided by the patient is not sufficient to rule out any medical comorbidities and there is a chance of missing out on any undiagnosed medical condition that the patient may be suffering from.
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Salivary visfatin concentrations in patients with chronic periodontitis: An analysis before and after periodontal therapy p. 864
Anudeep Mopidevi, Gautami S Penmetsa, CD Dwarkanath, Kavyamala Dubba, Praveen Gadde
Background and Aims: Visfatin, also known as pre-B-cell colony enhancing factor, is secreted from a variety of cells and is thought to have some proinflammatory and immunomodulating effects. It is indicated that serum/plasma levels of visfatin increase in a number of inflammatory disorders. The present study aims to assess salivary visfatin concentrations and investigate its relationship in patients with chronic periodontitis before and after periodontal therapy. Methods: This prospective clinical study included a total of 20 subjects who were divided into two groups with 10 patients in each viz Group A: Periodontally healthy subjects, Group B: Chronic periodontitis subjects. In group B, the subjects were further assigned as T1 and T2 groups before and after periodontal therapy. Periodontal parameters including plaque index, gingival index, sulcus bleeding index, probing depth and clinical attachment level were recorded at baseline and patients were subjected to periodontal therapy. An ELISA analysis was performed to measure the visfatin levels in saliva in study groups before and after 12 weeks of periodontal therapy. Statistical Analysis Used: The results were evaluated statistically using Student t-test, one way ANOVA, Post-hoc Tukey's test and Pearson's rank correlation method. Results: The salivary visfatin concentrations were reduced significantly after periodontal therapy. There were statistically significant differences elicited in salivary visfatin levels of Group A and T1 of Group B and also between T1 and T2 of Group B. Conclusions: Salivary levels of Visfatin are reduced after periodontal therapy to the levels comparable with those found in healthy individuals. Therefore, the salivary visfatin levels may have the potential to be a target marker for assessment of responses to periodontal therapy.
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Antimicrobial photodynamic therapy using indocyanine green as a photosensitizer in treatment of chronic periodontitis: A clinico-microbial study p. 870
Kunal S Sethi, Chetan P Raut
Background: Photodynamic therapy (PDT) has gained much attention in recent years in the treatment of periodontitis. Number of photosensitizer have been developed and has been used in various clinical studies. However, the use of recently developed photosensitizer has been limited. Aim: The present study aims at comparing and evaluating the effects of photodynamic therapy using Indocyanine green in the treatment of chronic periodontitis. Materials and methods: In present randomized clinical trial, 30 subjects were equally divided into two groups i.e. test group (SRP + Photodynamic therapy) & control group (SRP). Clinical parameters evaluated at baseline and 3 month follow up were, Plaque index, Sulcus Bleeding Index, Probing Pocket Depth, Clinical Attachment Level, Gingival Recession. Microbiological analysis of plaque sample was also done to check for anaerobic mixed flora. Results: Significant reduction was seen in all the clinical parameters in the test group. Anaerobic culture of plaque samples of test group also revealed significant reduction of microorganisms in comparison with control group. Conclusion: Indocyanine Green can act as an alternative to other photosensitizers in photodynamic therapy as an adjunct to SRP in the treatment of chronic periodontitis.
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Comparative evaluation of demineralized bone matrix and type II collagen membrane versus eggshell powder as a graft material and membrane in rat model p. 877
Avinash Kavarthapu, Sankari Malaiappan
Introduction: The regeneration of supportive periodontal tissues after destructive periodontal disease has become one of the primary objectives of periodontal therapy. Demineralized bone matrix (Osseograft), when used, has shown osteoinductive potential and collagen membrane (GTR) prevents the migration of epithelium into it. The literature showed that eggshell which consists of hydroxyapatite and calcium carbonate shows osteoconductive as well as inductive properties. Eggshell membrane which is made of type X collagen matrix can be used as a barrier membrane. Hence, the aim of the study was to compare the demineralized bone matrix with GTR membrane to eggshell constituents and its membrane as a regenerative material in Wistar rats. Materials and Methods: A critical size periodontal defect of 1.5 × 6 mm was created on either side adjacent to mandibular incisors after raising the full thickness flap. Osseograft and collagen membrane covered the defect on one side and the eggshell components and its membrane filled the defects. The animals were sacrificed on the 45th day. Results: Histological evaluation showed intensive new bone formation on both sides of the defect. Inflammation has resolved completely with no signs of eosinophils. Complete defect healing was noted in both the defects. A minimal amount of epithelial entrapment was noted in both the sites. There was no significant difference observed between the comparisons. More connective tissue was found in the test group. Conclusion: Within the limits, it can be concluded that eggshell powder along with membrane can be used as a potential graft material.
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Application of platelet-rich fibrin membrane and collagen dressing as palatal bandage for wound healing: A randomized clinical control trial p. 881
Varsha Sharma, Ashish Kumar, Komal Puri, Mansi Bansal, Manish Khatri
Background: The palatal donor site of the free gingival graft (FGG) significantly influences the pain and discomfort experienced by the patient, and there is a potential for postoperative bleeding. The aim of this study was to compare the wound healing parameters with the use of a commercially available collagen dressing (CollaCote®) and platelet-rich fibrin (PRF) membrane as palatal bandage. Materials and Methods: Twenty patients requiring FGG either for reduced/inadequate gingiva or gingival recession in the maxillary or mandibular anterior region were divided into two groups. In the first experimental group (10 patients), CollaCote® membrane was placed over the palatal wounds; conversely, the second experimental group patients were treated with a PRF membrane as palatal bandage. Clinical parameters recorded includes depth, immediate, and delayed bleeding, size of wound, pain, and tests for epithelialization which included hydrogen peroxide test and toluidine blue test at various time intervals. Results: Intragroup comparisons showed significant improvement in wound healing parameters in both the groups. No statistically significant difference was found on intergroup comparison with respect to depth, hemorrhage, pain, epithelialization, and size, though the PRF group healed slightly better initially. Conclusion: Both CollaCote® and PRF palatal bandages significantly accelerate palatal wound healing and reduce the patient's pain and discomfort. PRF was easier to handle and suture and is also autogenous and economical as compared to CollaCote®.
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Isolation and genetic characterization of mutans streptococci associated with dental caries in rural field practice of a dental institution: In vivo study p. 889
B Santosh Kumar, H Indiresha Narayana, B V Sreenivasa Murthy, Sylvia Mathew, P Damodhar, S S Shantha Kumar
Background: Streptococcus mutans is well-known causative microorganism in the development of dental caries because they drop the plaque pH and produce acids from carbohydrates and survive in the acidic environment. It is now evident that knowledge of the bacteria enforces empirical approach to therapy, then specific antimicrobial therapy that might allow more conservative treatment options. Over the past few decades, there has been a remarkable increase in the prevalence rate of dental caries among children and the elders. Genotypic methods help in the detection and manipulation of nucleic acids which allows microbial genes to be examined directly. Aim: The aim of this study is to isolate and characterize S. mutans from rural population and to obtain genomic DNA and screen DNA band pattern. Methodology: A total of 80 plaque samples were collected from the buccal surfaces of maxillary and lingual surfaces of mandibular first molar with carious teeth in patients at a rural outreach center in Chikkaballapur district, Karnataka. Among these, 48 clinical isolates of S. mutans were recovered. Further, genomic DNA was extracted from all the positively isolated strains including the standard strain (microbial type culture collection 497), and stored at 4°C in tris EDTA buffer (TE). To analyze the molecular heterogeneity of the clinical strains, polymerase chain reaction (PCR), and restriction fragment length polymorphism was performed using restriction enzymes Hind III and Hae III. Using agarose gel electrophoresis, genomic DNA band pattern was analyzed. Results: Statistically significant difference was seen in the “dex” gene collected from sample DNA and standard DNA in three different parameters (S. mutans 497). Conclusion: Genomic DNA of S. mutans was successfully isolated from the rural population. Dex gene was successfully amplified using PCR. Hae III enzymes successfully digested PCR amplicons and the fragments exhibited visible heterogeneity.
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Time required for haemostasis under pressure from dental extraction socket p. 894
Saurabh Kumar, Arun Paul, Rabin Chacko, Sarah Deepika
Introduction: It is generally expected that the time required for a clot to form in an extraction socket must be similar to that of the average physiological bleeding time (2-9 minutes). However, in dental practice does hemostasis require the full clot to form or does it occur earlier? Conventionally there is no accepted average time range for socket hemostasis with estimates ranging from 20 minutes to 40 minutes. This study is an attempt to quantify the average time period required for hemostasis to occur in an extraction socket. Methodology: 1205 consecutive patients attending the dental clinic and requiring dental extractions were evaluated for the average duration of hemostasis after extraction. Exclusion criteria were children (<15 years), pregnant mothers and patients who had a systemic bleeding disorder or were on anticoagulants. The socket was inspected first after five minutes after an extraction and later at 10 minutes and 15 minutes if bleeding continued. Results: Bleeding from an extraction socket settled in less than five minutes in about 83% of individuals and in 10 minutes in 96.5% of cases. Hence it is expected that in an otherwise normal healthy individual socket compression by biting over gauze for around 10 minutes will produce adequate haemostasis. Prolonged bleeding beyond 10 minutes was rare and was controlled with suturing and pressure applied with a gauze pack in healthy individuals. Conclusion: Checking for hemostasis after placing a pressure pack for 5-10 minutes over an extraction socket is a useful act of risk management before discharge of the patient from the clinic to rule out any hemorrhagic tendency.
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Comparison between Rotary (Mtwo) and Manual (H-Files) Techniques for Instrumentation of Primary Teeth Root Canals p. 899
D R Murali Krishna, Jyothsna Vittoba Setty, Ila Srinivasan, Anjana Melwani
Background: The aim of the study is to compare instrumentation time between manual (H-files) and rotary (Mtwo) files along with patient and operator compliance in primary lower molars. Materials and Methods: 30 primary teeth were selected and divided into two groups of 15 in each group instrumented with H-files and Mtwo files respectively. Time taken for instrumentation was calculated using stop watch. Patient and operator compliance was recorded through questionnaire. Statistical Analysis Used: Chi Square test was used to compare the distribution of teeth and number of canals. Independent Student t test was used to compare the mean time taken for instrumentation with both techniques in different canals and the mean overall time for instrumentation where P value is less than 0.001. Chi Square Goodness of Fit test was used to compare the patient's and operator's perspective regarding instrumentation techniques. Results: The instrumentation time recorded with Mtwo files is less when compared with H–files. 66.7% children preferred H–files over Mtwo, 60% children reported pain while using H–files, 60% of children were scared on sight of Mtwo rotary system. Operator could manage 80% of children easily while using H–files, but it was found that operator ease of comfort was more with Mtwo rotary system. Conclusion: Time taken for instrumentation with Mtwo files was less as compared to H-files. It was convenient for the operator to manage the child using H-files but with the use of Mtwo files, marked reduction in the instrumentation time was appreciated.
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Comparison of quality of obturation and post-operative pain using manual vs rotary files in primary teeth - A randomised clinical trial p. 904
S Divya, Ganesh Jeevanandan, S Sujatha, E M G Subramanian, Vignesh Ravindran
Introduction: Cleaning and shaping plays a very important role in success of root canal procedures. There are various instrumentation techniques available for root canal preparation. Recently, an exclusive rotary file for root canal preparation of primary teeth has been introduced. Aim of the Study: The aim of this in vivo study was to compare the quality of obturation and intensity, and duration of post-operative pain between two rotary file systems with manual files during the pulpectomy of primary molars. Materials and Methods: Forty five primary mandibular molars were included in this study, which was randomly allocated into one of the three experimental groups (n = 15). Group A: Instrumentation was done using Hand K-file; Group B: Instrumentation was done using Kedo-S rotary file system; and Group C: Instrumentation was done using K3 rotary file system. The quality of obturation was recorded as optimal, underfilled, or overfilled using standardized intraoral periapical radiographs. This study also evaluated the intensity and duration of postoperative pain at different time intervals: 6, 12, 24, 48, and 72 hours following the pulpectomy. Results: With respect to quality of obturation, less underfilling was noticed in Kedo-S rotary files (16.7%) followed by using K3 rotary files (33.3%) and hand K files (43.3%). Kedo-S file showed the least underfilled canals (16.7%) and comparatively more overfilled canals (26.6%) and it was statistically significant (P value of 0.001 and 0.002 respectively). On comparing the intensity and duration of postoperative pain among the three groups, there was no statistically significant difference between these groups (P > 0.05). Conclusion: Kedo-S pediatric rotary file system shows considerably better quality of obturation when compared to that of K3 rotary and hand K file systems without much of any significant difference in relevance to the post-operative pain.
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Characterization of saliva in immunocompromised patients and tobacco users: A case–control study p. 909
Abha Rani, Mamatha Gowda Panchaksharappa, Neetha Mellekatte Chandrashekarappa, Rajeshwari G Annigeri, Varsha Kanjani
Objective: The aim of the study was to assess salivary flow rate, salivary pH, and salivary albumin concentration in systemically compromised subjects and tobacco users and its comparison to healthy controls. Materials and Methods: Sixty patients were selected and then were equally divided into systemically compromised group, tobacco users, and control group with 20 in each group. Saliva flow rate was assessed using modified Schirmer test (MST), salivary pH was estimated by pH meter, and salivary albumin concentration was determined using bromocresol green method. Results: The salivary flow rate readings measured by MST were 22.65 ± 2.79, 22.6 ± 3.57, and 33.22 ± 2.30 mm/3min in systemically compromised individuals, tobacco users, and control group, respectively (P < 0.001). The salivary pH was 6.80 ± 0.24, 6.81 ± 0.25, and 7.18 ± 0.17 in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). The salivary albumin concentration was 2.49 ± 0.61, 0.73 ± 0.13, and 1.14 ± 0.12 g/dl in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). Conclusion: MST can be routinely used as chair-side investigation to evaluate salivary flow which is objective, inexpensive, easy-to-perform, and patient-friendly. The salivary flow rate, salivary pH, and salivary albumin level in systemically compromised subjects, tobacco users, and normal individuals showed significant differences.
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Cutting efficiency of different diamond burs after repeated cuts and sterilization cycles in autoclave p. 915
Carla Castiglia Gonzaga, Denis Roberto Falcão Spina, Fernanda Mara de Paiva Bertoli, RenataCalixto Lopes Feres, Ana Beatriz Franco Fernandes, Leonardo Fernandes da Cunha
Context: The aim was to evaluate the cutting efficiency of different diamond burs after successive cuts and repeated sterilization in an autoclave. The morphology and grit sizes were analyzed and correlated to cutting efficiency. Materials and Methods: Ten medium-grit diamond burs of five different manufacturers were investigated (KG, KG Sorensen; TH, Tri-Hawk; KM, Komet; HC, Heico; and FD, Frank Dental). Changes in the cutting efficiency of diamond burs on composite resin blocks were measured after five repeated cuts and after five sterilization cycles. Grit sizes were analyzed by scanning electron microscopy (SEM) and correlated to cutting efficiency. The data were statistically analyzed using 3-way ANOVA and Tukey's test (α = 0.05). Results: Significant differences were observed for diamond burs (P < 0.0001) and condition (P < 0.0001). FD presented the lowest mean cut time (21.88s), followed by KM (36.08s). TH (40.18s), HC (41.65s), and KG (42.23s) had the highest cut times. The number of cuts was not statistically significant. New burs had a significantly shorter cutting time (33.38s) when compared with the ones after sterilization cycles (39.55s). A moderate to strong positive correlation was found between diamond size and cutting time (Pearson's coefficient of 0.77). Conclusion: All diamond burs demonstrated lower cutting efficiency after repeated autoclaving. Cutting efficiency did not decrease as the number of cuts increased.
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Bond strength of hard direct reline materials to heat-cured acrylic denture base after immersion in denture cleansers p. 920
Farzaneh Sadat Fatemi, Mahroo Vojdani, Amir Ali Reza Khaledi, Sorour Mohammadi
Background: Immersion-type denture cleansers are commonly used for denture hygiene maintenance. Hence, it is crucial to investigate the effect of denture cleansing solutions on bond strength between direct reline materials and denture base resin. Aims: This in vitro study aimed to determine the effect of denture cleansers on bond strength between direct hard reline materials and denture base resin. Materials and Methods: Cylindrical columns of hard-liners (Hard GC Reline, TDV Cold Liner Rebase, Tokuyama Rebase II Fast) were bonded to heat-polymerized denture base resin. A total of fifty specimens were fabricated for each reline material and divided into five groups (n = 10): Group I (control): No solution was used; Group II: Specimens were stored in distilled water for 60 days; Groups III, IV, and V: Specimens were stored in distilled water for 60 days with daily immersion in either sodium hypochlorite, calgon + sodium hypochlorite, or dentipur tablet for 5 min. The shear bond strength was examined at a cross-head speed of 1 mm/min. Failure mode was evaluated by stereomicroscope. Statistical Analysis: Data were analyzed by two-way ANOVA and Chi-square test (α=0.05). Results: The results showed no significant interaction between the direct hard-liners and denture cleansers (P = 0.119). Hard GC Reline had the highest bond strength, followed by Tokuyama Rebase II Fast, and then, TDV Cold Liner Rebase. No significant difference existed in bond strength between samples immersed in water and cleansers or between the cleansers themselves. Hard GC Reline had more mixed failure mode compared to TDV Cold Liner Rebase and Tokuyama Rebase II Fast. There was a significant correlation between mixed mode of failure and higher values of bond strength (P = 0.008). Conclusions: Within the limitations of the present study, denture cleansing solutions could not significantly influence the bond strength between hard direct liners and denture base resin.
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Knoop microhardness of conventional and microwaved denture base acrylic resins p. 927
Amanda C Schoeffel, Patricia Bagio, Vinicius T Sakima, Simone Soares, Karin H Neppelenbroek, Vanessa M Urban
Background: Microwave polymerization reduces the time of acrylic resin processing, but it is important to select a proper cycle to avoid overheating, porosity, and impairment to the materials' properties. Aims: To evaluate the microhardness of conventional (Vipi Cril-VC) and microwaved (Vipi Wave-VW) acrylic resins after microwave polymerization cycles and the cycles recommended by the manufacturer. It was also evaluated the effect of thermocycling on the microhardness of these materials. Methods and Materials: Specimens (n = 10) were made: 1. WB (water-bath recommended for VC polymerization); 2. M630/25 (10 min at 270 W; 5 min at 0 W; 10 min at 360 W: recommended for VW polymerization); 3. M550/3 (3 min at 550 W); and 4. M650/5 (5 min at 650 W). After 48 h in distilled water at 37°C, specimens were subjected to Knoop test under 25 g during 5 s. The same specimens were submitted to thermocycling (5,000 cycles; 5°C and 55°C; 60 s) and the microhardness was again measured. The results were analyzed by repeated measures one-way analysis of variance/Bonferroni for each material (α = 0.05). Results: For both materials, no difference was obtained for groups polymerized using the cycles recommended by the manufacturer (VC = 19.8 ± 0.9 KHN; VW = 21.0 ± 1.6 KHN) and M650/5 (VC = 19.9 ± 1.5 KHN; VW = 20.9 ± 0.8 KHN). After thermocycling, microhardness decreased in experimental cycles for VC (M550/3 = 17.0 ± 1.9 to 14.6 ± 1.2 KHN; M650/5 = 19.9 ± 1.5 to 17.8 ± 0.8 KHN) and in all microwave cycles for VW (M630/25 = 21.0 ± 1.6 to 18.3 ± 0.9 KHN; M550/3 = 17.5 ± 3.0 to 15.7 ± 2.0 KHN; M650/5 = 20.9 ± 0.8 to 18.2 ± 2.0 KHN) (P = 0.000). The lowest hardness was observed for both resins processed by M550/3 (P = 0.001). Conclusions: Both materials could be polymerized in microwave during 5 min showing hardness similar to the cycles recommended by the manufacturer. Thermocycling did not decrease the hardness of VC polymerized with both cycles recommended by the manufacturer and VW polymerized with the water-bath conventional cycle.
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Comparative analysis of tooth discoloration induced by conventional and modified triple antibiotic pastes used in regenerative endodontics p. 933
Meenakshi Venkataraman, Somya Singhal, Aseem P Tikku, Anil Chandra
Background: Success of the regenerative endodontic treatment depends upon the disinfection of the root canal system. Because almost no instrumentation is carried out, the disinfection protocol relies only on the medicaments used. The most commonly used medicament is triple antibiotic paste (TAP) composed of metronidazole, ciprofloxacin, and minocycline. The major drawback associated with the minocycline is tooth discoloration. Several antibiotics have been suggested as an alternative to minocycline. However, the tooth discoloration potential of these alternative formulations has not been documented. Aim: The present study is designed to evaluate the crown discoloration produced by different modifications of TAP. Materials and Methods: Freshly extracted human anterior teeth (n = 40) were sectioned 3 mm above and 5 mm below the cementoenamel junction. After access cavity preparation and canal enlargement, specimens were randomly divided into four groups (n = 10 for each group), and each group received the following antibiotic paste fillings: TAP with minocycline, TAP with amoxyclav, and TAP with clindamycin. Samples in control group were left empty. Images were taken with DSLR on day 0, 1, and at weeks 1, 2, and 3 at a fixed resolution. The analysis of slices was performed using the ImageJ software and mean values of pixel intensity were calculated. Statistical Analysis Used: Data were analyzed with ANOVA and Tukey HSD tests. Results: TAP with minocycline and amoxyclav induced more coronal discoloration compared with the clindamycin group (P <.001). Conclusion: Modified TAP with clindamycin did not induce clinically visible discoloration up to 3 weeks after placement.
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Dental caries prevalence among 5- to 15-year-old children from SEAR countries of WHO: A systematic review and meta-analysis p. 937
Sonal S Kale, Pradnya Kakodkar, Sahana H Shetiya, SA Rizwan
Objectives: The aim of this review was to estimate the prevalence of dental caries in children 5–15 years of age in the countries of the South-East Asia Region (SEAR) of World Health Organization (WHO) and to describe the different caries indices used in these population-based studies. Materials and Methods: A systematic search was carried out in two databases from 1st January 2005 to 31st May 2015. Studies were included if they met the predetermined eligibility criteria. Quality assessment was done with eight-item checklist. Meta-analysis was done for 5, 12, 15, and 6–15 years age group using software STATA version 12. Results: The search strategy yielded 265 unique articles of which 36 met the inclusion criteria included for the review. Data were available for only three SEAR countries. The quality of the majority of the studies ranged from moderate to high. Heterogeneity between the studies was high (I2 > 98%). Variation in dental caries prevalence was found among different ages and among different SEAR countries. The most commonly used index for measuring dental caries was the dentition status of the 1997 WHO criteria. Conclusion: Dental caries continues to be a prominent oral health problem among children in the SEAR countries with huge variation in the prevalence across ages and countries. This review results can be used to update the “WHO Oral Health Country/Area Profile Program” for dental caries among children for SEAR.
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Relationship of sociodemographic factors on dental caries experience among 11–14-year-old schoolchildren in India p. 948
Radhey Shyam, BC Manjunath, Adarsh Kumar, Ridhi Narang, Mamta Ghanghas
Background: As dynamics of caries is changing, there is a need to understand the impact of sociodemographic factors on dental caries to broaden the horizon of dental caries etiology. Aim: The aim of this study was to assess the relationship of sociodemographic factors on dental caries experience among 11–14-year-old schoolchildren in India. Materials and Methods: A cross-sectional study was carried out among 11–14-year-old schoolchildren in 2015 at Rohtak, India, after approval from the Institution's Ethics Committee. A multi-stage cluster sampling technique was employed for selecting a school randomly from every cluster. Every odd-numbered child from selected class was included in the study through systematic random sampling. Demographic factors were recorded such as education, occupation, income, and socioeconomic status (SES) were assessed using modified Kuppuswamy classification (Oberoi SS 2015). Dental caries was recorded using Caries Assessment Spectrum and Treatment index. Data were analyzed using SPPS 18, Kruskal–Wallis, and Chi-square tests were used with P value fixed at 0.05. Results: The prevalence of dental caries was 28.6% with mean decayed, missing, or filled teeth of 0.60 ± 1.13. Age, gender, position of child, number of siblings, type of family, father's and mother's education, and father's occupation had no significant relationship with dental caries (P > 0.05), whereas mother's occupation, family income, and SES were significantly related to dental caries (P < 0.05). Conclusions: High socioeconomic status of parents had a significant role on increased dental caries experience among children.
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Impacted maxillary molars with rare etiology: A simplified approach to facilitated Eruption p. 954
Tulika Tripathi, Shilpa Kalra, Priyank Rai
Impaction of maxillary molars is an extremely rare condition and difficult to manage. This case reports a rare cause for impacted maxillary molars which has not been reported in the literature till date. A 13-year-old patient with missing right maxillary first and second molars reported to the outpatient department. Cone beam computed tomography scan of maxilla revealed a complex relationship between the roots of first and second molars and a developing third molar crown. Surgical enucleation of third molar facilitated spontaneous eruption of both first and second molars. Dilaceration of the roots and pressure from developing third molar germ led to the impaction of both maxillary molars which has not been reported in literature yet. Hence, careful determination of etiologic factor for impaction and its elimination with periodic introspection may help in treating the problem with simple and conservative methods.
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Nasolabial cyst in buccal mucosa p. 957
SM Balaji, Rooban Thavarajah, Preetha Balaji
Nasolabial cysts are a rare non-odontogenic, soft-tissue, developmental cyst reported till date in the sublabial area and anterior maxillary region. The cyst is a slowly enlarging asymptomatic swelling and non-painful. The cyst is believed to be associated with remnants of the nasolabial duct. In this report, we report a nasolabial cyst of a 48-year-old man in whom the cyst occurred in the buccal mucosa. To the best of our knowledge, this is the first case of nasolabial cyst occurring entirely in the buccal mucosa without involving vestibule. The etiopathogenesis of the cyst is reviewed in light of this case.
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Recurrent ameloblastoma 24 years after hemimandibulectomy: A case report and review of literature p. 960
Saravanan Balasubramaniam, Balaji Jayaraman, Rohini Thirunavukkarasu, Arun Kumar Kamalakaran
Ameloblastoma is a benign, locally aggressive epithelial odontogenic tumor with a high recurrence rate. The management of ameloblastoma has always been controversial and an enigma to the surgeons. Literature suggests that 50% of the recurrences occur during first 5 years after the primary surgery, and the recurrence rate following a radical approach such as a segmental resection is 4.6%. The reasons for recurrence after a radical approach can be multifactorial such as remaining stumps, soft tissues, or intraoperative contamination. The purpose of this case report is to emphasize the fact that a recurrence even after 24 years is possible in spite of a radical segmental resection, and hence, a continuous follow-up of the patient is needed and to highlight the fact that the possibility of malignant ameloblastoma or ameloblastic carcinoma should be ruled out when dealing with such ameloblastomas recurring after a long period after a radical primary surgery.
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Cara smile: Use of planning software to facilitate esthetic dental treatment in a case p. 964
Leonardo Fernandes Da Cunha, Ana Beatriz Franco Fernandes, Marina Samara Baechtold, Gisele Maria Correr, Carla Castiglia Gonzaga
Treatment of the anterior teeth is challenging. Computer resources and software are available to facilitate a digital smile approach, thus allowing the dentist to plan and predict an esthetic result for a patient, particularly when an integrated multidisciplinary approach is necessary. Digital smile design has emerged as a tool in cosmetic dentistry that helps both professionals and the patient to visualize the result, in addition to facilitating a discussion between the two before establishing a final treatment decision. Here, we present a case involving a 27-year-old female who underwent multidisciplinary treatment initiated by digital planning using specific software, namely Cara Smile. The patient presented with complaints of maxillary tooth malalignment, staining, and fractures. To obtain the correct width-to-height ratio, a simulated gingival procedure was performed in the software. Gingivectomy was performed using digital simulation, and 90 days after surgery, cast and wax-up models maintaining the previously planned width-to-height ratio for the maxillary anterior teeth were made. Esthetic crowns and veneers were fabricated using the digital planning protocol. Therefore, Cara Smile is useful to facilitate the diagnosis through digital photos, improve communication between the various professionals involved in treatment, and guide the predictability of treatment and patient acceptance.
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A clinical and histological evaluation of platelet-rich fibrin and CGF for root coverage procedure using coronally advanced flap: A split-mouth design p. 970
Dhanadivya Krishnakumar, Jaideep Mahendra, Geetha Ari, Rajapriya Perumalsamy
The management of gingival recession associated with esthetic concerns and root hypersensitivity is challenging and its sequelae are based on the assessment of etiological factors and the degree of tissue involvement. Procedures using pedicle flaps, free soft-tissue grafts, combination of pedicle flaps with grafts, barrier membranes, and the use of platelet concentrates are all effective for this purpose. The use of the second-generation platelet concentrate, platelet rich fibrin (PRF) has been widely used. Lately, concentrated growth factor (CGF) has evolved as a promising regenerative material, wherein it also acts as a scaffold and accelerates wound healing due to its dense fibrin meshwork. A 21-year-old male patient presented with bilateral multiple gingival recessions due to faulty tooth brushing. Coronally advanced flap with Zuchelli's technique was planned as a treatment modality. Platelet concentrates PRF and CGF were placed bilaterally during the procedure, and the outcome of the treatment was compared. The percentage of root coverage was clinically evaluated, and histological evaluation was also done to assess the density of fibrin meshwork in the platelet concentrates. Nearly 100% of root coverage was achieved with both PRF and CGF membrane 3 months postoperatively. However, CGF showed satisfactory wound healing by the 10th-day postoperatively compared to PRF. As CGF operates on varying centrifugation to separate cells in the venous blood, thereby resulting in fibrin-rich blocks that are much larger, denser, and richer in growth factors as also shown histologically.
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Permanent maxillary first molar with three mesiobuccal canals p. 975
Rohit Nair, Sandhya Khasnis, Jayaprakash D Patil
It is mandatory for every clinician to have a thorough knowledge about the normal internal anatomy of teeth; equally important is the awareness about variations in internal anatomy that could be seen with different teeth. The outcome of a root canal therapy depends significantly on the clinician's awareness about root canal anatomy, followed by their clinical skills. Literature states that the permanent maxillary first molar shows a wide variation in the number of canals particularly with respect to the mesiobuccal root. This case report describes the endodontic management of a permanent maxillary first molar with three distinct mesiobuccal canals.
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Intracranial variant of encephalotrigeminal angiomatosis – A case report p. 978
N Mohan, R Karthik, Saramma Mathew Fenn, PT Ravikumar, A Cicilia Subbulakshmi
Encephalotrigeminal Angiomatosis is a rare developmental phakomatoses characterized by the occurrence of nevus flammeus (port-wine stain) along the distribution of branches of trigeminal nerve, vascular angiomas in the eye, and leptomeningeal angiomas affecting 1 in 1,00,000 South Asian population. Herewith, such a rare case of such encephalotrigeminal angiomatosis in a 24-year-old male is described.
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