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   Table of Contents - Current issue
Coverpage
January-February 2019
Volume 30 | Issue 1
Page Nos. 1-160

Online since Wednesday, March 20, 2019

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GUEST EDITORIAL  

Revitalizing Alma-Ata: Strengthening primary oral health care for achieving universal health coverage Highly accessed article p. 1
Manu Raj Mathur
DOI:10.4103/ijdr.IJDR_934_18  PMID:30900646
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EDITORIAL Top

Effect of smoking on implant–bone interface p. 3
SM Balaji
DOI:10.4103/ijdr.IJDR_140_19  PMID:30900647
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Reconnoitering the association between body mass index and oral health among elementary school children in Hyderabad, Telangana, India Highly accessed article p. 4
Jagadeeswara Rao Sukhabogi, BR Chandra Shekar, I Venkata Ramana, G Satish Kumar, N Harita, G Annapoorna
DOI:10.4103/ijdr.IJDR_714_17  PMID:30900648
Objective: To evaluate the association between body mass index (BMI) and oral health status among elementary school children in Hyderabad, Telangana, India. Materials and Methods: This cross-sectional study was conducted among elementary school children selected from government, private-aided and private-unaided schools in Hyderabad. A stratified cluster random sampling technique was used to select study participants. All parents were requested to be personally present on the day of examination. All eligible children were assembled in a hall and their height in inches and weight in kilograms were recorded by two calibrated investigators. The oral health status of children was assessed using a predesigned oral health assessment proforma. Plaque status was assessed using Sillness and Loe plaque Index and caries using decayed and filled teeth (dft) by a trained and calibrated investigator. Results: One hundred and seventy-one children (89 males and 82 females) were included in the present study. Mean plaque score was 1.4 ± 0.6 with no significant difference in the mean plaque score between children in three different categories of nutritional status (P = 0.07). Mean dft among primary teeth was 1.1 ± 1.1 with a significantly higher score among children who were malnourished (2.4 ± 0.9) compared to children who were overweight (0.9 ± 0.9) and normal (0.4 ± 0.6) (P < 0.001). Conclusion: BMI was negatively associated with caries experience in primary dentition with no association with plaque scores. Overweight children with malnutrition had significantly higher caries experience compared to children with normal BMI.
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Prevalence of Tobacco and associated risk factors among university law students in Indore City p. 10
Sonali Gupta, Prashant Mishra, Sandesh Nagarajappa, Sandeep Kumar, Afsheen Lalani
DOI:10.4103/ijdr.IJDR_228_17  PMID:30900649
Introduction: Tobacco use is one of the major preventable causes of death and disability worldwide. The practice of law can be demanding and exceedingly stressful. Trends in tobacco use among young people are important to document because these findings will help inform the development of appropriate preventive intervention programs for youth. Aim: To assess prevalence of tobacco and associated risk factors among university law students in Indore city. Objective: To identify the strength of association related to tobacco consumption. Materials and Methods: A descriptive cross-sectional study was conducted among 278 law students in Indore city using convenient sampling technique. The data was collected using pre-tested close ended self-administered questionnaire. Frequency distribution analysis was performed. Bivariate analysis was done followed by logistic regression analysis. The level of significance for all the tests was set at P < 0.05. Results: The present study revealed that 32% of the study subjects consumed smoking tobacco as compared to 2.5% of smokeless tobacco. Nearly two-third of the law students consumed tobacco at public places 185 (66.5%) under the influence of friends. Only 18 (6.5%) study subjects tried to quit tobacco in the last 12 months whereas 65 (23.4%) of them never wanted to quit the habit of tobacco consumption. A bivariate analysis was performed to identify the risk factors related to tobacco consumption. It was found that male individuals (OR=2.04, P =0.004*) whose family members had the habit of tobacco consumption (OR=2.9, P =0.002*) were at a higher risk for consuming tobacco. The factors that became significant in bivariate analysis were then entered in logistic regression analysis [Enter method] to identify the strength of association. The individuals who had the habit of tobacco consumption among family members emerged as the strongest risk predictor leading to tobacco consumption amongst the students. Conclusion: The present study revealed that smoking form of tobacco consumption (cigarette- 32%) was more prevalent among the male study subjects under the influence of friends and with family members who had the habit of consuming tobacco at their place of residence.
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Effect of motivation on oral hygiene and caries status among young adults in Hyderabad City Highly accessed article p. 15
Patanapu Shiva Kumar, Dolar Doshi, Suhas Kulkarni, Padma Reddy, Srikanth Reddy, Adepu Srilatha
DOI:10.4103/ijdr.IJDR_220_17  PMID:30900650
Background: Motivation is a theoretical construct used to explain behavior, it gives the reasons for people's action, desires, and needs, and it drives an individual to a certain action and determines human behavior. Aim: To determine the effect of motivation on oral hygiene and caries status among young adults in Hyderabad city. Settings and Design: A cross-sectional study was carried out among 18–20-year-old engineering college students of Nagole Institute of Technology and Sciences. Materials and Methods: Intrinsic motivation was evaluated using a self-reported 12-item dental intrinsic motivation scale (DIM-S). The oral examination included simplified oral hygiene index (OHI-S) and decayed, missing, filled teeth index (DMFT index). Statistical Analysis Used: Mann–Whitney U-test and ANOVA test were used for comparison among the variables included in the study. Spearman's correlation was used to correlate DIM-S with oral parameters. Results: A total of 393 students participated in the study with majority of them being male (61.8%). It was observed that 69% of the students were extrinsically motivated and only 31% of them were intrinsically motivated. However, intrinsically motivated females had a higher significant score for calculus index–simplified and OHI-S scores. All oral parameters showed a negative correlation, except decayed component and the overall DMFT. However, no statistical significance was noticed among the variables. Conclusion: The present study revealed that to motivate people successfully, one not only has to give them information but also has to pay attention to the individual reasons which restrict their behavior.
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Evaluation of knowledge regarding emergency management of avulsed traumatic dental injuries in children among general dental practitioners in India p. 21
Pratik Bipinkumar Kariya, Sweta Singh, Seema Bargale, Swara Shah, Narayan Kulkarni, Bhavna H Dave
DOI:10.4103/ijdr.IJDR_807_16  PMID:30900651
Context: Traumatic dental injuries (TDIs) leading to dental avulsion occur very frequently in society. Management of avulsion is critical for the dentist, as it requires appropriate knowledge. Aim: The study was conducted to evaluate the knowledge of the general dental practitioners (GDPs) regarding the emergency management of TDI leading to avulsion in children. Setting and Design: Questionnaire-based cross-sectional survey design was utilized to assess the knowledge. Subjects and Methods: Data for this cross-sectional survey were collected through questionnaires from July to September 2014. A total of 278 GDP were contacted and requested to fill a pretested questionnaire to assess the knowledge regarding tooth avulsion. The GDPs were grouped on the basis of their educational qualification and years of clinical experience. Statistical Analysis Used: Chi-square test was used for intra- and inter-group comparison. Results: A total of 224 (80.57%) GDPs consented to participate in the survey. Markedly low knowledge levels were noted in the sample irrespective of educational qualification and years of experience with respect to replantation of the avulsed primary tooth, holding the root instead of the crown, choice of appropriate storage medium for transportation of avulsed teeth, use of medications, and splinting type and time. Clinical experience and higher educational qualification of GDPs revealed statistical significant difference in the methods of management for TDI leading to avulsion. Conclusion: Higher professional education and added clinical experience were associated with better knowledge in the management of TDI leading to avulsion. The finding warrants the need for informative educational programs to update and boost the knowledge of practicing dentists regarding emergency management of avulsed teeth.
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Attitude and awareness of general population towards radiation hazards and safety: An institutional study p. 27
Sneha R Sharma, Freny R Karjodkar, Kaustubh P Sansare, Mohd Saalim, Isha D Mishra, Satyapal Johaley, Shikha N Goyal
DOI:10.4103/ijdr.IJDR_15_18  PMID:30900652
Context: Radiological investigations play a pivotal role in the diagnosis and treatment of a wide range of procedures. Aim: To assess the knowledge regarding adverse consequences of radiological examination and encourage awareness regarding radiation protection amongst general public. Settings and Design: A questionnaire-based cross-sectional study conducted amongst patients visiting the dental outpatient department. Materials and Methods: 1,000 adult male and female patients within the age of 20–70 years who visited the outpatient department during May–July 2017 were included in the study. Statistical Analysis: Comparison of frequencies of responses to each item with age and gender was done using chi square test. For all statistical tests, P < 0.05 was considered to be statistically significant, keeping α error at 5% and β error at 20%. Results: 85.3% participants had visited a hospital earlier and 69.3% had undergone the procedure of an X-ray earlier. Out of those patients, only 24.7% of the participants had any knowledge about the equipment or the procedure while taking a radiograph. 5.2% of the participants were given any safety measures during the radiological procedure. 14.4% had knowledge of the risks and hazards associated with radiation. Conclusions: This short study showed that there is a need for educating the general population about the hazards and risks associated with radiation exposure.
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Pulpotomy with curcumin: Histological comparison with mineral trioxide aggregate in rats p. 31
AR Prabhakar, Praveenkumar S Mandroli, Kishore Bhat
DOI:10.4103/ijdr.IJDR_278_17  PMID:30900653
Context: It is important to develop new therapeutic materials that have requisite clinical actions, are safe and economical. Aims: This study aims to histologically evaluate curcumin, an extract of turmeric (Curcuma longa) as a pulpotomy agent in rat molars and to compare it to mineral trioxide aggregate (MTA). Settings and Design: Animal study. Subjects and Methods: Twelve Wistar-Albino rats were randomly divided into two groups of 6 each. Pulpotomies were performed on caries free maxillary first and second molars on both sides of the arch, with MTA and curcumin (24 teeth each), respectively. Access cavities were sealed with resin-modified glass ionomer cement. Postoperative histological evaluation of pulpotomized teeth in both groups was done at 7, 14, and 30 days under a light microscope (×10). Statistical Analysis Used: Data were evaluated with Freidman's test and Mann–Whitney test at 0.05 level. Results: (a) There was a gradual reduction in inflammatory cell response in both groups across time periods tested (MTA P = 0.074, curcumin P = 0.039). (b) The overall architecture of pulp was maintained better in the curcumin group across all time periods tested (P = 0.368). (c) Dentinal bridge formation was consistently seen across time periods tested in MTA group (P = 0.9094) and was feeble in curcumin group (P = 0.9094) across time periods tested. Conclusions: Curcumin has been shown to have wound healing properties. It has the potential to be developed into a predictable and cost-effective vital pulp therapy medicament.
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The antibacterial influence of nanotopographic titanium, zirconium, and aluminum nanoparticles against Staphylococcus aureus and porphyromonas gingivalis: An In vitro study p. 37
M Karthikeyan, SC Ahila, B Muthu Kumar
DOI:10.4103/ijdr.IJDR_91_16  PMID:30900654
Background: Nanoparticle coated implants have revolutionized the field of implantology. Peri-implantitis is one of the main for implant failure. Most implant failures are due to Streptococcus mutans, Staphylococcus aureus, Porphyromonas gingivalis, and Actinomyces concomitant. Aim: To evaluate and compare the antibacterial effect of titanium, zirconium, aluminum nanoparticles against S. aureus and P. gingivalis at 24, 72 hrs and 1 week intervals. Materials and Methods: According to ISO/TR 11175:1993, the samples were prepared in disc shape with 20-mm diameter and 1-mm thickness in Grade IV titanium. The samples were decontaminated by sonicating in acetone and subsequently in water three times for 15 min. A total of eighty samples were made, then coated with nanoparticles, and divided into Group-A (control), Group-B (Ti nanoparticles coating), Group-C (Zi nanoparticles coating), and Group-D (Al nanoparticles coating). The discs were sterilized under ultraviolet radiation and placed in Mueller-Hinton agar medium for S. aureus and blood agar for P. gingivalis. The colonies were counted at 24, 72 hrs and 1 week intervals. Statistical Analysis Used: The values were statistically analyzed using one-way ANOVA and Tukey honestly significant difference test. Results: The P < 0.001 showed that statistically significant difference in colony forming unit had been found in titanium nanoparticles coated samples at 24, 72 hrs and 1 week intervals. Conclusion: TiO2 nanoparticle coated titanium discs showed significant antibacterial effect.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Comparative evaluation of salivary zinc concentration in autistic and healthy children in mixed dentition age group-pilot study p. 43
Rahul R Deshpande, Pranav Prakash Dungarwal, Komal K Bagde, Priyadarshini S Thakur, Pankti M Gajjar, Ananth P Kamath
DOI:10.4103/ijdr.IJDR_728_16  PMID:30900655
Context: Autism prevalence is increasing, with current estimates at 1/68–1/50 individuals diagnosed with autism. Diagnosis is based on behavioral assessments. Early diagnosis and intervention are known to greatly improve functional outcomes in people with autism. Diagnosis, treatment monitoring, and prognosis of autistic children's symptoms could be facilitated with biomarkers to complement behavioral assessments. Aims: The aim of this study is to compare and evaluate salivary zinc concentration in saliva samples of autistic and healthy children in mixed dentition age group. Settings and Design: Cross-sectional comparative study carried out in dental college and special child school. Unstimulated whole saliva collected for finding a biomarker. Subjects and Methods: Unstimulated whole saliva sample was collected from 10 autistic and 10 healthy children in mixed dentition age group. Diluted saliva sample was then subjected to inductively coupled plasma emission spectroscopy for the estimation of salivary zinc concentration. Statistical Analysis Used: Mann–Whitney U-test. Results: In children with autism salivary zinc concentration showed a linear equation when compared to healthy children. Conclusions: The low salivary zinc concentration in autistic children can reveal the pathogenesis of autism.
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Gingival crevicular fluid resistin levels in chronic periodontitis with type 2 diabetes before and after non-surgical periodontal therapy: A clinico-biochemical study p. 47
Astha Joshi, Sreedevi Maddipati, Anirban Chatterjee, Ratika Lihala, Ankita Gupta
DOI:10.4103/ijdr.IJDR_215_17  PMID:30900656
Aim: Periodontitis and diabetes mellitus share a bidirectional relationship. Resistin is an adipocytokine shown to be associated with type 2 diabetes mellitus. Hence, the present study aims to estimate the effect of non-surgical periodontal therapy (NSPT) on GCF resistin levels in healthy individuals with gingivitis and well controlled diabetics with periodontitis, and correlate the same with HbA1c levels of the diabetic subjects. Materials and Methods: The present study was a comparative interventional trial set in Department of Periodontics, the Oxford Dental College, Bangalore. Forty subjects participated in the study and were divided into two groups; group I (healthy individuals with gingivitis) and group II (diabetic individuals with mild to moderate periodontitis). Periodontal parameters were assessed and GCF was collected and analysed for resistin before and 3 months after NSPT. Statistical Analysis: All the analysis was done using SPSS version 18. A P value of < 0.05 was considered statistically significant. Results: A significant difference was observed in GCF resistin concentrations between the two groups at baseline, wherein group II had significantly higher values. Following NSPT, there was a significant reduction in GCF resistin concentrations in both the groups, however intergroup comparison showed no difference in the amount of reduction. When all samples were analysed together, no significant correlation could be found between resistin and the parameters assessed. Conclusion: Resistin levels are increased in diabetes related periodontitis. However, post treatment a similar response can be seen between healthy and well controlled diabetics. Hence, resistin can be used as an inflammatory biomarker for diabetes related periodontal disease.
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Influence of infiltrant application time on the reduction of opaqueness of proximal enamel caries p. 52
Gabriel Garcia de Carvalho, Andressa Cavalcanti Pires, Frederico Barbosa de Sousa
DOI:10.4103/ijdr.IJDR_267_17  PMID:30900657
Introduction: Infiltrant resins were developed to hamper carious lesion progression and mask the whitish appearance of first evidence of caries. Objective: This study aimed at testing the hypothesis that a long application time of resin infiltrant in proximal enamel caries improves esthetic outcome compared to the commercially recommended time. Materials and Methods: Twenty teeth with uncavitated inactive proximal white enamel caries lesions (selected by two calibrated examiners; inter-examiner κ = 0.87) were divided into two groups (experimental and control group; n = 10) that agreed regarding lesion surface area. Lesions were infiltrated following the protocol recommended by the manufacturer (two applications, 3 min application first and another 1 min application later; control) and by the protocol tested in this study (one application of 30 min; experimental). Enamel opaqueness (esthetic outcome) was measured by a calibrated examiner (intra-class coefficient of 0.9) before and after infiltration using fluorescence microscopy. Results: Reduction of enamel opaqueness was significantly higher in the experimental group (40.0% ± 18.5%) than in the control group (18.6% ± 14.9%) (P = 0.0105, one-tailed t-test; Hedge's g of 1.28, 95% confidence interval of 0.43/2.13, and power of 86%). Conclusions: It can be concluded that the application time of 30 min provides a greater reduction in opaqueness of proximal enamel lesion compared to the application time recommended by the manufacturer. The high effect size could stimulate patients to comply with the treatment time.
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A comparative evaluation of transdermal diclofenac patch with oral diclofenac sodium as an analgesic drug following periodontal flap surgery: A randomized controlled clinical study p. 57
Vikas Diwan, T Siddeshappa Srinivasa, K Yeltiwar Ramreddy, Vandita Agrawal, Sonika Nagdeve, Humera Parvez
DOI:10.4103/ijdr.IJDR_84_17  PMID:30900658
Background: Pain is an inevitable outcome of any periodontal surgery. Controlling postoperative pain is of utmost importance so as to increase patient compliance. The present study aims to compare the degree of postoperative analgesia with the use of oral diclofenac sodium and transdermal diclofenac patch following periodontal flap surgery in patients with chronic periodontitis. Materials and Methods: A total of 20 patients requiring full mouth flap surgery were selected for this study. Flap surgery was performed quadrant-wise and transdermal diclofenac patch was applied on the right arm following surgery of one of the quadrants and 100 mg oral diclofenac sodium twice daily was prescribed following surgery of the subsequent quadrant. The postoperative pain was recorded on visual analog scale and pain intensity scale 24 h after the surgery. Results: Both the statistical and clinical observation showed that diclofenac sodium administered transdermally has equal efficacy as compared to drug administered orally. Conclusion: The study concludes that the diclofenac administered transdermally has equal potency in relieving postoperative pain as compared to orally administered diclofenac sodium following modified flap surgery. Transdermal patch has an added advantage of better patient compliance as it does not cause gastric disturbance.
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Effect of sugar-free chewing gum on plaque and gingivitis among 14–15-year-old school children: A randomized controlled trial p. 61
P Abdul Saheer, Preetika Parmar, Shanila Abdul Majid, Mamtha Bashyam, Pallavi Swamy Kousalya, Tency Mathew Marriette
DOI:10.4103/ijdr.IJDR_247_17  PMID:30900659
Aim: The aim of the study was to find out the effect of sugar-free chewing gums (xylitol and sorbitol) on plaque and gingivitis among 14–15-year-old school children. Materials and Methods: A single center, double-blind, randomized controlled trial was conducted on 14–15-year-old children. Sample size was determined to be 48. Participants were randomly allocated to test group (xylitol [n = 12], sorbitol [n = 12]) and control group (no gum, n = 24). Duration of the study was 14 days. Baseline assessment of plaque, gingival, and bleeding score, followed by oral prophylaxis. Selected children received daily two chewing gum (1.1 g each) to chew for 20 min postbreakfast and postlunch. Follow-up was done on 15th day. Analysis was done using independent t-test, ANOVA, and post hoc test. Significance level was kept at P < 0.05. Results: There was a significant reduction in plaque, gingival, and bleeding score in test group (P < 0.05) compared to control group. Conclusion: Sugar-free gum (xylitol and sorbitol) significantly reduced the plaque, gingival, and bleeding score.
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The effect of chlorhexidine-thymol and fluoride varnishes on the levels of Streptococcus mutans in saliva in children aged 6–8 years p. 67
Ghadir Mohammad Ben Khadra, Ettihad Abo Arrag, Mostafa Alammori, Mohammad Fakhri AlKadi
DOI:10.4103/ijdr.IJDR_208_17  PMID:30900660
Background: Streptococcus mutans is considered as the main pathogenic factor for initiation and progression of dental caries. Fluoride is one of the most effective agents used to control caries. Chlorhexidine (CHX) is the most antimicrobial agent against S. mutans and dental caries. Aims: The study aimed to compare the effectiveness of antimicrobial activity of CHX-thymol (CHX/T) and fluoride varnishes on S. mutans levels in children's saliva aged from 6 to 8 years old. Materials and Methods: The total number of children involved in this study is sixty, ages 6 and 8 years old. The participants were divided into three groups by block randomization: Group 1 CHX/T varnish, Group 2 fluoride varnish (f varnish, and Group 3 control group. Varnish was applied onto all tooth surfaces of the participants. At the baseline conditions, saliva samples were collected from the participants for bacterial examination test. This procedure was repeated in week 1, 4, and 12. Bacterial quantitative test was performed, and the number of S. mutans was estimated. Results: The results revealed the significant efficacy of the two groups (fluoride and CHX/T varnishes) in reducing salivary S. mutans numbers when compared to the control group (P < 0.05). In terms of salivary colony-forming unit counts reduction of S. mutans, no significant difference was observed between the fluoride and CHX/T varnish groups (P > 0.05). Conclusion: The outcomes showed that there was a significant reduction in S. mutans counts in children's saliva following the application of fluoride and CHX/T varnishes.
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Effect of thermocycling on the micro-tensile bond strength between self-adhesive resin cement and nonphosphate monomer cements on zirconium-oxide ceramics p. 73
S Sathish, S Lakshmi, Pia Patel, H Annapoorni
DOI:10.4103/ijdr.IJDR_361_17  PMID:30900661
Objectives: The objective of the present study is to evaluate the bond strength of: (a) Zirconia blocks (tribochemical treatment and zirconia primer) and resin blocks bonded using self-adhesive resin cement (phosphate monomer cement). (b) Zirconia blocks and resin blocks bonded using nonphosphate monomer cement. (c) Micro-tensile bond strength of zirconia and resin blocks, bonded with self-adhesive resin cement and nonphosphate monomer cement after thermocycling. Materials and Methods: Twenty zirconium-dioxide specimens (5 mm × 5.4 mm × 13 mm) were produced using a metal mold. Each zirconium block was duplicated in light-curing resin material specimen (5 mm × 5.4 mm × 13 mm) using a mold made of addition silicon impression material. A total of 40 specimens were made, of which 20 specimens were zirconia blocks and 20 were resin blocks, which would be bonded to each other using phosphate monomer-containing cement (Multilink [10 nos.]) and nonphosphate monomer-containing cement (RELY-X [10 nos.]). The specimens were then divided into two groups of n = 10 each. The surface of zirconium specimen of one group (Group 1) was treated with zirconia primer and bonded with phosphate monomer-containing cement, and the other groups (Group 2) were not treated with any surface conditioning and were bonded with a nonphosphate containing cement. The specimens in each group were further subdivided into two subgroups of n = 5 each as follows: Group 1-1A (subjected to thermocycling), 1B (nonthermocycled) and Group 2-2A (subjected to thermocycling), 2B (nonthermocycled). Then, they were subjected for testing of tensile bond strength under a universal testing machine. Results: Resin cement selection seems to be a more relevant factor in the bonding of zirconia. The phosphate monomer-containing cement has the better bond strength after thermocycling compared to the nonphosphate monomer group. Thermocycling reduced the bond strength of both the groups and a significant difference was seen in the bond strength of nonphosphate monomer cement group subjected to thermocycling compared to the nonthermocycled one. Tensile bond strength values were significantly affected by the luting agent system employed and by thermal aging. Hence, for long-term durability, luting of zirconia with a phosphate monomer-containing cement after the zirconia has been surface treated is preferable as their bond strength did not show much significant difference after being subjected to thermocycling, compared to the nonthermocycled group. Conclusion: Resin cement selection seem to be a more relevent factor in the bonding of zirconia thermocycling does affect adhesion to to zirconium oxide ceramics.
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Oral health status and knowledge among 10-15years old type 1 diabetes mellitus children and adolescents in Bengaluru p. 80
S Geetha, M Pramila, Kittu Jain, CM Suresh
DOI:10.4103/ijdr.IJDR_572_17  PMID:30900662
Context: Type 1 diabetes mellitus (T1DM) is a chronic systemic metabolic disease. This disorder affects mainly children and adolescents. The main complications of diabetes mellitus affect the organs and tissues rich in capillary vessels such as kidney, retina, and nerves. These complications are secondary to the development of microangiopathy. Similar changes in small vessels can be found in the oral tissues. There is a significant increase in gingival inflammation and plaque seen in children with T1DM. Aims: The aim of this study is to assess the oral health status and knowledge among T1DM children and young adolescents aged 10–15 years in Bengaluru. Subjects and Methods: One hundred and seventy-five 10–15 year-old children with T1DM and 175 age, sex, and socioeconomic status matched nondiabetic controls were included in the study. Oral health status was assessed using community periodontal Index and decayed/decayed-missing/missing-filled/filled teeth index (DMFT/dmft). Oral health knowledge was assessed using 11 item questionnaire. Chi-square test and Student's t-test were used in the statistical analysis. Results: With regard to periodontal status, subjects with healthy periodontal tissue were less in diabetic than control group. Patients with bleeding and calculus were more in diabetic group than control group. The difference between diabetic group and control group was statistically significant (P = 0.001).The mean number of DMFT/dmft were less in diabetics (0.07 ± 0.006)/(0.26 ± 0.05) compared to control groups (0.1 ± 0.01)/(0.84 ± 0.2), respectively. Overall, oral health knowledge was more among diabetic patients (8.3 ± 1.7) compared to controls (7.5 ± 1.8). Conclusions: The results of the present study showed more gingival changes and higher oral health knowledge in diabetic group when compared to control group.
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Patterns of oral hygiene behaviors, daily habits, and caries prevalence in India and dominican republic: A comparative study p. 87
Payal Kahar
DOI:10.4103/ijdr.IJDR_297_17  PMID:30900663
Background: The purpose of the study was to gain integrative knowledge on oral hygiene behaviors and daily habits affecting caries experience among rural people in India and Dominican Republic (DR). Materials and Methods: Participants were recruited in two countries: La Esquina community, Province Maria Trinidad Sanchez in DR and in Ramgarh, district Chhindwara in the state of Madhya Pradesh in India. A total of 104 participants (18–80 years) were in the DR sample while 202 participants (18–85 years) were in the Indian sample. Face-to-face interviews collected information on oral hygiene behaviors, daily habits, and dental care. The caries experience was quantified using decayed, missing, and filled teeth (DMFT) index. Results: There were significant differences in a few oral hygiene behaviors, daily habits, and levels of caries experience between the Dominican and Indian subgroups. Use of toothbrush (χ2 = 65.2; P < 0.001), self-reported use of fluoridated toothpaste (χ2 = 94.04; P < 0.001), use of tobacco (χ2 = 32.4; P < 0.001), dental visit (χ2 = 24.84; P < 0.001), attitude toward seeking professional dental care (χ2 = 85.07; P < 0.001), and DMFT scores (F = 13.3; P < 0.001) were significantly different between the two countries. The caries experience was higher in the Dominicans (9.6 ± 8.0 vs. 4.0 ± 5.7) than India's rural. Conclusions: Oral health practices varied considerably between rural populations in these two countries. Caries prevalence was significantly higher in Dominicans despite higher consumption of tobacco and lesser use of toothbrush among rural Indians in the subcontinent.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Evaluation of postoperative complications of open reduction and internal fixation in the management of mandibular fractures: A retrospective study p. 94
Chandini Ravikumar, Mimansa Bhoj
DOI:10.4103/ijdr.IJDR_116_17  PMID:30900664
Background: Mandible is one of the most prominent bones of the facial skeleton leading to high prevalence of fracture during facial trauma. The management of mandibular fractures has evolved from intermaxillary fixation (IMF) to a combination of IMF and wire osteosynthesis, lag screw, and plate fixation. Despite the evolution in techniques, no technique including open reduction and internal fixation (ORIF) has proven to be completely devoid of complications. However, ORIF has many advantages and has resulted in better outcome when compared with the closed reduction methods. Aim: The aim of this retrospective study is to assess the incidence of postoperative complications in 98 patients treated with ORIF for mandibular fractures. Materials and Methods: A sample size of 98 patients with mandibular fractures reporting to Saveetha Dental College and Hospital, Chennai, from January 2014 to November 2016, treated by ORIF was included in the study and was split into three groups. The patient's records were analyzed for deriving the number and type of complications that occurred during the postoperative period of ORIF. Results: Patients with fractures in the condyle region reported with the highest number of complications when compared to the angle and parasymphysis regions. The most common complications that the patients reported were infection that led to plate removal and paresthesia. Others were wound dehiscence, occlusal disturbances, and facial nerve paralysis which were less common. Conclusion: The most common postoperative complication of the procedure in this retrospective study was found to be infection of the plates that are preventable with better aseptic techniques.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis p. 97
Farhan Durrani, Arpit Galohda, Sanjay Kumar Rai, Nishant Kumar Singh, Rati Verma, Dhananjay Singh Yadav, SM Karthickraj
DOI:10.4103/ijdr.IJDR_250_17  PMID:30900665
Background: Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines. Materials and Methods: Five patients of age group 25–50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis. Results: After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced. Conclusion: Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.
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Immunohistochemical expression of cyclooxygenase-2 in oral squamous cell carcinoma p. 102
Nirupa Thomas, Rekha Krishnapillai, P Ramakrishnan Bindhu, Priya Thomas
DOI:10.4103/ijdr.IJDR_362_17  PMID:30900666
Background and Aim: Oral cancer is a major health problem in South East Asia. The immunohistochemical (IHC) overexpression of COX-2 in squamous cell carcinoma is well documented. This IHC study was undertaken to understand the COX-2 expression in different grades of oral squamous cell carcinoma (OSCC) and to compare the COX-2 expression in OSCC and normal mucosa. Material and Methods: A total of 30 cases of OSCC and 10 cases of normal mucosa and positive control colon cancer were studied for IHC expression of COX-2. Of the 30 cases studied 10 cases each of well, moderately and poorly differentiated carcinoma were studied. COX-2 staining was evaluated on the basis of presence or absence of the positive tumor cells and percentage of positive tumor cells. Statistical Analysis: The various statistical tests used in this study were t-test and Chi-square test which was carried out using SPSS for Windows 22.0.0 and Minitab version 17.1.0 software package. Results: There was significant increase in COX-2 staining intensity from well to poorly differentiated OSCC. Significant difference was observed in staining intensity between moderately and poorly differentiated SCC. The percentage of positive tumor cells were high in poorly differentiated SCC compared to well and moderately differentiated OSCC. No significant expression of COX-2 was noted in normal mucosa. Interpretation and Conclusion: Our results revealed that the COX-2 enzymes were expressed, suggesting that they play complementary roles during oral carcinogenesis. In near future researches on administration of chemoradiation therapy combined with COX-2 should be evaluated to improve therapy response.
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Assessment of iatrogenic damage to adjacent teeth during crown and bridge preparation p. 107
Sheikh Bilal Badar, Robia Ghafoor, Muhammad Hasan Hameed, Natasha Anwer
DOI:10.4103/ijdr.IJDR_312_17  PMID:30900667
Introduction: Iatrogenic damage to the adjacent tooth during crown preparation is a frequent disastrous effect. The aim of the study was, therefore, to determine the frequency of different types, degree and location of iatrogenic damage to the adjacent tooth during crown and bridge preparations in a tertiary care setting that lead towards the morbidity of tooth. Materials and Methods: A prospective study was conducted in Aga Khan University dental laboratory in two months period in which a total of 150 dental casts fulfilling the inclusion criteria were analyzed using non-probability convenient sampling technique. The casts were examined using 3.5x magnifying loupes for the location, degree and type of damage to the proximal surface adjacent to the prepared tooth using Moonpar and Faulkner criteria. Data were analyzed by using SPSS version 22. Chi square test was used to assess the association between the experience of practitioner and degree of damage to adjacent tooth. It was also used to determine the association between location of tooth and degree of damage to adjacent tooth. Inter-examiner reliability was assessed by using kappa statistics. Results: A high prevalence of damage to the proximal surface of adjacent teeth (78% on mesial tooth and 60.6% on distal tooth) was observed, with the majority (32.6%) belonging to the mild categories. There were statistically significant associations between the experience of practitioner and the damage to the surface mesial to the preparation. However, more severe damages occurred in mandibular teeth preparations as compared to maxillary teeth preparations. Conclusions: A high frequency of iatrogenic damage to the adjacent teeth had been found during crown and bridge work with the middle of the tooth as the most susceptible site. However, the majority of damages were of milder type including only abrasions.
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Comparative evaluation of effects of natural antioxidants on the shear bond strength of composite resin to bleached enamel p. 112
Ritu Rana, Mamta Kaushik, Roshni Sharma, Pallavi Reddy, Neha Mehra
DOI:10.4103/ijdr.IJDR_397_17  PMID:30900668
Context: The use of antioxidants immediately after bleaching showed increased bond strength. Aims: This study aimed to compare the effects of natural antioxidants on the shear bond strength of composite resin to bleached enamel. Materials and Methods: Fifty extracted single-rooted upper incisors were decoronated by sectioning the roots 2 mm below the cementoenamel junction, and then, crowns were embedded in autopolymerizing acrylic resin block (3.0 cm × 3.0 cm × 3.0 cm) with the labial surface exposed. They were randomly divided into five groups, depending on the type of antioxidant used (n = 10): (i) Group 1: control (no bleaching), (ii) Group 2: bleaching only, (iii) Group 3: bleaching + 10% sodium ascorbate (antioxidant), (iv) Group 4: bleaching + green tea, and (v) Group 5: bleaching + white tea. Labial surfaces of 40 teeth were bleached with 38% hydrogen peroxide for 20 min following manufacturer's instructions. After that, the experimental groups (Groups 3, 4, and 5) were treated with respective antioxidant solutions before composite restorations were done using a cylindrical plastic mold (3 mm × 5 mm). Shear bond strength of the specimens was tested under universal testing machine. Statistical Analysis: Data were analyzed with ANOVA and Tukey's post hoc test. Results: There were statistically significant differences between shear bond strength of control groups (Groups 1 and 2) and experimental groups (P < 0.05), but no significant difference in bond strength was observed among the antioxidants used. Conclusion: Application of antioxidants immediately after bleaching showed increased bond strength. Green tea and white tea extract can be used as alternative antioxidants in improving the bond strength of enamel.
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SYSTEMATIC REVIEW Top

Effectiveness of school-based dental screening in increasing dental care utilization: A systematic review and meta-analysis p. 117
Vinita Sanjeevan, Chandrashekar Janakiram, Joe Joseph
DOI:10.4103/ijdr.IJDR_523_18  PMID:30900669
Background: School based dental screening has been a popular public health intervention. However, literature provides contrasting evidence regarding effectiveness of such programs on the utilization of dental services. Objectives: We designed this review to understand the differences in dental attendance rates of children below 15 years of age, receiving a school based dental screening versus those not receiving it. Material and Methods: The standard methodological procedures prescribed by The Cochrane Collaboration for Systematic review and meta-analysis was employed. An electronic (MEDLINE via PUBMED, Cochrane trial registry, and Google scholar) and a manual search (2016) were made to identify studies. Results: Five studies met the inclusion criteria, covering a population of 28208 school children of which 21447 were included in the meta-analysis. The review concludes that school based dental screening marginally increases the dental attendance by 16 percent as opposed to a non-screening group (RR 1.16 (95% CI 1.11, 1.21). The quality of evidence was found to be low. Conclusions: There is evidence of marginally increased dental attendance rate of 16 % following screening. As the quality of evidence was found to be low, the results of this review may be used with caution.
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SHORT COMMUNICATIONS Top

Altmetrics: A new paradigm for scholarly communication p. 125
Kuldeep Singh Shekhawat, Arunima Chauhan
DOI:10.4103/ijdr.IJDR_27_17  PMID:30900670
Counting citations have been the usual norm to determine the impact of any research and/or scholar. However, with majority of the scholarly activities happening on the World Wide Web, traditional counting of citations is now being termed “slower.” The recent explosion of online data storage for many articles may serve as a pool which uses social media sites to navigate. Altmetrics has been proposed as the new entity which aims to change the focus of the scholarly reward system to value and encourage web-native scholarship. This paper makes an attempt to understand altmetrics.
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CAD/CAM system influence marginal fit of different ceramic types? p. 127
Isabella Gargantini de Almeida, Deborah Bordinassi Antunes, Nathassya Xavier Braun, Andressa Restani, Fabiana Gouveia Straioto, Graziela Avila Galhano
DOI:10.4103/ijdr.IJDR_77_18  PMID:30900671
Objective: This study aimed to evaluate the marginal fit of zirconia and lithium disilicate ceramic restorations processed by computer-aided design (CAD)/computer-aided manufacturing (CAM) system. Materials and Methods: Ten models were prepared from a metal die, on which scanning was carried out to obtain the virtual model for the processing of zirconia and lithium disilicate ceramics using the CAD/CAM technique. Gypsum models were fabricated and used for scanning the restorations. The infrastructures were designed using software, and CAD/CAM was used to fabricate the restorations (n = 10). The analysis of the marginal discrepancy was measured at 12 points of the margin using the original metallic die. For each crown, an arithmetic average of the discrepancy values was obtained. Results: The marginal fit of the copings of lithium disilicate was 133.10 ± 26.87 μm and zirconia was 127.34 ± 47.97 μm. There was no statistically significant difference (P = 0.7709) between the materials. Conclusion: The marginal fit is similar between lithium disilicate and zirconia ceramics milled in the CAD/CAM system used.
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Central giant cell granuloma – A case report p. 130
Preetha Balaji, SM Balaji
DOI:10.4103/ijdr.IJDR_61_19  PMID:30900672
Central giant cell granuloma (CGCG) of the jaws is a benign, intraosseous, osteolytic lesion of debatable etiology. CGCG lacks in clinical and radiographical pathognomonic features to distinguish from common lesions occurring in this region. Histopathology still remains the predominant diagnostic modality to identify the disorder. Clinically aggressive lesions and atypical lesions can lead to early damage and may necessitate aggressive therapy to prevent recurrences. A case of an aggressive type of CGCG of the maxilla in a young adult male patient with diagnostic and treatment challenge is presented.
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EMERGING TECHNOLOGY AND TECHNIQUES Top

Surgical retention for immediate obturator in maxillectomy patients p. 133
Rajendran Appadurai, D Lingeshwar, B Dilshad, S Maria
DOI:10.4103/ijdr.IJDR_201_17  PMID:30900673
Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.
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CASE REPORTS Top

Reattachment of complex fractures; a reality by advances in self-etch bonding systems p. 135
Anuraag Gurtu, Sonali Roy, Praveen Chandra, Rashmi Bansal
DOI:10.4103/ijdr.IJDR_643_16  PMID:30900674
An 18-year-old female patient reported to the Department of Conservative and Endodontics with the chief complaint of fractured tooth with respect to 21 and increased pain and mobility tooth with respect to 22. Intraoral periapical radiograph of 21 revealed coronal loss of tooth structure involving enamel, dentin, and pulp, suggestive of split tooth with respect to 21. Intraoral examination revealed a fracture of coronal structure of 22 and increased mobility in the coronal aspect, suggestive of horizontal crown–root fracture. For management of 21, after endodontic phase, placement of fiberpost, and coronal buildup, intentional reimplantation was done to expose and reattach the vertically fractured root fragment. For management of 22, after endodontic phase, crown lengthening was done, and the fractured fragment was reattached by making it a Natural Richmond's Crown. Radiographs revealed a complete sealing of the fractured fragment and proper positioning of the tooth.
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Cemental tear: An unusual cause for persisting endodontic periodontal lesion p. 140
Amrita Chawla, Vishal Kumar
DOI:10.4103/ijdr.IJDR_746_17  PMID:30900675
Cemental tear represents a rare form of root surface fracture which makes teeth prone to periodontal breakdown. The diagnosis of cemental tear becomes a challenge as it is usually neglected or misdiagnosed and is also underreported in the literature. Correct diagnosis and early treatment of cemental tear can prevent further periodontal breakdown and may preserve the affected tooth for a longer duration. This case presents the diagnosis, treatment, and an analysis of a right maxillary lateral incisor with an improper endodontic treatment coupled with a cemental tear. Despite surgical removal, the cemental tear led to the development of an endodontic periodontal lesion. This article intends to help recognize early signs and symptoms of cemental tear and establish timely diagnosis. It determines that if the periodontal destruction caused by cemental tears is diagnosed and treated early, it may be possible to prevent further periodontal breakdown and preserve the tooth for a longer period.
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Calcifying cystic odontogenic tumor associated with ameloblastoma – A rare histological variant p. 144
Keerthi Muddana, Aruna Kumari Maloth, Shyam Prasad Reddy Dorankula, Pavan G Kulkarni
DOI:10.4103/ijdr.IJDR_105_17  PMID:30900676
Calcifying odontogenic cysts (COCs) represent a heterogeneous group of lesions that exhibits a variety of clinical, behavioral, and histological features. COC or Gorlin's cyst is now classified by the World Health Organization as a tumor. Calcifying cystic odontogenic tumor (CCOT) is an uncommon developmental odontogenic lesion that demonstrates histopathologic diversity. Odontogenic tumors such as ameloblastoma have been reported to be associated with CCOT. In this paper, we report a case of ameloblastomatous CCOT in a 16-year-old girl with involvement of mandibular posterior region, which is an extremely rare histologic variant.
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Management of periodontic-endodontic lesion in aggressive periodontitis-9 months follow-up: Report of a case p. 149
Avinash Kavarthapu, Sankari Malaiappan
DOI:10.4103/ijdr.IJDR_417_17  PMID:30900677
The case report describes the successful management of a right mandibular first molar with a periodontic-endodontic lesion in a 28-year-old female with aggressive periodontitis. The treatment carried out to treat this condition was primarily by endodontic treatment followed by regenerative periodontal therapy where the bone graft along with platelet-rich fibrin was used. The prognosis of the tooth was fair at the baseline. Along with the above treatments, patient's compliance played a major role in improving the prognosis of the tooth. Hence, treating periodontic-endodontic lesion is not a difficult task if all the protocols were being followed during the length of the treatment.
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Reconstruction of infra orbital rim with rib cartilage p. 154
M Sadique Hussain, Achuthan Nair, G Anup Kumar, Mohamed Shahid
DOI:10.4103/ijdr.IJDR_205_17  PMID:30900678
Maxillo Mandibular injuries are most common through road traffic accident. The defects and deformities are usually prominent in case of facial injuries. The ultimate aim of recontouring and reconstruction of the facial defect is to achieve the maximum functional as well as esthetic part of the face. Here we present a case of fracture in to multiple fragment of the infra orbital rim, reconstructed with rib graft.
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LETTER TO EDITOR Top

The langerhans cell histiocytosis in oral and maxillofacial area p. 157
Konstantinos Natsis, Maria Piagkou
DOI:10.4103/0970-9290.254522  PMID:30900679
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ERRATUM Top

Erratum: Prevalence of periodontal disease in endemically flourosed areas of Davangere Taluk, India p. 158

DOI:10.4103/0970-9290.254535  PMID:30900680
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Erratum: A comparison of the effect of application of sodium ascorbate and amla (Indian Gooseberry) extract on the bond strength of brackets bonded to bleached human enamel: An In vitro study p. 159

DOI:10.4103/0970-9290.254536  PMID:30900681
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Erratum: Antimicrobial efficacy of Acacia nilotica, Murraya koenigii L. Sprengel, Eucalyptus hybrid, Psidium guajava extracts and their combinations on Fusobacterium nucleatum and Porphyromonas gingivalis p. 160

DOI:10.4103/0970-9290.254537  PMID:30900682
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