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   Table of Contents - Current issue
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May-June 2019
Volume 30 | Issue 3
Page Nos. 329-480

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GUEST EDITORIAL  

Importance and implications of research experience in undergraduate dental curriculum p. 329
Satheesh Elangovan
DOI:10.4103/ijdr.IJDR_568_19  PMID:31397401
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EDITORIAL Top

Oral microbes and NCDs p. 331
SM Balaji
DOI:10.4103/ijdr.IJDR_558_19  PMID:31397402
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Prevalence of dental caries, oral health awareness and treatment-seeking behavior of elderly population in rural Maharashtra p. 332
Subhash Salunke, Vinod Shah, Truls Ostbye, Anjali Gandhi, Deepak Phalgune, Matilda Olajumoke Ogundare, Vaidehi Sable
DOI:10.4103/ijdr.IJDR_356_17  PMID:31397403
Background and Objective: There have been numerous studies of oral health status of school children and young population; however, similar studies in elderly population in India are lacking. With advances in medical science and consequent increase in life expectancy, elderly population is on the rise and is a subject of growing concern for public health policy. Hence, an attempt was made to study factors influencing decayed, missing, and filled teeth (DMFT) index, oral health awareness, and dental treatment-seeking behavior of elderly population. Methods: A cross-sectional community-based survey was conducted between September 2014 and December 2014 in villages in rural Maharashtra. Sociodemographic and health-related information were collected from 352 participants 60 years of age and above in 10 villages. Results: Prevalence of dental caries was 76.4% in a study population with median DMFT score of 12 with interquartile range of 7–22. The majority of the participants cleaned their teeth with fingers using charcoal and mishri. Only 17.2% participants used toothbrush. About 39% participants had experienced dental pain, of which majority did not visit dentist. The median DMFT index who used toothbrush and toothpaste was significantly less when compared with participants who did not use tooth brush and tooth paste. The majority of the participants had one or more missing teeth, but only 2.2% were using dentures. Conclusion: There is an urgent need for comprehensive oral health educational programs, and accessible and affordable oral health services to be provided to rural community.
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Epiphora drainage by DCR – Long-term results p. 337
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_437_19  PMID:31397404
Background: Dacryocystorhinostomy (DCR) refers to the surgical procedure that is used to relieve the chronic obstruction of the nasolacrimal duct obstruction (NLDO). In a maxillofacial setting, NLDO may arise subsequent to a facial trauma or orthognathic surgery. There is a dearth of literature from this part of the world. This article intends to provide a single maxillofacial center experience in DCR. Materials and Methods: This is a retrospective, noncomparative, noninterventional, record audit type of study of all consecutive patients fulfilling inclusion and exclusion criteria. All patients with epiphora and diagnosed with lacrimal apparatus damage between 1 January 2008 and 31 December 2017 requiring DCR were considered for the study. Details of demographics, phase of treatment (primary/retreatment), types of bones involved, age, complications, period suffering from epiphora, and follow-up were obtained. All data were entered and analyzed using the Statistical Package for the Social Service (version 16; IBM). Descriptive statistics of the frequency and mean ± standard deviation (SD) as appropriate were presented. Chi-square test and one-way analysis of variance were used appropriately. P ≤ 0.05 was taken to be statistically significant. Results: In all, 83 patients fulfilled the inclusion and exclusion criteria. It is more common in males (n = 56, 67.47%) with a mean ± SD of 32.24 ± 10.80 (18–59 years) with 27 (32.53%) of them presenting primarily after fractures. Fracture was the most common pathology seen in 81.93% (n = 68) of cases, while the rest were as a result of orthognathic cases. Le Fort II and III set of bones contributed to 59% of cases, while the orbitonasal complex contributed to only three cases. NLD obstruction was seen in 68 (81.9%) of cases. On an average, the patients suffered for 9.3 ± 6.74 months (range 0.5–22 months) before seeking treatment and the average follow-up was 31.07 ± 11.69 months (range 15–54 months). Discussion and Conclusion: Fractures and surgeries involving nasal bones carry an innate risk of damaging the NLD system. The pattern of need for DCR and occurrence of NLDO in this part of the world have been described. The extent of the anatomical variations and need for proper surgical planning are highlighted.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

East java extract propolis as potential intracanal medicament in experimentally induced chronic apical periodontitis p. 342
Tamara Yuanita, Sri Kunarti, Nanik Zubaidah
DOI:10.4103/ijdr.IJDR_236_17  PMID:31397405
Introduction: A persistent infection after cleaning and shaping root canal is the main etiology of root canal treatment failure. Enterococcus faecalis has been considered as one of the most resistant species in root canal treatment. E. faecalis can stimulate receptor activator of nuclear factor-kappa B ligand (RANKL) which can increase nuclear factor of activated T-cell (NFATc1) in chronic apical periodontitis. East Java propolis has antibacterial effects and is biocompatible with in vitro effects. Aim: This study is aimed to analyze the East Java propolis extract as potential intracanal medicament in chronic apical periodontitis caused by E. faecalis bacterial infection. Materials and Methods: This study used 30 Wistar rats divided into three groups. In Group I, the first upper right molar tooth as healthy tooth was used for negative control group. In Group II, the first upper right molar tooth was used for a prepared root canal, and 10 ml brain heart infusion broth containing E. faecalis ATCC29212 106 CFU was injected into the canal and restored with glass-ionomer cement (GIC) for the experimentally induced chronic apical periodontitis group. In Group III, after root canal preparation, E. faecalis ATCC 29212 106 CFU was injected, and then, 10 μl propolis applied and tooth restored with GIC. It took 21 days for the periapical lesions to develop after pulp infection. The rats were then sacrificed to conduct immunohistochemical examinations in order to measure the expressions of RANKL and NFATc1. Results: The average of RANKL and NFATc1 expression in Group III was significantly lower than those in the experimentally induced chronic apical periodontitis group (P < 0.05). Conclusion: It can be concluded that East Java propolis extract is a potential intracanal medicament through the study of experimentally induced chronic apical periodontitis caused by E. faecalis infection in Wistar rats.
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A clinical evaluation on the effect of astringent on keratinization of oral mucosa before and after the insertion of complete denture p. 347
Rohit S Menon, MR Dhakshaini, Anil Kumar Gujjari, Usha Hegde
DOI:10.4103/ijdr.IJDR_620_17  PMID:31397406
Context: Conventional complete dentures still remain a viable method of treatment for many patients in this era of fixed prosthesis like dental implants. All patients undergoing complete denture treatment need nonsurgical preprosthetic treatment for the preparation of healthy denture bearing mucosa as well-keratinized healthy mucosa is desirable for a complete denture. Aims: To evaluate and compare the keratinization before and after denture insertion at intervals of 1 week and 1 month. Settings and Design: The present study was conducted on 24 completely edentulous male subjects divided into control and study groups. Each patient in study group was asked to massage with astringent on the denture bearing mucosa over a 4-week period. Subjects and Methods: Exfoliative cytology was used to collect the surface cells from the palatal mucosa and buccal mucosa. The first smear was taken before the denture insertion. The second and third smears were taken after the stimulation treatment with astringent gel for each patient after 1 week and after 4 weeks. Each smear was stained with the Papanicolaou's technique. The number of basal cells, intermediate cells, and superficial cells were recorded to calculate the degree of keratinization. Statistical Analysis Used: Descriptive statistics, paired samples t-test, independent t-test, and repeated-measures analysis of variance. Results: The result showed statistically significant increase in the keratinization of palatal mucosa after 4 weeks of astringent therapy and no effect was noted in the keratinization of buccal mucosa. Conclusions: Astringent has shown to increase keratinization of palatal mucosa, and so it can be used to increase the quality of the denture bearing mucosa; moreover, the astringent stimulation has no effect on the keratinization of buccal mucosa.
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Accuracy of Demirjian's and Indian-specific formulae in age estimation using eight-teeth method in Kanyakumari population p. 352
S Akhil, T Isaac Joseph, KL Girish, Pradeesh Sathyan
DOI:10.4103/ijdr.IJDR_768_17  PMID:31397407
Background: Most of the scientific formulae for age estimation in forensic odontology were tested among western population and hence cannot be applied to the Indian population consistently. Therefore, it was in this context that Dr. Ashith B. Acharya had carried out a study using the modified Demirjian's method in Indian population and found out that the study gave inferior results for age estimation. So he developed Indian-specific regression analysis and worked out a formula. Aim: This study was done to validate age using Demirjian's eight-teeth method and to compare the effectiveness of Demirjian's formula and Indian-specific formula in Kanyakumari population. Material and Methods: Digital orthopantomographs of 150 patients fulfilling the inclusion and exclusion criteria in the age group of 8–24 years were used in the study. The third quadrant in the radiograph was assessed visually from mandibular central incisor to the third molar using Demirjian's modified criteria chart. Calculation of the dental age was done using Demirjian's formula and Ashith B. Acharya's Indian-specific formula. The difference between chronological age and dental age was calculated, and the mean absolute error (MAE) was obtained. Results: The MAE was 0.20 years for the whole of Kanyakumari population, and for males it was 0.10 years and for females 0.29 years with Indian-specific formula, whereas the MAE was 2.66, 1.86, and 3.51 years, respectively, for the whole of Kanyakumari population, males, and females using Demirjian's formula. Conclusion: The observations from this study suggest that the MAE was less between chronological age and estimated dental age which was calculated using Indian-specific formula, compared with the values obtained using Demirjian's formula. Thereby we conclude that Indian-specific formula is more reliable in age estimation of Kanyakumari population.
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Comparison of skeletal changes related to patients with chronic kidney disease and healthy individuals in digital panoramic radiography p. 358
Mehrdad Abdinian, Mojgan Mortazavi, Zahra Jandaghian
DOI:10.4103/ijdr.IJDR_175_18  PMID:31397408
Background: Chronic kidney disease (CKD) is a prevalent condition affecting bone metabolism. Bone changes in CKD patients also known as renal osteodystrophy happen due to disorders in the regulation of water and electrolytes caused by the disease. The aim of this study is to investigate the bone changes of CKD stages 3–5 patients without dialysis using digital panoramic radiography. Materials and Methods: In this cross-sectional study, panoramic radiographs were obtained from 30 patients with CKD stages 3–5 and 30 age and gender matched healthy individuals. The mean values of quantitative parameters such as mental index (MI), panoramic mandibular index (PMI), and antegonial index (AI) were measured and qualitative parameters such as mandibular cortical index (MCI) and trabecular bone pattern (TP) were recorded based on Kelemetti and Lindh calcifications, respectively. Statistical analysis was performed using t-test, Chi-square, and Mann–Whitney test (α = 0.05). Results: The mean values of MI, PMI, and AI in the two groups were not statistically significant (P > 0.05). MCI and TP were significantly different between the two groups. MCI showed more defects in mandibular cortex of CKD patients (6.7% of patients vs. 0% of control group were C3, P = 0.038), and TP showed more porosity in mandibular bone of CKD patients (10% of patients vs. 0% of control group were sparse, P = 0.001). Conclusion: The amount of MI, PMI, and AI were not related to CKD. While MCI and TP were significant parameters that showed mandibular cortical situation and trabecular bone pattern, they assess osteoporosis level in a more reliable manner in CKD stages 3–5 patients without dialysis.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Awareness of orthodontic treatment among school teachers in Karad Taluka p. 363
Aniket Harishchandra Mhatre, Pratap Mane, Kasseya Roy Mathew, Chanamallappa R Ganigar, Renuka Pawar, Sandesh Phaphe, AR Yusuf Ahammed
DOI:10.4103/ijdr.IJDR_631_17  PMID:31397409
Introduction: Health is defined as a state of complete physical, mental, and social well-being. Awareness of orthodontic treatment varies in different regions. Undergoing orthodontic treatment to correct malocclusion would be very beneficial to children as it could help eliminate bullying by peers regarding facial appearance. This kind of bullying by peers could affect the child psychologically. Materials and Methods: A questionnaire survey was conducted in Karad Taluka in Maharashtra. A total of 378 subjects were selected. The schools were randomly selected. A questionnaire including general information, knowledge, and awareness of orthodontic treatment was prepared, and the teachers were given 15 min to fill it. Since it was a short period of time to gather information from other sources, the participants answered the questionnaire using their own knowledge. The purpose of this questionnaire, which consisted of 12 questions in both English and Marathi was to evaluate the level of knowledge the teachers had about orthodontic treatment. The purpose of the study and questionnaire forms were explained by the examiner. The responses of the teachers to the questions were recorded on a 2-point Likert scale {YES or NO}. Results: Simple descriptive statistics was applied to describe the study variables. A Chi-square test of independence was performed to check independence between answers and gender for each question. Conclusion: Within limits of this study, it may be concluded that knowledge of available treatments was more in males compared to females in rural areas.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Relationship of the airway size to the mandible distance in Chinese skeletal Class I and Class II adults with normal vertical facial pattern p. 368
Alqassam Firwana, Hua Wang, Lian Sun, Jialu Wang, Wei-Bing Zhang
DOI:10.4103/ijdr.IJDR_526_18  PMID:31397410
Objective: This study aims to evaluate the pharyngeal airway dimensions among Chinese adults in relation to Class I and Class II facial skeletal patterns using three-dimensional cone-beam computed tomography (CBCT) images. Materials and Methods: A total of 156 initial CBCT images were evaluated, which were classified into skeletal Class I and Class II according to ANB angle with mean (SD) age being 22.56 ± 4.0 years and 22.32 ± 3.6 years. The pharyngeal airway volume, airway area, minimum cross-sectional area (MCA) and the distance from uvula (tip of the soft palate) to mental spine (U-MS distance) were assessed with Dolphin imaging software. Results: Compared with Class I group, Class II group displayed significantly smaller pharyngeal airway volume, airway area and MCA (P <.01, P =0.03, and P =0.008, respectively), and shorter U-MS distance (P <.001). Comparing gender subgroups, the female subgroup showed the smallest airway measurement. Spearman correlation test results showed that the airway volume and area had a significant positive correlation with U-MS distance (r = 0.22, P = 0.005, and r = 0.28, P < 0.005, respectively) and negative correlation with ANB angle (r = −0.23, P = 0.002, and r = −0.21, P = 0.007, respectively). Conclusions: Pharyngeal airway volume, airway area, MCA, and the U-MS distance were smaller in skeletal Class II than Class I Chinese adult subjects and lower in female Class II subgroup. Additionally, there was a correlation observed between the mandibular distance (U-MS), ANB angle and airway size.
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Fluoride concentration of bottled water and public water in Lebanon p. 375
Mounir Doumit, Lamia Abi Aad, Mouhamad Machmouchi
DOI:10.4103/ijdr.IJDR_604_18  PMID:31397411
Background and Aims: People in Lebanon turned to bottle water consumption because of its poor public water quality. In general, fluoride is known as dental caries preventive. A study in 1986 and two other national surveys in 1994 and 2004 showed that the concentration of fluoride in public Lebanese water was insignificant for the prevention of dental caries (less than 0.3 mg/L). The aim of the study was to measure the fluoride concentration in the highest selling and known commercial brands for bottled water in Lebanon, as well as to assess their effectiveness regarding prevention of dental caries. Result: Fluoride has a notable therapeutic effect but in small doses that fluoride can be found in drinking water. Analysis using an absorptiometry of 625nm and another technique using an Orion electrode of 9609 BN have shown the low content of fluoride in the Lebanese waters (less than 0.3 mg/l). Strategies have recently been evolved based on fluroide supplementation (if the results turn negative) to reduce the index of caries in LEBANON.
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Morphological variations of the maxillary sinus floor adjacent to periapical chronic injuries p. 381
Yris Eliza Chavez-Lazo, Luis Ernesto Arriola-Guillén, Yalil Augusto Rodríguez-Cárdenas, Gustavo Armando Ruiz-Mora, Maria Eugenia Guerrero
DOI:10.4103/ijdr.IJDR_669_17  PMID:31397412
Background: Today, there are several diagnostic methods to determine the exact size and nature of periapical lesions. Furthermore, there are studies that described thickening of the mucous membrane of the maxillary sinus (MS) in patients with periapical lesions and demonstrated a causal relation. Aims: This study aims to evaluate the morphological variations of the MS floor (MSF) adjacent to chronic periapical lesions in molars and premolars using cone-beam computed tomography (CBCT). Methods: Twenty-five CBCTs with periapical lesions adjacent to maxillary molars and premolars were evaluated. A total of 50 maxillary sinuses were analyzed (12 males and 13 women) taking into account density changes within the sinus cavity. The thickening of the sinus mucosa and the periapical lesions was measured in a caudal-cephalic direction. The axial and sagittal axis was taken as reference on the sagittal and coronal sections. Statistical Analysis: Chi-square, Fisher exact, and the Mann–Whitney tests were used in this study. Results: A significant association between the size of the periapical lesions (>4 mm) and the presence of MSF affectation was found on sagittal and coronal views (P < 0.001). No significant differences between the presence or absence of periapical lesions and the thickening of the sinus mucosa were found (P = 0.241). The presence of opacification on the MS had no direct associations with the periapical lesions. Conclusions: Maxillary sinus floor affectation was associated with chronic periapical lesions >4 mm. The opacification or thickening of the sinus mucosa was not related with the periapical lesions.
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Comparison of WALA ridge and dental arch dimensions changes after orthodontic treatment using a passive self-ligating system or conventional fixed appliance p. 386
Tarso Esteves, Karina Maria Salvatore Freitas, Darwin Vaz de Lima, Paula Cotrin, Rodrigo Hermont Cançado, Fabrício Pinelli Valarelli, Marcos Roberto De Freitas, Renata Cristina Gobbi de Oliveira
DOI:10.4103/ijdr.IJDR_361_18  PMID:31397413
Objective: To compare changes in WALA ridge and mandibular dental arch dimensions in orthodontic patients treated with a passive self-ligating system and conventional appliances. Design: Original paper. Setting: Orthodontic department at Inga University Center, Maringá, PR, Brazil. Materials and Methods: Pretreatment (T1) and posttreatment (T2) dental casts of 60 patients with Class I malocclusion treated with slight to moderate crowding that were divided into two groups. Group 1: 30 patients treated with a passive self-ligating system, at a mean initial age of 17.68 years and mean treatment time of 2.31 years. Group 2: 30 patients treated with conventional appliances, at a mean initial age of 19.23 years and mean treatment time of 2.56 years. Measurements were taken using a digital caliper directly on pre and posttreatment dental casts to evaluate the transversal dimension behavior of the mandibular dental arch and the WALA ridge width. Results: Self-ligating group presented an increase in WALA ridge width and mandibular transversal dimensions significantly greater than the conventional group, with the exception of intermolar cusp tip distance and intercanine WALA ridge. There was no statistically significant difference between the groups. There was also observed a significantly greater increase of the transversal buccal axis dimensions in the premolar area when compared to the WALA ridge increase in both groups. Conclusions: Treatment with a passive self-ligating system resulted in a significantly greater increase of the WALA ridge width and mandibular arch dimensions when compared to conventional appliance.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Effect of surface treatments on staining and roughness of bleached enamel p. 393
Débora Drummond Hauss Monteiro, Pablo Thiago Valentim, Daniel Cunha Elias, Allyson Nogueira Moreira, Tulimar Pereira Machado Cornacchia, Cláudia Silami Magalhães
DOI:10.4103/ijdr.IJDR_233_16  PMID:31397414
Background: The objectives were to evaluate the effect of surface treatments and waiting time before contact with dye on bleached enamel staining and surface treatments on roughness. Methods: One hundred bleached teeth were randomly assigned to G1 artificial saliva, G2 2% sodium fluoride (Flugel, Nova DFL), G3 casein phosphopeptide-amorphous calcium phosphate fluoride paste (MI Paste Plus, GC America), G4 rinse for bleached color maintenance (Keep White Rinse, DMC), and G5 polishing with impregnated disks (SuperBuff Disk, Shofu). Fifty specimens were immersed in coffee immediately after treatment; the others 1 h after. Color difference (ΔE) was evaluated with a spectrophotometer (Vita EasyShade) and roughness (Ra, Rq) with an optical profilometer (NewView 7300). Effects were analyzed with two-way ANOVA, Friedman, and Kruskal–Wallis test (P < 0.05). Results: Surface treatments (P = 0.878), waiting time (P = 0.105), and interaction (P = 0.145) were not significant to bleached color maintenance. Roughness was different among the evaluation time points (2nd evaluation >1st evaluation >3rd evaluation) (P < 0.001); not among surface treatments (G1, G2, G3, G4, G5) (P > 0.05). Conclusions: Surface treatments were similar to saliva for bleached enamel color maintenance. Immediate or 1-h postponed contact with coffee did not affect bleached enamel color. Bleaching increased enamel roughness; surface treatments and artificial saliva decreased it.
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In vitro antimicrobial potential of infant mouthwashes against streptococcus mutans biofilm: A preliminary study p. 399
Glenda Guimarães Sampaio, Gabriela Leódido, Letícia Machado Gonçalves, Marco Aurélio Benini Paschoal
DOI:10.4103/ijdr.IJDR_500_17  PMID:31397415
Background: Children and teenagers accumulate dental plaque easily due to immature motor coordination present at this specific age. Thus, chemical solutions such as mouthwashes are used for biofilm control. The widespread use of mouthwash could potentially change the oral environment though there is no evidence of its effects on the biofilm. Aim: The present study aimed to investigate the in vitro antimicrobial potential of infant mouthwashes on mature Streptococcus mutans biofilm. Methods: The susceptibility of S. mutans biofilm UA 159 (ATCC700610) to infant mouthwashes was tested with childrens mouthwashes containing the following active agents: G1-cetylpyridinium chloride, G2-xylitol and triclosan and G3-Malva sylvestris and xylitol. Phosphage-buffered saline (PBS) was used at the negative control (G4). In this study, cariogenic biofilm was exposed once a day for one minute to the mouthwashes over a period of five days. Following this, an aliquot of each mouthwash used was seeded in brain heart infusion (BHI) agar and then incubated at 37°C, 5% CO2 for 48 h. The results were expressed as colony-forming units (CFU) and converted into log10. The results were submitted to ANOVA and Tukey's test at 5%. Results: It was observed 7.75, 7.66, and 7.49 CFUlog10 values to G1, G2, and G3, respectively, with 9.53 CFUlog10 value to G4. Accordingly, all studied mouthwashes showed no significant statistical difference between them but with statistically significant bacterial reduction in comparison to control group. Conclusion: Infant mouthwashes presented a highly significant antimicrobial effect on cariogenic biofilm in an in vitro model, which raises concern when used by a young population.
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Comparative evaluation of microleakage around Class V cavities restored with alkasite restorative material with and without bonding agent and flowable composite resin: An in vitro study p. 403
Priyatama Meshram, Vikas Meshram, Devendra Palve, Sanjay Patil, Vandana Gade, Amber Raut
DOI:10.4103/ijdr.IJDR_767_17  PMID:31397416
Background: Marginal adaptability of restorative material is one of the prime factors for success of a restoration. Aim: To evaluate microleakage at enamel restoration and dentin restoration interface of Class V cavities restored with new alkasite restorative material Cention-N, with and without using bonding agent and flowable composite resin. Materials and Methods: Thirty Class V tooth preparations were divided into three groups (n = 10): Group-I restored with Cention-N (Ivoclar Vivadent) without adhesive, Group-II was restored with Cention-N after application of eighth-generation bonding agent (3M ESPE, Single Bond Universal Adhesive), and Group-III was restored with flowable composite resin (Tetric-N-Flow, Ivoclar Vivadent). All samples were subjected to 200 thermocycles between temperature baths at 5°C and 55°C. All samples were cut longitudinally through the center of the restorations with the help of isomet diamond saw. The sections were then observed under binocular stereomicroscope at 20×. Two evaluators scored the depth of dye penetration independently at enamel and dentin margins. Statistical Analysis: Kruskal–Wallis nonparametric analysis followed by Dunn's multiple comparison tests were done to evaluate differences among the experimental groups. Mann–Whitney test was used to compare the difference between occlusal and gingival scores within each restoration. Results: Microleakage seen in decreasing order: Cention-N without adhesive >Flowable composite >Cention-N with adhesive. Conclusion: Microleakage at enamel restoration interface was less than microleakage at dentin restoration interface of each group, but the difference was not statistically significant. Least microleakage was seen with Cention-N with adhesive followed by flowable composite. More microleakage was seen with Cention-N without adhesive.
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Effect of ionizing radiation on the properties of restorative materials p. 408
Renally Bezerra Wanderley E Lima, Laís César De Vasconcelos, Maria Luiza Pontual, Sônia Saeger Meireles, Ana Karina Maciel Andrade, Rosângela Marques Duarte
DOI:10.4103/ijdr.IJDR_72_17  PMID:31397417
Aim: The aim of this study is to evaluate the effect of different doses of the ionizing radiation (0 Gy, 10 Gy, 30 Gy, and 60 Gy) on the physical properties of dental materials. Methodology: Disc-shaped samples from each material (Ketac Molar Easymix, Vitro Molar, Vitremer, Vitro Fil Lc, Filtek Z 250 and Filtek Z 350) were made for water solubility, sorption analysis (n = 20), microhardness (n = 20), and surface roughness analysis (n = 24). Specimens were divided into four groups, according to radiation dose: control group (0 Gy), 10 Gy, 30 Gy, and 60 Gy. For water solubility and sorption analysis, the specimens were irradiated and were stored for 21 days to calculate the water solubility and sorption values. Microhardness analysis was carried out before and after irradiation doses. For surface roughness analysis, the specimens were submitted to brushing test, and after 24 h, initial surface roughness analysis was made in a rugosimeter. Subsequently, the samples were irradiated and final surface roughness analysis was made. The original water solubility and sorption, surface roughness, and microhardness values were subjected to ANOVA two-way statistical analysis and Paired t-test and Tukey post hoc test (α = 0.05), respectively. Results: Water solubility and sorption values, and surface roughness values presented statistical difference between groups (0, 10, 30 e 60 Gy) for all materials. Conclusions: High doses of ionizing radiation (30 Gy and 60 Gy) increased the surface roughness, sorption, and solubility for the most materials.
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Diffusion of hydroxyl ion on external root surface using different irrigating solutions: An In vitro study p. 414
Monique Costa Moreira França, Tânia Mara da Silva, Renata Camila Queiroz, Cláudia Villela Bin, Flávia Goulart Da Rosa Cardoso, Márcia Carneiro Valera
DOI:10.4103/ijdr.IJDR_253_17  PMID:31397418
Aims: The aim of this study was to evaluate the diffusion of hydroxyl ion to the external root surface using different irrigating solutions and intracanal medication with calcium hydroxide. Materials and Methods: Sixty bovine tooth roots were randomly divided into six experimental groups (n = 10), according to the irrigating substance used during biomechanical preparation: 12% glycolic propolis extract (PROP); 20% glycolic ginger extract (GENG); 2% sodium hypochlorite with surfactant (NaOClS); 2% chlorhexidine gel (CLX); 2.5% sodium hypochlorite (NaOCl); and physiological saline solution. After filling the root canals with calcium hydroxide paste, pH measurements were taken directly at the external cavities over time intervals of up to 30 days. Statistical Analysis Used: Data were submitted to two-way ANOVA and Tukey's test (P < 0.05). Results: The pH of the external root surface was increased when the surfactant associated with NaOCl was used. However, the pH values were very close for the different groups. Hydroxyl ion diffusion up to the external root surface did not exceed the pH value of 8.5, and in the hollow passage of the canal, the pH was higher than 12. Conclusions: Hydroxyl ion diffusion of calcium hydroxide paste through the dentinal tubules up to the external root surface allows minimal alkalinization of this surface, and it is greater when using NaOCl with surfactant during biomechanical preparation.
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Evaluation of debris and smear layer removal with XP-endo finisher: A scanning electron microscopic study p. 420
Anita Jayakumaar, Arathi Ganesh, Rajeswari Kalaiselvam, Mathan Rajan, Kandaswamy Deivanayagam
DOI:10.4103/ijdr.IJDR_655_17  PMID:31397419
Context: The presence of smear layer and debris can prevent the irrigant and sealer from penetrating the dentinal tubules thereby compromising the seal of the root canal filling. Aim: This study aims to evaluate the efficacy of XP-endo Finisher with ProTaper Next and HyFlex in smear layer and debris removal. Materials and Methods: Thirty-two extracted mandibular premolar teeth were selected and sectioned at the cementoenamel junction. The roots were then randomly divided into 4 groups. In group 1 and 2, canals were instrumented with X2 ProTaper Next (25 0.06 taper). In group 3 and 4, canals were instrumented with HyFlex system (25 0.06 taper). The canals in group 2 and 4 were further finished with XP-endo Finisher. Irrigation was carried out using 3% sodium hypochlorite during instrumentation, and 17% ethylenediaminetetraacetic acid was used as the final rinse. The roots were then split longitudinally. The canal wall was observed under the scanning electron microscope in coronal, middle, and apical thirds at a magnification of ×400 and ×1000 for evaluation of debris and smear layer, respectively. Photomicrographs were taken, and qualitative assessment for debris and smear layer removal was done. Statistical Analysis Used: The results were analyzed using Kruskal–Wallis test and Mann–Whitney U-test. Results: Lower debris and smear layer scores were seen in canal thirds instrumented with ProTaper Next and XP-endo Finisher (P < 0.01). Conclusion: The use of XP-endo Finisher as an adjuvant during shaping and cleaning produced cleaner root canal walls.
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On the understanding of zinc-oxide eugenol cement use prior to etch-rinse bonding strategies p. 424
Catarina Pires Bezerra, Cristiano Fukugawa Campos, Julio Leite, Marina Struncová Fernandes, Cintia Helena Coury Saraceni, Flávia Pires Rodrigues, Maristela Dutra-Correa
DOI:10.4103/ijdr.IJDR_302_16  PMID:31397420
Context: Zinc-oxide eugenol (ZOE) is frequently used due to its satisfactory biological response, sedative effect on the pulp, and easy removal. However, literature is very controversial about the influence of the temporary cement-containing eugenol on the bond strength properties. Aims: This study aims to clarify the literature controversy by evaluating the bond strength of ZOE or ZOE-free applied before bonding procedures and the 7-day resting period after the first session. Settings and Designs: Twelve recently extracted third molars were randomly divided into three groups: Group 1: Control (without treatment), Group 2: Temp-Bond NE; Group 3: Temp-Bond. Subjects and Methods: After temporary restorations, the teeth were immersed in distilled water and stored for 7 days at 37°C. The temporary cement was mechanically removed, and prophylaxis was performed. The adhesive procedures were performed, and a 6-mm-high composite resin block was built. The teeth were immediately stored at 100% relative humidity at 37°C for 24 hours. Specimens with 0.7 (±0.2) mm2 of cross-sectional area were obtained and subjected to a microtensile bond strength (μTBS) test at 1 mm/min until failure. Statistical Analysis Used: Analysis of variance (ANOVA) and Tukey's post hoc test were used for statistical analysis. Results: ZOE or ZOE-free cement did not interfere in the μTBS between resin composite and dentine when used with a two-step-etch-rinse adhesive material, considering 7 days of resting period after the first session, by the ANOVA and Tukey's post hoc test (P < 0.05). Conclusions: The authors recommend the removal of the temporary cementation at least seven days after the first session and suggest that the clinicians follow-up further studies to use the cement in case its removal is recommended within a longer period.
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SYSTEMATIC REVIEWS Top

Effect of extraction or nonextraction orthodontic treatment modality on favorability of eruption of impacted third molars p. 428
Dhanyashri Kamalakannan, Venkateswaran Anathanarayanan, Sridevi Padmanaban
DOI:10.4103/ijdr.IJDR_142_17  PMID:31397421
Objective: The objective of the study is to determine if extraction of permanent teeth, for orthodontic purpose, causes a change in third molar angulation and also to determine if extraction of permanent teeth causes an increase in eruption space available for third molars. Methods: This systematic review includes retrospective cohort studies which evaluated the change in third molar angulation or eruption space available for third molars among orthodontic patients treated by a fixed appliance with either extraction or nonextraction protocol. Search engines used were MEDLINE, IndMED, Web of Science, Cochrane, EMBASE, and Google Scholar from the year 1975 to 2015. Separate data collection forms were used to extract data from the studies. The Cochrane Risk of Bias Assessment Tool was used to assess the studies included in the systematic review. Results: Fifteen studies included in the systematic review proved that third molar angulation and eruption space improved in patients treated with extraction treatment modality. However, two studies concluded that change in third molar angulation and eruption space occurred irrespective of the type of treatment involved. Conclusion: The angulation and eruption space of third molar improved following extraction of premolar or molar. Nonextraction treatment modality did not cause any adverse effects.
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Effectiveness of school dental health education on the oral health status and knowledge of children: A systematic review p. 437
PR Geetha Priya, Sharath Asokan, RG Janani, D Kandaswamy
DOI:10.4103/ijdr.IJDR_805_18  PMID:31397422
Objective: To evaluate the effectiveness of school dental health education on the oral health status, oral health-related knowledge, and practice behavior of 6–12-year-old children. Methods: Hand search and electronic search based on the keywords on school dental health education in seven search engines till 2017 identified 7434 articles. Trials involving school-based dental health education with a minimum follow-up period of 6 months were screened. Risk of bias assessment was done independently by two authors. Results: Among the 18 articles which fulfilled the eligibility criteria, six were randomized controlled trials (RCTs) and 12 were non-RCTs. Quality assessment showed that 12 trials had a low risk of bias. Oral health-related knowledge improved in children. Oral health-related practice behaviors such as frequency and duration of brushing improved. Use of fluoridated toothpaste was increased. Plaque scores and gingival bleeding scores reduced. Conclusion: School dental health education had a positive impact on the oral health status, knowledge, and practice behavior of children. There is a definite need for high-quality RCTs analyzing the effectiveness of school dental health education on specific oral health outcomes.
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EMERGING TECHNOLOGY AND TECHNIQUES Top

Innovative method “DV-PIMS” technique and dental implant design for grafting injectable platelet-rich fibrin around the dental implant – Goat jaw cadaver study p. 450
Deepak M Vikhe, Seemit V Shah, Juan Blanco Carrion, Umesh G Palekar
DOI:10.4103/ijdr.IJDR_195_19  PMID:31397423
Aims: Dental implants have revolutionized the treatment modality for replacing missing teeth. The ability of implants to osseointegrate with the bone leads to its success. The problem is sometimes there is inadequate bone available for implant. If hygiene is not maintained, biofilms of bacteria can be formed around the dental implant. One approach to this problem has been development of bioactive surgical additives. Platelet-rich fibrin (PRF) appears as an alternative. There are various techniques of using PRF. These techniques need skill and practice to use PRF. Objective: To evaluate implant stability and flow of injectable PRF (i-PRF) of regular implant and modified innovative design implant. Materials and Methods: Thirty goat jaw bones were selected. Implants were placed in mandibular posterior region. Fifteen implants were placed using regular dental implant system (Group A) on the left side of jaw bone. The other 15 implants were placed using modified dental implant (Group B) on the right side of jaw bone. The body of these implants at middle has drainage vents to drain/flow the i-PRF-like dye. The dye was injected through regular and modified implants (DV-PIMS technique). Then the stability was checked with the help of Periotest. Cross section was taken 3 cm away from dental implant at the angle of mandible, to check the flow of i-PRF/platelet-rich plasma (PRP)-like dye. Results: Periotest evaluation showed a mean of 2.3 for implant Group B and a mean of 1.5 for implant Group A. The flow of i-PRF-like dye was seen in Group B, and Group A does not show any flow. Conclusion: There are various techniques of using PRF. These techniques need skill and practice to use PRF. This (DV-PIMS) method aims to explain new implant design that disperses an i-PRF solution from inside out. The screw section of the new implant is made of a reservoir running vertically down inside. That reservoir is filled with (injectable) PRF, and then a cover screw is placed. The solution will begin to slowly diffuse out, through the vents in implant, keeping biofilms from forming or avoiding at the screw–bone interface and accelerate healing process.
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EPIDEMIOLOGICAL WORK Top

Prevalence and gender distribution of malocclusion among 13–15-year-old adolescents of Kerala, South India p. 455
Shobha Sundareswaran, Praveen Kizhakool
DOI:10.4103/ijdr.IJDR_801_16  PMID:31397424
Objectives: To determine the prevalence and gender distribution of malocclusion in 13–15-year-old adolescents of Dravidian ethnicity, residing in urban and rural areas of Kerala, South India. Materials and Methods: A total of 1554 children (779 males, 775 females), from both urban and rural areas were examined in school settings. Survey proforma for personal details and occlusal registration according to Bjork et al. (1964) were used. Chi-square test was used for analysis. Results: Overall prevalence of malocclusion was 89.9% which included Angle's Class I, Class II (17.6%) and Class III (8%) malocclusions. Other anomalies detected were increased overjet (11.8%), anterior crossbite (27.5%), anterior open bite (1.6%), posterior crossbite (5.1%), scissor bite (4.4%), midline deviation (6.8%), bimaxillary protrusion (BMP-21.3%), crowding (66.6%), spacing (15.3%), rotations (45.4%), ectopic eruptions (11.1%), peg laterals (2.4%) and missing teeth (6.6%). Males showed a higher predilection for increased overjet, deep bite, spacing and missing teeth. Class III, BMP, midline deviations and rotations were found to be more prevalent among the rural group, whereas Class II, increased overjet, deep bite and ectopic eruptions were more prevalent among the urban. Conclusion: Information regarding the detailed pattern of malocclusion prevalence and the high prevalence of BMP among South Indian population of Kerala may provide a baseline data for planning orthodontic services.
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Prevalence of dental fluorosis among 12–15-year-old students in Enugu Metropolis, Nigeria p. 462
Linda Oge Okoye, Osa-Eloka Christiandolus Ekwueme, Elizabeth O Sote, Benneth Tochukwu Amaechi
DOI:10.4103/ijdr.IJDR_498_17  PMID:31397425
Background: Excessive ingestion of fluoride during tooth development, particularly at the maturation stage, may result in dental fluorosis, with clinical implications. Literature is scarce on dental fluorosis in Enugu, Nigeria. Purpose: The aim of this study was to assess the prevalence of dental fluorosis in Enugu, a major city in South East Nigeria. Materials and Methods: A multistage sampling technique was used to select a calculated sample of 400 students. A pretested interviewer-administered questionnaire was used to ascertain student's sociodemographic and related variables. The student participants were examined for dental fluorosis using Dean's index criteria according to the World Health Organization guidelines. Data were analyzed using SPSS version 16, and Chi-square test of association was used to compare proportions and ratios with significant level set at P < 0.05 and 95% confidence level. Results: Among the 400 students analyzed, 231 (57.8%) and 169 (42.2%) were male and female, respectively. Mean age was 13.43 ± 1.021 years. The prevalence of dental fluorosis was 11.3%, with the preponderance of very mild score (82.2%), and no observed severe dental fluorosis. The difference in the distribution of the scores of fluorosis among the children was highly statistically significant (χ2 = 72.80, P = 0.000). Dental fluorosis was found present in 39 (10.3%) of 378 users of fluoridated toothpaste and in 6 (27.7%) of the 22 users of nonfluoridated toothpaste. The differences in the presence and absence of dental fluorosis were statistically significant among users of fluoridated toothpaste. Conclusion: This study shows the prevalence of dental fluorosis to be low among secondary school students of Enugu metropolis.
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CASE REPORTS Top

Telescopic overdenture for oral rehabilitation of partially edentulous patient p. 468
Mahesh Verma, Parul Mutneja, Rekha Gupta, Shubhra Gill
DOI:10.4103/ijdr.IJDR_69_17  PMID:31397426
A case report describing the rehabilitation of a patient presenting with partially edentulous arches and compromised abutment teeth has been described. The aim of this study was to restore function and esthetics and uplift the psychological status of the patient by fabrication of a fixed removable prosthesis using the existing abutment teeth as telescopic overdenture.
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Recurrent oral submucous fibrosis with nil mouth opening surgical management and reconstruction with bilateral nasolabial flap: A case report and review of literature p. 472
Kamal Kanthan Ravikumar, U Nausath Khan, Priyadarshini , Karthik Ramakrishnan, S Nachiappan
DOI:10.4103/ijdr.IJDR_423_17  PMID:31397427
Oral submucous fibrosis [OSF] is a premalignant condition characterized by inflammation and progressive fibrosis of submucosal tissue, resulting in trismus. It is associated with chewing of areca nut in betel quid. Mortality rate is significant because it transforms into oral squamous cell carcinoma at a rate of 2.3%–7.6%. The aim of this article is to share our experience in managing a case of recurrent oral submucous fibrosis with nil mouth opening by surgical excision, coronoidotomy, and reconstruction of buccal defect using bilateral inferiorly based nasolabial flap, followed by active oral physiotherapy. The patient had reached an acceptable mouth opening with no further recurrence. The patient was observed closely for any malignant transformation. Surgical excision of bands and coronoidotomy followed by reconstruction with nasolabial flaps and active physiotherapy in the postoperative period remains a good option for recurrent and advanced cases of OSF with acceptable functional and cosmetic results.
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Endodontic management of maxillary first molar with an anatomical variation of two palatal canals: A case report p. 478
A Sriganesh, GL Saravana Priyan
DOI:10.4103/ijdr.IJDR_854_18  PMID:31397428
An in-depth knowledge of the root canal anatomy is important for any successful root canal treatment; however, complexities exist within the root canal morphology. The maxillary first molar has variations in its root morphology and canal configurations. In literature, this variation is only observed in an estimated 1.12%-1.17%. One such case is described in this case report which provides the endodontic management of a left maxillary first molar with two palatal canals using loupes magnification.
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