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   Table of Contents - Current issue
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March-April 2020
Volume 31 | Issue 2
Page Nos. 167-336

Online since Tuesday, May 19, 2020

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EDITORIAL  

COVID-19—Future of dentistry Highly accessed article p. 167
SM Balaji
DOI:10.4103/ijdr.IJDR_347_20  PMID:32436891
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

A comparative evaluation of the DNA damage in the serum of chronic periodontitis patients with and without diabetes mellitus type II p. 169
Amita Rao, Biju Thomas, Rajendra B Prasad, Suchetha B Kumari, R Vishakh, Tarona A Subba
DOI:10.4103/ijdr.IJDR_503_17  PMID:32436892
Context: Periodontal disease is an immunoinflammatory disease that is initiated by the interaction between microbial plaque and the periodontal tissues. There is very limited data available on the assessment of DNA damage with relation to periodontal diseases. Therefore, a need for a study in this area was felt. Aims: To evaluate the DNA damage in the serum of chronic periodontitis patients and chronic periodontitis with diabetes mellitus (DM) type II patients and to compare it with healthy controls, to assess whether periodontitis can have systemic effects beyond the periodontium. Settings and Design/Subjects and Methods: This cross-sectional study was conducted involving 150 subjects in the age group of 30–60 years, from October 2010 to May 2015. A blood sample of 5 ml of venous blood was collected from each of the study subjects, from the antecubital vein. Fresh blood was used to assess the DNA damage. The DNA damage was estimated using the alkaline single-cell gel (comet) assay. Results: The DNA damage to the cells was calculated by assessing the percentage of “DNA in tail.” The results showed that the values were higher in the periodontitis with diabetes group, as compared to the periodontitis and control group. When the Olive moment was calculated, the values were higher in the periodontitis with diabetes group as compared with the other two groups. Although the values were seen to be higher, it was not statistically significant. Conclusions: The results obtained from this study although statistically insignificant suggest that the DNA damage was higher in chronic periodontitis as compared with healthy control. There was a potentiated difference of the values in patients with DM type II when compared to chronic periodontitis alone.
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Cone beam computed tomographic–Based retrospective study on newark population for the assessment of distance between incisive canal and maxillary central incisors: Clinical implications p. 175
Sonam Khurana, Parv Parasher, Padma Mukherjee, Mel Mupparapu, Priti P Lotlikar, Adriana G Creanga
DOI:10.4103/ijdr.IJDR_88_19  PMID:32436893
Aims: To calculate the relative distance between the incisive canal and maxillary central incisors using cone beam computed tomography (CBCT) and utilize the results in treatment planning in a clinical setting. Methods and Materials: A retrospective study was conducted on CBCT taken for other purposes in the Oral and Maxillofacial Radiology Department. All the quantitative measurements were performed between the incisive canal and both maxillary central incisors using CBCT on 61 subjects. The anterior-posterior measurements were taken on both sides and the average of both values was considered for the statistical analysis. All the linear measurements were performed on the axial plane at three different vertical reference points located on the sagittal plane. Statistical Analysis: The interexaminer reliability was tested by interclass correlation coefficient using two-way mixed and absolute agreement model. The comparison of linear measurement among each level was done by “Repeated measure ANOVA” and contrast method was used for pair-wise comparison when repeated measure analysis of variance (ANOVA) was significant. Results: The average anterior-posterior distance between the maxillary central incisor roots and the incisive canal measured was approximately 5–6 mm. The incisive canal width increases from the root apex level of maxillary central incisors (P3) to the oral opening level of the incisive canal (P1). Conclusions: The results of our study could be helpful in a clinical setting requires significant retraction of maxillary incisors or implant placement in maxillary anterior region.
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Caries experience, clinical consequences of untreated dental caries and associated factors among school going children - A cross-sectional study p. 180
Faizunisa Habib, Preetha E Chaly, Mohammed Junaid, H Mohammed Musthafa
DOI:10.4103/ijdr.IJDR_120_19  PMID:32436894
Objective: To assess the dental caries experience, clinical consequences of untreated dental caries, and associated factors among 6–13 years school going children in Tiruvallur taluk of Tiruvallur district, Tamil Nadu. Materials and Methods: The study population included a sample of 1,060 study subjects, aged 6–13 years from both government and private schools. The subjects were interviewed regarding oral hygiene practices, diet, dental visits, body mass index, income of the parents using a closed-ended questionnaire. Caries experience was assessed by recording the Pulpitis, Ulceration, Fistula, Abscess (DMFT)/dmft score and untreated carious lesion was assessed using Pulpitis, Ulceration, Fistula, Abscess (PUFA)/pufa index. Pearson's Chi-square test, independent sample t-test, Kendal tau correlation and binary logistic regression were performed to determine the relationship between DMFT, dmft, PUFA, pufa scores, and various independent factors. Result: Among the study subjects, the mean DMFT and dmft scores were 0.12 ± 0.45 and 0.79 ± 0.15, respectively. The mean PUFA and pufa scores were 0.02 ± 0.150 and 0.14 ± 0.55, respectively. Subjects who never visited the dentist and who belonged to underweight group had significantly 2.2 times and 2.3 times, respectively, increased chances for caries experience in deciduous dentition. Subjects who never visited the dentist and who belong to underweight group had significantly 1.8 times and 1.7 times respectively, increased chances for odontogenic infection in deciduous dentition. Conclusion: Dental caries experience and odontogenic infections were found to be higher in the primary dentition compared to permanent dentition. The habit of not visiting the dentist had increased the chances of developing dental caries and odontogenic infection in primary dentition.
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Assessment of validity and reliability of Kvaal's method for age estimation among a population sample – A retrospective study p. 186
Prashant Kumar Chandan, Karandeep Singh Arora, Mayank Das, Prabhpreet Kaur, Shreeyam Mohaptra, Shubhangi Pareek
DOI:10.4103/ijdr.IJDR_209_18  PMID:32436895
Objectives: The present research was carried out with an aim to estimate and correlate chronological age and estimated age by Kvaal's Method in North Indian population using digital panoramic radiography. Further, the study was an attempt to evaluate the reliability of Kvaal's method for age estimation and to arrive at a population-specific regression equation. Materials and Method: One hundred digital orthopantomograms of participants aged between 20 and 70 years of age were selected. The evaluation of 6 teeth according to Kvaal's method was carried out using measure tool of Sidexis Software (provided by the manufacturer). Correlation coefficient was carried out between chronological age and estimated age and further regression analysis was carried out for obtaining a population specific regression equation. Results: It was observed that coefficient of determination (R2) is highest (0.223) for mandibular canine which indicates that age can be better estimated with this particular tooth. Conclusion: It was observed that large variations between the chronological and estimated age were not found. Also, Kvaal's formula proved accurate for estimating age using all the six selected teeth. Thus, it was concluded that mandibular canine would be the better tooth for age estimation, followed by maxillary second premolar and maxillary three teeth taken together.
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Assessment of dental satisfaction among school teachers in a metropolitan city p. 191
Pandi S Shulamithi, Suhas Kulkarni, Dolar Doshi, Madupu Padma Reddy, Bandari Srikanth Reddy, Adepu Srilatha
DOI:10.4103/ijdr.IJDR_324_18  PMID:32436896
Background and Aims: Dental satisfaction is a multi-dimensional concept, reflecting the total experience of health care and a major driving force of treatment seeking behaviour. At community level, school teachers, being the role model, also play a major role in public health. The aim of this study is to assess the dental satisfaction among school teachers in Hyderabad. Methods: A cross-sectional survey was carried out among 515 private school teachers in Hyderabad. The survey tool used was Dental Satisfaction Questionnaire (DSQ) developed by Davies and Ware (1982). Data was analysed with SPSS (Statistical Package for the Social Sciences) version 22. Results: The study comprised of 123 (23.9%) males and 392 (76.1%) females. Based on age, significant relation was found only for subscales 'access', 'quality' and 'general satisfaction' (P = 0.01, P = 0.04, P = 0.03 respectively). Though female subjects had higher mean scores for all subscales, significant difference was found only for subscales 'cost', 'quality', 'access total', 'general satisfaction', and 'overall Dental Satisfaction Index' (DSI) (P < 0.001, P = 0.001, P = 0.008, P < 0.001, P = 0.001 respectively). Subjects who had visited a dentist had higher mean scores and significant relation was found for subscales 'access' and 'general satisfaction' (P = 0.04, P = 0.04 respectively). Furthermore, subjects who visited a private practitioner had higher mean scores for most of the subscales. Conclusion: Female subjects, subjects who had dental visit and those who had visited a private practitioner had higher dental satisfaction. Moreover, age and recent dental visit did not show any effect on dental satisfaction.
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The location of the inferior alveolar nerve in the malaysian population: Implications for dental implant planning p. 197
Sujaysen R Kumar, Pravinkumar G Patil, Chan S Choy, Abhi Veerakumarasivam
DOI:10.4103/ijdr.IJDR_553_17  PMID:32436897
Background: The location of the inferior alveolar nerve (IAN) is generally constant in fully grown mandibles. If we know its average distance from the lower border of the mandible, available bone length from the crest of the edentulous ridge can be estimated by physical measurement of the whole length of mandible in that area. This study aimed to measure the superio-inferior distance of the inferior alveolar nerve (SIDIAN) from the base of the mandible in posterior regions on the right and left side based on cone-beam-computed tomography (CBCT) scans and to evaluate gender and ethnicity-related variations in the Malaysian population. Materials and Methods: A total of 100 CBCT-Digital Imaging and Communications in Medicine files of the patients of 3 ethnic populations (Malay, Chinese and Indian) between the ages of 18 and 80 years were selected for the study. The files were imported onto the iCAT software. The measurements of the SIDIAN to the lower border of the mandible in molar regions were done on both sides. The data was analysed using t-test, one-way analysis of variance test, and correlation coefficient test via the SPSS software. Results: Statistically significant positive correlations were identified between the SIDIAN from the lower border of the mandible in the first and second molar regions within the same side as well as between both sides of the mandible (r ≈ 0.8). There were no statistically significant differences between genders. However, there were statistically significant differences on both molar regions and on both sides in all three ethnic groups (P < 0.05). In general, the SIDIAN from the lower border of the mandible was greatest amongst Chinese and smallest amongst Indians. Conclusions: The strong positive correlations on both sides of the mandible indicate the presence of symmetry. Ethnicity-related variations exist in terms of the location of the IAN in the mandible.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Biomechanical finite element analysis of a single implant threaded in anterior and posterior regions of maxilla bone p. 203
Laith A Sabri, Falah A Hussein, Abdulsalam R AL-Zahawi, Besaran Y Abdulrahman, Kareem N Salloomi
DOI:10.4103/ijdr.IJDR_510_18  PMID:32436898
Context: The ability of implant dentistry to be a successful alternative for edentulous patients has increased in the last decade. Clinical features such as osseointegration and stability, in addition to the endurance of the integration urged the researchers towards a better understanding of the design parameters that control long term success of the implants. It is therefore necessary to quantify the effect of changing implant design parameters on interface stress distribution within the maxilla bone. Methods and Materials: A 3D-finite element study was conducted to investigate the effect of changing implant shape parameters (implant body design and implant thread depth) on stress distribution while insertion of the implant in two different regions of maxilla bone (anterior (type III bone) and posterior (type IV bone)). A 3D-CAD geometry of implant-maxilla bone was created through importing digitally visualized CT skull images of a human adult, and then converted into a workable solid body through using a collection of engineering software. Tapered and cylindrical implant models with three different implant V-shaped thread depths (0.25 mm, 0.35 mm, 0.45 mm) were threaded into maxilla bone to investigate the design parameters effect on the final stress status. The proposed implant was of commercial dimensions of 10 mm length and 4 mm in diameter. A vertical static load of 250N was directly applied to the center of the suprastructure of the implant for each model. Results: Evaluations were performed for stress distribution patterns and maximum equivalent Von Mises (EQV) stresses for implants in two regions of maxilla bone under 250N vertical static loading. The obtained results throughout this work showed that, for all models, the highest stresses were located at the crestal cortical bone around the implant neck. The von-Mises stress distribution patterns at different models were similar and higher peak von-Mises stresses of cortical bone were seen in tapered implant body compared to cylinder body in all models. Conclusions: Within the restrictions of the current model, the results obtained can be applied clinically to select properly both implant thread depth and body shape design for a foreseeable success of implant therapy.
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Treatment of miller type I and II gingival recession defects using three-dimensional porcine collagen matrix with coronally advanced flap: A randomized clinical split-mouth trial (a 1-year follow-up) p. 209
Haydar Barakat, Suleiman Dayoub
DOI:10.4103/ijdr.IJDR_897_18  PMID:32436899
Introduction: The main goal of periodontal plastic surgery is obtaining complete root coverage (CRC) and an optimal appearance. Aim: The aim of this study was to evaluate the effectiveness of a three-dimensional porcine collagen matrix (PCM) with coronally advanced flap (CAF) in treating of Miller type I and II gingival recession (GR). Materials and Methods: Twenty patients were enrolled in this study, presenting 40 Miller type I and II GR. Patients were randomized into test group (PCM + CAF) and control group [connective tissue graft (CTG + CAF)]. Clinical parameters such as recession depth (RD), probing depth, clinical attachment level (CAL), and width of keratinized gingiva (WKG) were evaluated at baseline and 12 months later. Root coverage percentage (RC%) and CRC were assessed at 12 months post surgically. Statistical analysis was performed using independent t-test for intergroup comparison. Statistical significance was set at 0.05. Results: The mean RD at 12 months was 0.20 mm for the test group and 0.12 mm for the control group, whereas the mean RC% was 94.22% for PCM + CAF and 96.48% for CTG + CAF. CRC was higher in CTG + CAF with 80%. CAL gain was 2.05 and 2.07 mm in the test and control sites, respectively. The gain of WKG was 1.35 and 1.30 mm in the test and control sites, respectively. Patient esthetic satisfaction at 12 months post surgically in both groups was equivalent. Conclusion: Within the limits of this study, using of PCM + CAF in treating GR is a successful and effective treatment option and could serve as an alternative to CTGs.
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Comparative evaluation of three different toothpastes on remineralization potential of initial enamel lesions: A scanning electron microscopic study p. 217
TP Chandru, M Bazanth Yahiya, Faizal C Peedikayil, N Dhanesh, N Srikant, Soni Kottayi
DOI:10.4103/ijdr.IJDR_745_18  PMID:32436900
Background: The early enamel lesions are reversible as it is a process involving mineral transactions between the teeth and saliva. Aim: To evaluate the efficiency of three different tooth pastes on remineralization potential of initial enamel lesions using Vickers Micro hardness Test and Scanning electron microscopy. Materials and Methods: Artificial carious lesions were prepared in human enamel with demineralizing solution. The treatment agents included were Colgate sensitive plus® toothpaste, Regenerate enamel science™ toothpaste, BioRepair® toothpaste and control as Deionized water. All the samples were subjected to treatment solutions as per the pH cycling model for 12 days to simulate the daily oral environment's acid challenge. The remineralization parameters-surface hardness and surface roughness of enamel blocks were evaluated with Vickers indenter and Scanning electron microscope respectively. Statistical Analysis: ANOVA test was used to check mean differences between the groups. Post hoc analysis was done using Tukey's post hoc test. SEM images were graded according to Bonetti et al grading criteria. Results: As per statistical analysis, maximum remineralization of enamel blocks occurred after applying Colgate Sensitive Plus® tooth paste followed by BioRepair® tooth paste and Regenerate enamel Science™ toothpaste. Least remineralization potential was shown by control group. Conclusion: Colgate sensitive plus tooth paste with Pro Argin™ formula can be regarded as a potential remineralising agent. It can be concluded as a noninvasive means of managing early enamel carious lesions.
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Comparison of soft tissue chin thickness at different levels of chin in subjects with various growth patterns p. 224
Javed Sodawala, Amit Akolkar, Fatema Sodawala, Sumit Gandhi, Shaheen Hamdani, Sayyed Muhammad Ali
DOI:10.4103/ijdr.IJDR_389_17  PMID:32436901
Aims and Objectives: To evaluate the association between mandibular growth pattern and soft tissue chin (STC) thickness measured at different chin levels and the gender differences in STC thickness at these different chin levels. Materials and Methods: Pretreatment lateral cephalograms of 161 subjects aged 18–45 years were selected, and subjects were divided into 4 groups depending on mandibular growth pattern defined by the mandibular plane to cranial base angle. The STC thicknesses were measured at pogonion (Pog), gnathion (Gn), and menton (Me). Group difference was evaluated using analysis of variance. Results: STC thickness was greater (p < .05) in the low-angle group, and it gradually decreased across the groups, the least being in the high-angle group. No sexual dimorphism was observed among the groups (p > .05). Conclusion: This study suggests that STC thickness measurements were smaller in high-angle group compared to low-angle group.
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Efficacy of omega 3 fatty acid as an adjunct in the management of chronic periodontitis: A randomized controlled trial p. 229
Shirish K Kujur, Varsha Goswami, Anand M Nikunj, Gangesh Singh, Shweta Bandhe, Himanta Ghritlahre
DOI:10.4103/ijdr.IJDR_647_18  PMID:32436902
Background: Periodontitis is conventionally treated with both surgical and nonsurgical methods. Various adjuncts have been used previously with compromised efficacy. Recently omega-3(ώ-3) polyunsaturated fatty acids (PUFA) including docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were shown to have therapeutic anti-inflammatory and protective actions in inflammatory diseases including periodontitis. The purpose of the present study was to evaluate and compare the clinical efficacy of ώ-3 fatty acids as an adjunct to scaling and root planing in the treatment of periodontitis. Methods: 110 Patients were selected for the study out of which 20 were excluded (12 not meeting the inclusion criteria and 8 refused to participate). 90 patients (48 in test and 42 in the control group) after randomisation through a coin toss method were enrolled in a single-blind randomised controlled trial conducted in the Periodontics department of a dental college. Full mouth subgingival scaling and root planing and ώ-3 fatty acid 500 mg (EPA/DHA 180/120 mg), BD daily for 1 month was given to the test group and subgingival scaling and root planing only was given to the control group. Clinical parameters like probing pocket depth, clinical attachment level, plaque index and gingival index were recorded at baseline, 1 and 3 months and were compared. Results: Statistical analyses demonstrated a significant reduction in probing pocket depth (t = 65.56, P = 0.000) and (t = 51.69, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. There was a significant gain in clinical attachment level (t = 63.29, P = 0.000) and (t = 31.03, P = 0.000) at 1 and 3 months, respectively, in test group compared to baseline and control group. The gingival index shows an appreciable reduction in both groups, and in test group, it is statistically significant at 3 months (t = 2.15, P = 0.03). There was no statistical significant reduction in plaque index at 3 months (t = 0, P = 0.997). Conclusion: The present study showed that adjunctive use of ώ-3 fatty acids proved to be beneficial over scaling and root planing alone in the treatment of chronic moderate periodontitis. The beneficial effects were in terms of significant improvements in clinical parameters, probing pocket depth, and clinical attachment level and gingival index. Dietary modulation is now emerging as an adjunct to periodontal therapy. Hence, omega-3 fatty acid may be used routinely in the management of chronic periodontitis.
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Influence of different restorative material and cement on the stress distribution of ceramic veneer in upper central incisor p. 236
Marcela Moreira Penteado, João Paulo Mendes Tribst, Amanda Maria de Oliveira Dal Piva, Karen Cristina Archangelo, Marco Antonio Bottino, Alexandr Luiz Souto Borges
DOI:10.4103/ijdr.IJDR_150_18  PMID:32436903
Aims: Considering new ceramic systems, doubts about the appropriate combination of ceramics and cement are common. Settings and Design: To evaluate the influence of the elastic modulus (E) of cement agents associated with different indirect veneers on the stress distribution using finite element analysis. Methods and Materials: The finite element analysis was applied to evaluate the stress distribution on the structures. For that, a computer-aided design software was used for a three-dimensional (3D) modeling of an upper central incisor with preparation for an indirect veneer. The model was imported into the analysis software in STEP (Standard for Exchange of Product data) format. Tetrahedral elements formed the mesh. Solids were considered isotropic, linearly elastic, homogeneous, and with ideal contacts. Load application (100N, 45°) occurred on the lingual face. Cement agents have their E classified as low, intermediate, and high. The ceramic materials used were a hybrid ceramic, a zirconia reinforced lithium silicate and a lithium disilicate. Results: It was observed that none of the factors significantly influenced the stress concentration in dentine. Groups with high E cementing agent showed the highest stress peaks. The E of restorative material was significant for the stress generated in the veneer, and groups with hybrid ceramic presented more homogeneous stress results. Conclusions: The higher E of the cement agent and the ceramic, the higher the stress concentration, suggesting that hybrid ceramic associated with low elastic modulus resinous cement has superior biomechanical behavior.
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Morphology of the palatal rugae before and after orthodontic treatment with and without rapid maxillary expansion and dental extractions p. 241
Danubia Bavaresco, Luiza Dal Zot Von Meusel, Ademir Franco, Irina Makeeva, Luiz Renato Paranhos, Graziela Oro Cericato
DOI:10.4103/ijdr.IJDR_12_19  PMID:32436904
Background: The palatal rugae contribute to oral swallowing, taste perception, and speech. From a forensic point of view, the distinctive morphology of these structures can be used to support human identification. However, the morphology of the rugae may be altered by trauma or therapeutic interventions in the palate. Objective: This study aimed to analyze the morphology of the palatal rugae before and after orthodontic treatment performed with and without maxillary expansion and dental extractions. Materials and Methods: The sample consisted of 60 dental casts taken before (n = 30) and after (n = 30) orthodontic treatment from patients aged >18 years. The patients were treated with rapid maxillary expansion by using Haas appliance (n = 10), by extracting the maxillary first premolars (n = 10) and by using only conventional fixed orthodontic appliances (n = 10). All the dental casts were analyzed twice by two independent examiners that were blind for the type of treatment. Results: All the differences between groups were statistically significant (P < 0.05). More alterations in the morphology of the palatal rugae were observed in patients treated with rapid maxillary expansion, whereas few alterations were performed in patients treated with no maxillary expansion or dental extractions. Conclusion: The use of palatal rugae for forensic purposes must be avoided in patients that underwent invasive orthodontic treatments, such as those founded on maxillary expansion and dental extractions.
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Comparative evaluation of occlusal pits and fissures morphology modification techniques before application of sealants: An In vitro study p. 247
Anju Singh, Konark , Vishwas Patil, Meena Juyal, Rachna Raj, Priyadershini Rangari
DOI:10.4103/ijdr.IJDR_956_19  PMID:32436905
Background: Pits and Fissures are recognized as being highly susceptible to caries. Pit and fissure sealants are one of the best methods of preventing caries as it occludes the fissures and pits from the accumulation of plaque and cariogenic microflora. There are different methods of cleaning and preparing occlusal pits and fissures for preventing caries which helps in alleviating oral health status of paediatric population. Aim: The aim of the present study was to evaluate and compare the microleakage of pit and fissure sealants after using five different preparation techniques, namely: A) Conventional technique using pumice prophylaxis, B) enameloplasty with round carbide bur, C) enameloplasty with fissurotomy bur, D) air polisher, and E) air abrasion. Materials and Methods: The study was conducted on 50 caries-free premolars extracted for orthodontic purpose. These teeth were randomly assigned to five groups, 10 teeth in each for receiving fissure sealant after different surface preparation; thermocycling and sectioning of samples were performed and microleakage was assessed under a stereomicroscope after methylene blue dye immersion. Results: The results of air abrasion groups were significantly superior with “0” microleakage when compared to all other groups followed by round bur, fissurotomy bur, air polisher and pumice prophylaxis. Conclusion: To improve the marginal adaptation of the sealants, minimally invasive methods are the most favoured methods of occlusal preparation. This study promises to show positive results for fissure sealants which are likely to play an important role in caries prevention and techniques that are intended to protect caries susceptible surfaces.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Estimation of salivary calcium level as a screening tool for the osteoporosis in the post-menopausal women: A prospective study p. 252
Amit Wasti, Jyoti Wasti, Ritunja Singh
DOI:10.4103/ijdr.IJDR_879_19  PMID:32436906
Aims and Objectives: The aim and objective of the present study was to explore the use of salivary calcium levels as a diagnostic biochemical marker for osteoporosis in menopausal women and also to find the correlation among oestrogen level, bone density and salivary calcium level. Materials and Methods: The study included 180 individuals and they were divided into three groups with 60 individuals in each group, comprised of healthy women, pregnant women and post-menopausal women. All the women were asked to collect at least 2 ml of unstimulated whole saliva in the sterile plastic sample containers. The samples were immediately subjected to biochemical estimation of calcium. Similarly, estimation was done for oestrogen level and bone density among all the groups. The results were obtained by one-way analysis of variance (ANOVA) using Statistical Software SPSS version 17. For the correlation among the bone density, salivary calcium level and serum oestrogen levels, Pearson's correlation was used. Results: The mean salivary calcium level in the healthy women group was found to be 3.0 ± 0.50 μg/ml. Similarly, pregnant women and post-menopausal group, it was found to be 3.20 ± 0.72 and 7.5 ± 0.90 μg/ml, respectively. When the intergroup comparison was done in the three groups, it was found to be highly significant (P = 0.001). Similarly, the difference in mean value for oestrogen level and bone density was highly significant among all the groups (P = 0.001). Conclusion: Among all the three groups, the salivary calcium levels do exhibit the correlation with bone mineral density. In the post-menopausal group, there was significant increase in salivary calcium level compared to other groups. Similarly, the study showed a negative correlation between salivary calcium and serum oestrogen. This substantiates the point that salivary calcium levels can definitely indicate the possibility of the presence or absence of osteoporosis in post-menopausal women.
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Acknowledgement of horizon of oral and maxillofacial surgery by health care professionals and general population p. 257
D Yesuratnam, S Balasubramanyam, D Nagasujatha, T Vedatrayi, B Usha Rani, Anitha Pasupuleti
DOI:10.4103/ijdr.IJDR_763_18  PMID:32436907
Background: Oral and maxillofacial surgery (OMFS) is a dental specialty evolving from the anatomical region of head and neck. Differing from the belief, its scope does not start and end with teeth. The aim of the study was to survey the perception of OMFS among dental, medical, and paramedical professionals. Materials and Methods: A structured questionnaire cross-sectional survey made up of 17 clinical situations pertaining to various complaints of patients was distributed among 50 medical and dental undergraduates, 50 medical and dental practitioners, and 50 general populations with a total number of 250 samples who were selected randomly. The collected data was tabulated using Microsoft excel for any predictable patterns. The results were analyzed taking absolute percentages of the responses into consideration. Results: The results were compiled and tabulated and the data analyzed. While wisdom tooth removal, trauma, and facial bone fractures were recognized to be mainly treated by maxillofacial surgeons, the other maxillofacial problems were poorly recognized to be treated by our specialty. In our study, 67.3% of general public and 62.4% of medical professionals approached other medical specialist for the clinical conditions. The Chi-square results of few clinical situations were statistically significant with a P value of less than 0.05, which suggest that there is indeed a statistically significant difference between the responses of medical profession and the public on whom to approach regarding certain clinical cases. Conclusion: The study revealed that the majority of the public are lacking in knowledge about the benefits that the specialty can offer. It has been found that even though the Medical professionals are better informed, lacunae existed about information as to where our major activity lies. If patients are to have access to the best treatment available, it is essential that we edify the public about the scope of our specialty.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Quadrilateral analysis applied to a city population with anterior openbite p. 263
Dhivya Dilipkumar, Dhinahar Sundar Raj, Dheena Dayalan, Poonkuzhali Suresh, R Sugapriya
DOI:10.4103/ijdr.IJDR_867_18  PMID:32436908
Aim: (1) To apply the quadrilateral analysis to adult male and female Chennai population with normal occlusion, (2) To compare the results to Chennai adult male and female with anterior openbite, (3) To evaluate the correlation of the quadrilateral variables and (4) To establish additional parameters to determine an openbite tendency. Materials and Methods: The study was carried out from the values taken from 120 pretreatment lateral cephalograms of the selected Chennai population and divided into two groups. Group A consists of 60 lateral cephalograms of 30 male and 30 female patients with balanced anteroposterior and vertical facial proportion and normal overjet and overbite relationship. Group B consists of 60 lateral cephalograms of 30 male and 30 female patients with anterior openbite and comparision done with 2 groups. Results in normal subjects the lower facial heights are equal. In anterior openbite subjects. The facial heights. The sagittal angle. The maxillary and mandibular sagittal ratios. Lower facial height and sagittal ratio is larger than normal. Results: statistical analysis performed with Version 23(SPSS) and Student's t test were done to describe the mean and standard deviation. To assess the relationship pearson correlation was used.The probability value of 0.05 is consdered as significant. Conclusion: The malformation of the craniofacial structure in anterior openbite subjects resides in the maxillomandibular complex. The overbite depth indicator, the sagittal angle, the maxillary, and mandibular sagittal ratio can be additional parameters in determining an openbite tendency.
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PECAM-1 overexpression signifies aggressive biologic behavior of oral lichen planus – A pilot study p. 277
A Lavanya, Wafa Khan, Preeti Singh, Dominic Augustine, Roopa S Rao, SV Sowmya, Vanishri C Haragannavar, K Shwetha Nambiar
DOI:10.4103/ijdr.IJDR_653_18  PMID:32436909
Context: The etiopathogenesis of oral lichen planus (OLP) is still debatable. According to literature, many studies have illustrated OLP as a T-cell-mediated chronic autoimmune disease. Currently, there is increased evidence of chronic inflammation in OLP and its association with vascular adhesion molecules (VAMs). Aim: The aim of this study was to evaluate the expression of VAM (PECAM-1) in OLP. Setting and Design: Tissue samples involved 20 archival cases of histopathologically confirmed OLP (n = 15) and normal mucosa (n = 5) as controls. Materials and Methods: The sections were subjected to immunohistochemical analysis using antibody to PECAM-1. Brown staining of the endothelial cells of blood vessels was considered positive. The expression of PECAM-1 in OLP was statistically analyzed using Wilcoxon sign-rank test. Results: The expression of PECAM-1 in OLP was statistically significant when compared with normal mucosa (P < 0.05). A statistically significant difference was also observed in PECAM-1 expression between the reticular type and erosive type of OLP. Conclusion: PECAM-1 was found to be overexpressed in OLP; difference in PECAM-1 expression was noted between the reticular and erosive types. The VAMs could be exploited as a possible therapeutic target in OLP to modulate the disease process thereby reducing the dependency on corticosteroids.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Evaluation of chemical disinfection and microwave irradiation on denture base materials: An in vitro study p. 282
Rohit Kabra, Shobha J Rodrigues, Umesh Pai, Ramya Shenoy, Thilak B Shetty, Puneet Hegde, M Mahesh, Sharon Saldanha
DOI:10.4103/ijdr.IJDR_622_17  PMID:32436910
Objective: This study evaluated the effect of chemical disinfection and microwave irradiation on the surface hardness and roughness of two commercially available hard relining materials (Ufi Gel hard, GC Kooliner) and one denture base resin (Trevalon). Materials and Methods: A total of 72 specimens (n = 24) were divided into four groups. C: Not disinfected, Cl: disinfected with 4% chlorhexidine solution, Gl: disinfected with 2% glutaraldehyde solution, Mw: disinfected with microwave irradiation (650 W; 6 min). Hardness and roughness measurements were made after polymerisation, 1st day, 14th day and 28th day. Results: Ufi Gel hard showed an increased roughness after 1st day (P = 0.021) following chemical disinfection and GC Kooliner showed similar results after 14th day (P < 0.05). Microwave irradiation showed a significant increase in surface roughness value after 1st day (P < 0.05) for both Ufi Gel hard and GC Kooliner. Hardness of both Ufi Gel (12.131 to 7.333 VHN) and Kooliner (9.133 to 5.276 VHN) was significantly reduced by chemical disinfection, while microwave irradiation resulted in an increased surface hardness of Kooliner (from 9.126 to 12.713 VHN) and Ufi Gel hard (from 11.698 to 14.940VHN). Results for Trevalon were not significant for both the disinfection methods. Conclusions: Microwave irradiation increased the surface roughness and hardness of Ufi Gel hard and Kooliner, while chemical disinfection resulted in a decreased hardness and increased roughness of both hard relining materials. There was no effect of either of the disinfection methods on Trevalon.
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Microleakage patterns of glass ionomer cement at cement-band and cement-enamel interfaces in primary teeth p. 291
P Shankar, Ramesh Venkatesan, D Senthil, J Trophimus, CU Arthilakshmi, Philomine Princy
DOI:10.4103/ijdr.IJDR_850_19  PMID:32436911
Context: In-vitro studies of microleakage are an initial screening method to assess the maximum theoretical loss of sealing ability in-vivo. Aims: Our objective was to determine and compare microleakage patterns of conventional glass ionomer cement (GIC) and resin-modified GIC (RMGIC) for band cementation. Methods: Forty caries-free second primary molars were randomly divided into two groups of 20 teeth each. Preformed molar bands in the two groups were cemented to enamel with one of two types of cement: Conventional GIC (Fuji I, GC Corporation; Tokyo, Japan) and RMGIC (Fuji Plus, GC Corporation; Tokyo, Japan). A dye penetration method was used for microleakage evaluation. Microleakage was determined by a stereomicroscope for the cement-band and cement-enamel interfaces. Statistical Analysis Used: Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests. Results: The mean microleakage value for conventional GIC (Fuji I) at cement-band and cement-enamel interfaces was 2.41 mm and 2.15 mm, respectively. The mean microleakage value for RMGIC (Fuji Plus) at cement-band and cement-enamel interfaces was 0.44 mm and 0.46 mm, respectively. Compared to conventional GIC, RMGIC showed less microleakage at both cement-band and cement-enamel interfaces. P < 0.001 and it was statistically highly significant. Conclusions: Bands cemented with RMGIC had significantly less microleakage between the cement-band and cement-enamel interfaces than conventional GIC
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SYSTEMATIC REVIEWS Top

Estimated prevalence of dental caries in athletes: An epidemiological systematic review and meta-analysis p. 297
Fellipe Navarro Azeredo, Ludmila Silva Guimarães, Walter Luís, Soares Fialho, Lívia Azeredo Alves Antunes, Leonardo Santos Antunes
DOI:10.4103/ijdr.IJDR_764_18  PMID:32436912
Background: Dental caries is a dysbiotic polymicrobial disease that can cause damage to an individual's successful, elite sporting performance. Aims: This study aimed to realize a meta-analysis to calculate a worldwide, pooled estimated prevalence of dental caries in athletes. Methods and Materials: This systematic review and meta-analysis was registered in PROSPERO (n° CRD42017068127). A systematic search was conducted in the electronic databases Pubmed, Scopus, Web of Science, Virtual Health Library (Lilacs) and Grey literature from inception up to April 2017. The MeSH terms “Sports,” Athletes,” and “Dental Caries” were used. The inclusion criteria used in this review were observational cross-sectional studies, longitudinal retrospective, and prospective studies that presented the prevalence of dental caries in athletes without intellectual disabilities. From selected articles, the risk of bias tools were assessed. After considering the qualitative heterogeneity among studies, a meta-analysis was conducted. Results: A total of 1,376 abstracts were initially retrieved, with only five meeting the inclusion criteria. Of these, one was considered to have a low risk of bias and four were considered to have a moderate risk of bias. The overall estimated prevalence of dental caries in athletes was 46.25% (95%CI 28.73-64.27). Conclusion: The estimated prevalence of dental caries in athletes, and particularly in athletes from developing countries is considered to be high. The pooled prevalence estimates have important implications in regard to preventive measures and research planning around the world.
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Abfraction: Etiopathogenesis, clinical aspect, and diagnostic-treatment modalities: A review p. 305
Anand N Badavannavar, Sneha Ajari, Krishna U S. Nayak, Shahnawaz Khijmatgar
DOI:10.4103/ijdr.IJDR_863_18  PMID:32436913
Background: Abfraction is a loss of tooth structure along the gingival margin and manifests with different clinical appearances. It has multifactorial etiology and may occur due to normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The theory behind the abfraction is that the tooth flexure in the cervical area is caused due to occlusal compressive forces and tensile stresses. This results in the fractures in the hydroxyapatite (HA) crystals. It is also caused by the low packing density of the Hunter–Schreger band (HSB) at the cervical area. Unfortunately, there is a lack of evidence regarding the outcome of abfraction with or without intervention. The aim of this review is to collect clinical information from the literature and discuss the etiology, pathogenesis, clinical representation, and management. Also, search databases for clinical studies that describe the role of sclerotic dentine in non-carious cervical lesions (NCCLs) are becoming a clinical challenge. Methods: The literature was searched that described the etiology, pathogenesis, clinical representation, and management of the abfraction lesions. Also, a specific question regarding the formation of sclerotic dentin in the NCCL lesion was described and searched for evidence that challenges etching, bonding, and successfully restoring NCCLs. The databases PUBMED, SCOPUS, MEDLINE, WEB of SCIENCE, and EMBASE were searched using the key terms. The inclusion criteria were the randomized controlled clinical trial, cohort studies, and cross-sectional studies that aimed at determining the role of sclerotic dentine in NCCLs and its effect on etching, bonding. Results: One clinical study was retrieved according to the PRISMA flowchart and PICO format. The longer etching time, total-etch adhesive system, and EDTA pre-treatment of the sclerotic dentin of cervical wedge-shaped defects could improve the bonding strength in lesions like NCCL's. Conclusion: In conclusion, clinical challenges that occur due to NCCLs are better managed by a proper understanding of factors like etiopathogenesis, ultra-structure of enamel, and dentine and their effect on the bonding of restorations of the tooth.
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CASE REPORTS Top

Impacted wisdom tooth in the floor of the orbit p. 312
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_251_20  PMID:32436914
Identification and management of ectopic supplemental tooth in anatomically complex areas such as the floor of orbit are challenging. This arises from the rarity and lack of consensus over management. The situation gets complex when there is an evidence of follicular pathology such as dentigerous cyst. In this report, a case of maxillary third molar associated with maxillary sinus and a distomolar in association with the floor of orbit medially to the inferior-orbital canal is presented. The surgical management of the condition is presented.
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Primary orthostatic tremor in mandible: A rare case report p. 315
Mauricio Kosminsky, Eduardo Grossmann, Rodrigo Lorenzi Poluha
DOI:10.4103/ijdr.IJDR_933_18  PMID:32436915
Primary orthostatic tremor (POT) is a rare movement disorder of unknown pathophysiology, characterized by fast tremor affecting a specific part of the body. The present paper reports a case of POT in mandible, discussing the approach and management. A 37-year-old male patient complained of involuntary mandibular movements, with onset 6 years ago, with no history of precipitating event. Usually, tremors were not present during patient's mastication or phonation. The oscillations presented rhythmically and symmetrically, with high frequency and low range of motion. Surface electromyography revealed an electromyographic discharge pattern bilaterally in the masseters, presenting a mean frequency of 13 Hz, and a predominance of postural type. Based on the history and clinical characteristics and electromyography, a diagnosis of POT was made. Several treatments have been employed over the years. Currently, the patient is being treated with buspirone hydrochloride 10 mg/day with a significant reduction of tremors. It can be concluded that knowledge of the characteristics of this condition is essential for the elaboration of a correct diagnosis and the better management of POT patients.
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Management of supraerupted maxillary molars in an adult patient using orthodontic miniscrew implants: A pre-prosthodontic therapy p. 318
Moina K Adeni, Ratna Parameswaran, Devaki Vijayalakshmi, Savan R Unni
DOI:10.4103/ijdr.IJDR_724_18  PMID:32436916
The sequelae of chronic edentulous space is the supraeruption of the opposing teeth which hinders prosthodontic replacement. Molar intrusion of overerupted teeth can be done using miniscrew implants which serves as a promising technique, especially in adult patients. This case report highlights pre-prosthodontic therapy by pure molar intrusion using Temporary Anchorage Device (TAD) in an adult patient seeking prosthesis to enhance chewing efficiency.
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Havoc of dental quacks in a district in India: A case series p. 323
Pooja Siwach, Vikas Jaysing Pawar, Arush Thakur, Fahmeeda Shaikh
DOI:10.4103/ijdr.IJDR_396_18  PMID:32436917
A “quack” is defined as “a fraudulent or ignorant pretender to medical skill or a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess.” A number of dental quacks are practicing roadside, making money by doing unethical and unhygienic practice, eventually, hampering the patient's oral and general health. Common quackery practices carried out in India are filling of teeth with acrylic resin, fixing the removable partial denture as fixed partial denture using wires and self-curing acrylic resin, using suction disc on the palatal surface of complete denture to improve retention, etc., leading to a number of unfortunate consequences. In this study, we present a case series of mal-treatments performed by different quacks in Dhule district of Maharashtra (India).
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Rehabilitation of unilateral loss of eye with customized ocular prosthesis: Case series p. 326
Kirti Jajoo Shrivastava, Saurabh Shrivastava, Naveen S Yadav, Saroj Gupta
DOI:10.4103/ijdr.IJDR_499_17  PMID:32436918
A patient who is suffering from complete loss of one eye or one phthisical eye due to injury, inflammation, or tumor experiences lot of physical and psychological trauma. Ocular prostheses are used in the management of a wide variety of acquired and congenital anopthalmia. Several techniques have been used in fitting and fabricating artificial eyes. These eyes can be prefabricated or custom made, but a prosthesis that is lifelike in appearance provides a sense of psychological security to the patient, which is better achieved with custom ocular prosthesis. This article discusses series of cases made by utilizing one of the latest techniques of iris duplication (digital imaging) and also aims at enhanced awareness of the cosmetic benefits of custom designed ocular prosthesis when compared with stock eye.
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Circum-zygomatic suspension wiring using lumbar puncture needle: A technical note p. 331
KR Ashok Kumar, Supriyo Pal, Ravi Kumar
DOI:10.4103/ijdr.IJDR_669_19  PMID:32436919
In the treatment of mid-facial fractures circum-zygomatic suspension wiring is one of the treatment modality. Earlier zygomatic awls were used to pass wire, which used to cause conspicuous trauma. In the present case we have used 16 gauge lumbar puncture needle for the suspension wiring for Lefort 1 fracture, which is inconspicuous as compared to an awl. The needle was passed in close proximity to bone to prevent soft tissue impaction between the wire and bone as it might lead to the necrosis of soft tissue, and the wire was twisted around the maxillary arch bar. The fragments were stable and occlusion was maintained. Six weeks post-operatively the bone healing was satisfactory, and the wires and arch bar were removed.
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Low-level laser therapy for management of large periapical lesions associated with open apex cases p. 334
Sudha Yadav, Ruchika R Nawal, Sangeeta Talwar, Mahesh Verma
DOI:10.4103/ijdr.IJDR_41_17  PMID:32436920
Context: Low-level laser therapy (LLLT) is an established method to accelerate wound healing through the phenomenon of biostimulation. Aims: This case study presents a novel approach for management of open apex cases associated with large peripapical lesions using 980-nm diode laser for biostimulation. Settings and Design: Case report. Materials and Methods: Two patients presenting with open apex associated with periapical lesion were selected. After access opening, canal disinfection was carried out with sodium hypochlorite and 980-nm diode laser. Calcium hydroxide was given as intracanal medicament for 1 week. When patient was asymptomatic, apical plug of 4–5 mm MTA was placed. In addition, seven sessions of LLLT were administered transcutaneously around the apices of involved teeth every alternate day for 15 days. Results: One year follow-up radiograph revealed remarkable healing of the lesion. Conclusion: The combination of increased cellular proliferation with laser biostimulation and meticulous canal disinfection with lasers has the potential of accelerating healing of the periapical lesions.
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