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   2011| September-October  | Volume 22 | Issue 5  
    Online since March 7, 2012

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Marsupialization of unicystic ameloblastoma: A conservative approach for aggressive odontogenic tumors
Dogan Dolanmaz, Osman A Etoz, Alper Pampu, Abdullah Kalayci, Omer Gunhan
September-October 2011, 22(5):709-712
DOI:10.4103/0970-9290.93461  PMID:22406718
Unicystic ameloblastoma (UA) is known as a distinct entity which has a less aggressive behavior when compared with conventional ameloblastoma. In this report, we have presented two cases of UAs, (of which one case showed a more aggressive behavior with mural invasion into the adjacent tissues and granular cell differentiation), both of which were successfully managed with enucleation following marsupialization. We aim to highlight how this method can be used for the successful management of such cases, rather than following more aggressive approaches. In both the cases, marsupialization was done for the UA lesions initially and follow-ups were maintained. When the tumor size had regressed on radiographic follow up, an enucleation procedure with ostectomy of the margins was carried out. Special importance was also given to the endodontic treatment of the teeth involved in the area of the lesion. The patients were free of the condition and did not show any signs of recurrence on radiographic follow-ups even after 30 months of the final procedure. Granular variant of UA is quite rare and had been considered to be more aggressive. Marsupialization of UA is an alternative treatment option of resection even for more aggressive variants, as long as the histological behavior of the lesion was carefully evaluated and strict radiographic follow-up is maintained.
  25 6,406 209
Survival of dental implants in native and grafted bone in irradiated head and neck cancer patients: A retrospective analysis
Aravind Buddula, Daniel A Assad, Thomas J Salinas, Yolanda I Garces
September-October 2011, 22(5):644-648
DOI:10.4103/0970-9290.93449  PMID:22406706
Aim: To study the long-term survival of dental implants placed in native or grafted bone in irradiated bone in subjects who had received radiation for head and neck cancer. Materials and Methods: A retrospective chart review was conducted for all patients who received dental implants following radiation treatment for head and neck cancer between May 1, 1987 and July 1, 2008. Only patients irradiated with a radiation dose of 50 Gy or greater and those who received dental implants in the irradiated field after head and neck radiation were included in the study. The associations between implant survival and patient/implant characteristics were estimated by fitting univariate marginal Cox proportional hazards models. Results: A total of 48 patients who had prior head and neck radiation had 271 dental implants placed during May 1987-July 2008. There was no statistically significant difference between implant failure in native and grafted bone (P=0.76). Survival of implants in grafted bone was 82.3% and 98.1% in maxilla and mandible, respectively, after 3 years. Survival of implants in native bone in maxilla and mandible was 79.8% and 100%, respectively, after 3 years. For implants placed in the native bone, there was a higher likelihood of failure in the maxilla compared to the mandible and there was also a tendency for implants placed in the posterior region to fail compared to those placed in the anterior region. Conclusion: There was no significant difference in survival when implants were placed in native or grafted bone in irradiated head and neck cancer patients. For implants placed in native bone, survival was significantly influenced by the location of the implant (maxilla or mandible, anterior or posterior).
  22 4,999 164
Elongated styloid process: Is it a pathologic condition?
Najmeh Anbiaee, Abbas Javadzadeh
September-October 2011, 22(5):673-677
DOI:10.4103/0970-9290.93455  PMID:22406712
Objectives: The aims of this study were to evaluate the length, morphology, and calcification patterns of the elongated stylohyoid process (ESP) on panoramic radiographs and to investigate the symptoms related to it. We then addressed the question: Is ESP a pathologic condition or a physiologic phenomenon? Materials and Methods: In this study, 207 stylohyoid complexes were evaluated based on length, radiographic appearance, and calcification pattern on panoramic radiographs. Similar to previous studies, we considered 30 mm as a threshold for elongation of the process. Complexes were classified into two groups based on length: ESP (greater than or equal to 30 mm) and normal (less than 30 mm). Clinical symptoms were evaluated by using a questionnaire and clinical examination. Data were analyzed by the Kolmogorov-Smilonov test, Mann-Whitney U test, and Spearman correlation. Results: The average length of the stylohyoid complex was 31.7 mm. The median was 30.0 mm and corresponded to the threshold for the ESP. The Spearman correlation between the length of the complex and age was 0.323 (P=0.0001). "Continuous" and "calcified outline" were the most frequent morphology and calcification pattern, respectively, for both groups. Clinical symptoms related to ESP were not detected. Conclusion: Classification of the stylohyoid complexes based on apparent length on panoramic radiographs in elongated and normal types appears to be incorrect. Considering that the radiographic appearance of the ESP and normal groups was similar and pathologic symptoms were not detected and that there was a relationship between age and length of the complex, elongation of this complex can be considered as a physiologic phenomenon.
  20 3,087 191
Rare foreign bodies in oro-facial regions
S Mohanavalli, J Jasline David, A Gnanam
September-October 2011, 22(5):713-715
DOI:10.4103/0970-9290.93462  PMID:22406719
Accidental entry of foreign bodies into the oro-facial region could be due to trauma, therapeutic interventions or iatrogenic. Various foreign bodies and locations have been reported, for example, wood in the orbit, impression material in the maxillary sinus, tooth fragments in the orbit. All these cases presented with inflammatory reaction and formation of infected granuloma, pus discharging sinus and serious complications like intra-cranial abscesses. Foreign bodies sometimes migrate within the tissues and become symptomatic after a certain period of time. In these cases, it is very difficult to correlate the direct relation between the suspected foreign bodies with the present clinical symptoms. The removal of foreign bodies is often a surgical challenge due to a combination of difficulty in access and close anatomical relationship to vital structures. To prevent complications, foreign bodies should be diagnosed and removed on time.
  20 3,322 164
Evaluation of DNA damage in oral precancerous and squamous cell carcinoma patients by single cell gel electrophoresis
Sanjit Mukherjee, Jay Gopal Ray, Keya Chaudhuri
September-October 2011, 22(5):735-736
DOI:10.4103/0970-9290.93475  PMID:22406732
Context: Single cell gel electrophoresis (SCGE) or "comet assay" is a rapid and very sensitive fluorescent microscopic method for detecting various forms of DNA damage at individual cell level. Aims: The aim of the present study was to detect the extent of DNA damage in oral cancer, oral submucous fibrosis (OSMF) and leukoplakia in comparison to normal individual. Settings and Design: A total of 44 consecutive patients with oral cancer (n=26), leukoplakia (n=12) and OSMF (n=6) and 10 healthy normal volunteers with normal oral epithelia (controls) were recruited from Dr. R. Ahmed Dental College and Hospital and were assessed for the extent of DNA damage using SCGE following clinical diagnosis. Materials and Methods: Peripheral blood was collected by venepuncture and comet assay was performed using SCGE. Mean tail length was compared between diagnostic groups and between different oral habit groups using t-tests and analysis of variance (ANOVA). Pearson's product moment correlation was used to examine the linear association between the extent of DNA damage and oral habit pack-years. Scheffe's pair-wise test was employed to adjust for multiple comparisons. Results: None of the controls were associated with any oral habits. Mean (±SD) tail lengths (in mm) for cancer (24.95 ± 5.09) and leukoplakia (12.96 ± 2.68) were significantly greater than in controls (8.54 ± 2.55, P<0.05). After adjustment, well-, moderately, and poorly differentiated carcinomas had significantly greater tail length than controls. Whereas the extent of DNA damage in cancer cases was significantly greater in leukoplakia than in compared to OSMF (11.03 ± 5.92), the DNA damage in latter was not different from controls. DNA damage for people with any oral habit (19.78 ± 7.77) was significantly greater than those with no habits (8.54 ± 2.55; P<0.0001). Conclusions: DNA damage measured by SCGE is greater in leukoplakia and squamous cell carcinoma, but not in OSMF. Deleterious oral habits are also associated with greater DNA damage.
  16 3,691 444
Comparison of oral manifestations with CD4 count in HIV-infected patients
Subodh Arun Sontakke, HR Umarji, Freny Karjodkar
September-October 2011, 22(5):732-732
DOI:10.4103/0970-9290.93470  PMID:22406727
Aim and Objective: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. Materials and Methods: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student's " t" test, was applied and objective conclusions were drawn. Result: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count <200 (group A), 10 patients were in group, B (CD4 count 200-500 cell/mm 3 ) and 2 patients in group C(CD4 >500 cell/mm 3 ). Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. Conclusion: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.
  13 9,796 342
Complications of exodontia: A retrospective study
Gokul Parameswar Venkateshwar, Mukul Nandkumar Padhye, Aman Rajiv Khosla, Shruti Tejprakash Kakkar
September-October 2011, 22(5):633-638
DOI:10.4103/0970-9290.93447  PMID:22406704
Purpose: The purpose of this study was to analyze the incidence of various complications following routine exodontia performed using fixed protocols. Materials and Methods: A total of 22,330 extractions carried out in 14,975 patients, aged between 14 and 82 years, who reported to the Department of Oral and Maxillofacial Surgery at Padmashree Dr. D. Y. Patil Dental College and Hospital, Nerul, Navi Mumbai, were evaluated for various complications. Results: The most common complications encountered were tooth fracture, trismus, fracture of cortical plates and dry socket. Wound dehiscence, postoperative pain and hemorrhage were encountered less frequently. Luxation of adjacent teeth, fracture of maxillary tuberosity, and displacement of tooth into adjacent tissue spaces were rare complications. Conclusion: The practice of exodontia inevitably results in complications from time to time. It is imperative for the clinician to recognize impending complications and manage them accordingly.
  13 11,006 373
Lycopene in the management of oral lichen planus: A placebo-controlled study
Nisheeth Saawarn, MC Shashikanth, Swati Saawarn, Vasanti Jirge, Nallan CSK Chaitanya, R Pinakapani
September-October 2011, 22(5):639-643
DOI:10.4103/0970-9290.93448  PMID:22406705
Context: Oxidative stress has been implicated in the pathogenesis of lichen planus, and a lower level of lycopene has been reported in erosive and atrophic oral lichen planus (OLP) patients. However, its efficacy in the management of OLP has not been reported. Aim: This study was designed to assess the efficacy of systemic lycopene in the management of OLP. Settings and Design: This prospective, randomized, double-blind, placebo-controlled study was done in the Oral Medicine Department of a postgraduate teaching dental hospital in India. Materials and Methods: Thirty symptomatic OLP patients, randomly divided into two groups of 15 each, were administered lycopene 8 mg/day and an identical placebo, respectively, for 8 consecutive weeks. Burning sensation using visual analogue scale and overall treatment response using Tel Aviv-San Francisco scale were recorded at every visit. The data obtained were analyzed statistically using Wilcoxon Rank test, Mann-Whitney and Fischer's Exact test. Results: A higher (84%) reduction in burning sensation was seen in lycopene than in the placebo group (67%). All 15 (100%) patients in the lycopene group showed 50% or more benefit and 11 (73.3%) patients showed 70-100% benefit, while this number was only 10 and 4 (26.7%), respectively, in the placebo group. Conclusion: Lycopene was very effective in the management of OLP, and oxidative stress may have a role in disease pathogenesis.
  13 7,590 643
Orofacial manifestation of hematological disorders: Hemato-oncologic and immuno-deficiency disorders
Titilope A Adeyemo, Wasiu L Adeyemo, Adewumi Adediran, Abd Jaleel A Akinbami, Alani S Akanmu
September-October 2011, 22(5):688-697
DOI:10.4103/0970-9290.93458  PMID:22406715
The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases with special reference to hemato-oncologic, immuno-deficiency disorders, and human immunodeficiency virus infection. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases with emphasis on hemato-oncologic and human immunodeficiency virus (HIV) infection. Mesh phrases used in the search were: Oral diseases AND hematological disorders; orofacial diseases AND leukemias; orofacial lesions AND lymphomas; orofacial diseases AND multiple myeloma, orofacial manifestations AND HIV. The Boolean operator "AND" was used to combine and narrow the searches. The full texts of these articles were thoroughly examined. References in these articles also were manually searched non-Medline articles. Only relevant articles were selected for the review. Orofacial manifestation of malignant hematological diseases may present as primary clinical features due to infiltration of orofacial tissues, or as secondary due to the subsequent infiltration of normal bone marrow elements, or tertiary due to the side effects of the treatment. HIV-associated orofacial lesion may be a clinical indicator of HIV infection in otherwise healthy, undiagnosed individuals; an early clinical feature of HIV infection; clinical markers for the classification and staging of HIV disease or may be a predictor of HIV disease progression. Orofacial manifestations of malignant hematological diseases and HIV infection are not uncommon findings in clinical practice. These manifestations may be clinical indicators of hematologic disorders in otherwise healthy, undiagnosed individuals.
  10 12,045 558
A comparison of lip prints between Aryans-Dravidians and Mongols
Prathibha Prasad, Vanishree
September-October 2011, 22(5):664-668
DOI:10.4103/0970-9290.93453  PMID:22406710
Context: Lip prints are very useful in forensic investigation and personal identification. Like finger prints, even lip prints can be instrumental in identifying a person positively. Aims: Indians are closer to Mongoloids than to Caucasoids or Negroids as indicated by the phylogenetic tree. Most of the studies on lip prints are done in their own population. We have compared lip prints of Manipuris with other Indians (Aryans and Dravidians) who are both close to Mongoloid race and are genetically similar. Materials and Methods: A total of 100 students 50 males and 50 females were selected of whom 30 males and 30 females were of Aryan and Dravidian features and 20 males and 20 females showed the Mongol features. Study materials used were Red colored lipstick, Lip brush, Cellophane tape, White chart paper and Magnifying lens. The lip prints were analyzed by dividing them into eight compartments. Results: Analysis of lip prints showed that the most common and the least common pattern in both males and females (Aryans-Dravidians and Mongols) were the same, but the compartment wise distribution of the lip patterns was different. Conclusion: In the present study, it is established that there is no similarity of lip prints from one individual to another individual and between males and females. Regarding the comparison with Mongols, more studies with a larger sample size is necessary.
  7 4,619 280
Microscope-aided endodontic treatment of maxillary first premolars with three roots: A case series
CS Karumaran, R Gunaseelan, J Krithikadatta
September-October 2011, 22(5):706-708
DOI:10.4103/0970-9290.93460  PMID:22406717
Maxillary premolars have a highly variable root canal morphology. However, the presence of three roots is a rare occurrence. This clinical article describes the unusual anatomy detected in maxillary premolars during routine endodontic treatment using microscope. The diagnosis and clinical management of maxillary first premolars with three roots and canals using radiographic interpretation, access cavity modification and visual enhancement with operative microscopes is discussed in the article.
  5 6,220 175
A comparative evaluation of the shear bond strength of five different orthodontic bonding agents polymerized using halogen and light-emitting diode curing lights: An in vitro investigation
Sujoy Banerjee, Rajlakshmi Banerjee
September-October 2011, 22(5):731-732
DOI:10.4103/0970-9290.93469  PMID:22406726
Purpose: With the introduction of photosensitive (light-activated) restorative materials in orthodontics, various methods have been suggested to enhance the polymerization of the materials used, including use of more powerful light curing devices. Bond strength is an important property and determines the amount of force delivered and the treatment duration. Many light-cured bonding materials have become popular but it is the need of the hour to determine the bonding agent that is the most efficient and has the desired bond strength. Aim: To evaluate and compare the shear bond strengths of five different orthodontic light cure bonding materials cured with traditional halogen light and low-intensity light-emitting diode (LED) light curing unit. Materials and Methods: 100 human maxillary premolar teeth, extracted for orthodontic purpose, were used to prepare the samples. 100 maxillary stainless steel bicuspid brackets of 0.018 slot of Roth prescription, manufactured by D-tech Company, were bonded to the prepared tooth surfaces of the mounted samples using five different orthodontic bracket bonding light-cured materials, namely, Enlight, Fuji Ortho LC (resin-modified glass ionomer cement), Orthobond LC, Relybond, and Transbond XT. The bond strength was tested on an Instron Universal testing machine (model no. 5582). Results: In Group 1 (halogen group), Enlight showed the highest shear bond strength (16.4 MPa) and Fuji Ortho LC showed the least bond strength (6.59 MPa) (P value 0.000). In Group 2 (LED group), Transbond showed the highest mean shear bond strength (14.6 MPa) and Orthobond LC showed the least mean shear bond strength (6.27 MPa) (P value 0.000). There was no statistically significant difference in the shear bond strength values of all samples cured using either halogen (mean 11.49 MPa) or LED (mean 11.20 MPa), as the P value was 0.713. Conclusion: Polymerization with both halogen and LED resulted in shear bond strength values which were above the clinically acceptable range given by Reynolds. The LED light curing units produced comparable shear bond strength to that of halogen curing units.
  5 3,766 175
Dental consultation in patients planned for/undergoing/post radiation therapy for head and neck cancers: A questionnaire-based survey
Apeksha Mainali, KN Sumanth, Ravikiran Ongole, Ceena Denny
September-October 2011, 22(5):669-672
DOI:10.4103/0970-9290.93454  PMID:22406711
Background: Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients. Aims and Objectives: To evaluate the attitude of oncologists toward dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancers and to evaluate the number of radiation oncologists who encounter oral complaints and consider worth referring to a dentist. Materials and Methods: A questionnaire-based study was carried out following mailing of covering letter and self-administered questionnaire comprising 11 items, to 25 radiation oncology centers selected in India based on convenient sampling. Results: Out of the 25 centers, we received response from 20 centers with 60 completely filled questionnaires. Five centers did not respond for further correspondences. Conclusion: The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.
  5 3,825 197
Evaluation of treatment for functional posterior crossbite of the deciduous dentition using Planas' direct tracks
Ana ClŠudia R Chibinski, Gislaine D Czlusniak
September-October 2011, 22(5):654-658
DOI:10.4103/0970-9290.93451  PMID:22406708
Background: Functional posterior crossbites are a common finding in children with deciduous teeth and must be treated as soon as they are diagnosed in order to avoid unwanted changes in normal growth and development patterns. Objective: This study objective was to evaluate the changes caused by Planas' direct tracks treatment on the arch dimensions of patients with functional posterior crossbite in first dentition. Materials and Methods: The sample consisted of 20 children, 4 to 6 years old, divided into two groups, paired up according to age and gender. Group test was composed of 10 patients with functional posterior crossbite treated with PDT. Group control consisted of 10 children with normal occlusion. The evaluation criteria were intercanine and intermolar distances and Carrea's analysis (arch perimeter). All data were collected by a pre-calibrated examiner on study casts obtained at baseline and after 4 months of treatment. The statistical analysis of the data was achieved using GraphPad InStat software, version 3.05 for Windows, with the level of significance set at 0.05. For the comparison between intercanine and intermolar distances, the Tukey-Kramer Multiple Comparisons test was used. When Carrea's analysis was considered, the Mann-Whitney test was used. Results: At the beginning of the study, all the evaluated criteria showed lower mean values in patients with posterior crossbites, and significant differences between test and control groups were noticed (P<0.05). After the end of follow-up period, these differences could not be verified (P>0.05). Conclusions: Within the limits of the present study, it is possible to conclude that the treatment with Planas' direct tracks was able to give back the normal dimensions of deciduous arch in patients with unilateral functional posterior crossbites, thus making it possible a better growth pattern.
  5 6,004 197
Maturation of permanent teeth in different facial types: A comparative study
Vikas Goyal, DN Kapoor, Santosh Kumar, Mahesh Sagar
September-October 2011, 22(5):627-632
DOI:10.4103/0970-9290.93446  PMID:22406703
Background: Accurate diagnosis of dental maturation help in diagnosis, treatment planning, and timing in orthodontics and dentofacial orthopedics. Aim and Objective: The present study is undertaken to compare and correlate chronological age and dental age of patients with average, vertical, and horizontal facial types, and to find out any sex difference in dental age in different growth patterns and to evaluated the reliability of Willem's method in Indian population. Materials and Methods: Subjects in the age group of 8-10 years were screened from Out Patients Department of Orthodontics and Dentofacial Orthopedics and from the various school of the City, were subjected to cephalometric radiography and orthopentomograms. Angular and linear measurements used included;-SN Go-Gn angle, J.R. (Jarabak ratio) and LAFH (lower anterior facial height), to group total sample of 150 children. Group 1 (average grower), Group 2 (vertical grower), and Group 3 (horizontal grower). Then dental age for each child in different group was calculated from OPG of each subject and compared with chronological age using Student t-test. Results: The results suggest a difference in dental age in subject with vertical and horizontal growers. Vertical grower showed earlier maturation compared to horizontal growth patterns. There was insignificant difference present when vertical grower and horizontal grower were compared with average growth pattern. Insignificant difference was found in dental age between males and females when compared to same growth pattern. Conclusion: Subjects with vertical growth pattern matured early than having the horizontal growth pattern in the same chronological age.
  4 5,023 200
Reliability of acridine orange fluorescence microscopy in oral cytodiagnosis
Nilima Prakash, P Sharada, GL Pradeep, N Soundarya
September-October 2011, 22(5):649-653
DOI:10.4103/0970-9290.93450  PMID:22406707
Context and Aims: The oral cavity is the most predominant location in the head and neck region for primary malignant epithelial tumors. Oral cancer is estimated to be the sixth most common malignancy. Early recognition is imperative for successful treatment and good prognosis. Exfoliative cytology is a simple and reasonably effective technique for rapid initial evaluation of a suspicious oral lesion. The present study was conducted to determine the reliability of acridine orange fluorescence microscopy for cytodiagnosis as a more rapid and easier method for the final evaluation of the cytological specimen. Materials and Methods: Smears were collected from 20 individuals with oral lesions suspicious of malignancy, oral lesions not suggestive of malignancy and normal buccal mucosa. One smear was stained with Papanicolaou stain and another one with acridine orange stain. The differences in the study group and control group were compared by means of the χ2 (Chi-square) test. The results were considered statistically significant whenever P was <0.05. Results: The acridine orange fluorescence stain reliably demonstrated malignant cells based on the differential fluorescence - a cytochemical criterion. The efficacy of the stain was higher than the conventional Papanicolaou stain in screening of oral lesions suspicious of malignancy. However, the acridine orange fluorescence stain did not differentiate effectively between malignant cells and rapidly proliferating cells, as the technique is based on the nucleic acid content. Conclusion: The fluorescent acridine orange method can be used reliably for the screening of carcinomas and it is especially helpful in the follow-up detection of recurrent carcinoma in previously treated cases.
  3 3,798 420
Root canal debris removal using different irrigating needles: An SEM study
Sheetal Ghivari, Girish Kubasad
September-October 2011, 22(5):659-663
DOI:10.4103/0970-9290.93452  PMID:22406709
Aim: This study was carried out to compare the efficacy of three irrigating needle designs in removal of debris from different parts of the root canal. Materials and Methods: Thirty human maxillary canines were prepared using HERO Shaper rotary system and irrigated with 1 ml of 5.25% sodium hypochlorite (NaOCl) after each instrument change. Three 25-gauge irrigation needle designs - brush-covered Navi Tip FX (Group I), side-vented needle RC Twents (Group II) and single-beveled (Group III) irrigating needles - were tested for their efficiency in debris removal in three different parts of the root canal (n=10 canals per group). Following instrumentation, the roots were vertically sectioned and divided into coronal, middle and apical thirds for observation under scanning electron microscope (×200 magnification). Debris on the canal wall was evaluated by using a four-scale scoring system described by Paque and his co-workers. Results: The canals irrigated with brush-covered needle Navi Tip FX (Group I) showed lower average debris score, indicating greater removal of debris in coronal third as compared to middle and apical thirds, whereas the canals irrigated with side-vented needle (Group II) and single-beveled needle (Group III) exhibited lower average score in the middle third than coronal and apical thirds. All the three needle designs exhibited higher debris score in apical third of the root canal. Tukey multiple comparisons test was applied at a significance level of P>0.05. A statistically significant difference (P<0.05) was observed in the debris removal in the coronal and middle thirds of root canals irrigated with brush-covered Navi Tip FX (Group I) and side-vented (Group II) needles, respectively, when compared with other needle design groups. Conclusion: Within the limitations of this study, it can be concluded that all the needle designs tested were effective in certain regions of the root canal with apical third uncleaned. Side-vented needle by creating turbulence removed debris effectively in coronal and middle thirds.
  3 3,848 260
Evaluation and comparison of castability between an indigenous and imported Ni-Cr alloy
Ganesh Ramesh, TV Padmanabhan, Padma Ariga, R Subramanian
September-October 2011, 22(5):733-733
DOI:10.4103/0970-9290.93471  PMID:22406728
Context: Since 1907 casting restorations have been in use in dentistry. Numerous companies have been manufacturing and marketing base metal alloys. Gold was a major component of casting alloys. But alloys with less than 65% gold tarnished easily and the increase in cost of gold post-1970s lead to the revival of base metal alloys such as nickel-chromium and cobalt-chromium alloys which were in use since 1930s. Aim: This study was conducted to evaluate and compare the castability between an indigenous alloy and an imported alloy, as imported base metal alloys are considered to be expensive for fabrication of crowns and bridges. Materials and Methods: This study was conducted to evaluate and compare the castability (for the accurate fabrication of crowns and bridges) between an indigenous base metal alloy-Non-ferrous Materials Technology Development Centre (NFTDC), Hyderabad (Alloy A) -and an imported base metal alloys (Alloy B). Castability measurement was obtained by counting the number of completely formed line segments surrounding the 81 squares in the pattern and later calculating the percentage values. The percentage obtained was taken as the castability value for a particular base metal alloy. The percentage of castability was determined by counting only the number of completely cast segments in a perfect casting (81 × 2 = 162), and then multiplying the resulting fraction by 100 to give the percentage completeness. Statistical Analysis Used: The Student t-test was used. Results: When the castability of alloys A and B was compared, the calculated value was less than the tabular value (1.171 < 2.048) leading to the conclusion that castability between alloys A and B is insignificant. Therefore we conclude that both the alloys have the same castability. Conclusions: Using the above-mentioned materials and following the method to test castability, we were able to derive favorable results. As the results were satisfactory, we can conclude that the castability of the indigenous alloy is on par with the imported alloy.
  3 2,703 106
Awareness of association between periodontitis and PLBW among selected population of practising gynecologists in Andhra Pradesh
Rajasekhar Nutalapati, Arpita Ramisetti, Ramesh Babu Mutthineni, Narendra Dev Jampani, Suresh Kumar Kasagani
September-October 2011, 22(5):735-735
DOI:10.4103/0970-9290.93474  PMID:22406731
Context: Preterm low-birth-weight (PLBW) infants are at a higher risk for a number of acute and chronic disorders. Studies point to an association between periodontal infection and increased rates of preterm birth, and pregnant mothers with periodontal diseases are at increased risk of subsequent preterm birth or low birth weight. However, the awareness level of gynecologists about this relationship is unknown. Aims: The aim of the present survey was to assess the awareness about the effects of periodontal disease on pregnancy among practicing gynecologists, and also compare such awareness between gynecologists in two places-Khammam (a district headquarter) and Hyderabad (a state capital). Settings and Design: Random, cross-sectional study in a population of practicing gynecologists from Andhra Pradesh. Materials and Methods: A random study population was selected from the practicing gynecologists in Khammam and Hyderabad. Sixty practicing gynecologists, 30 each in Khammam and Hyderabad, were approached and they consented to join the study. Data were collected in questionnaire format from the subject population. Collected data were statistically analyzed. Chi-square test with Yates correction was used to analyze the data. A " P" value of <0.05 was taken as a significant difference. Results: 73.3% of the gynecologists said that their patients complain of bleeding gums, swellings and mobility. 58.3% of the gynecologists were aware that gum diseases occur at a higher rate in pregnant females. 38.3% of the gynecologists were aware that periodontal diseases can affect the outcome of delivery. No significant difference was found between the awareness levels of gynecologists in Khammam and in Hyderabad. Conclusions: There is a need for interdisciplinary approach for the prevention of PLBW cases by the integration of periodontal care into obstetric management. Effort should be made to increase awareness among the gynecologists.
  3 2,713 219
Periodontal vaccine
Ranjan Malhotra, Anoop Kapoor, Vishakha Grover, Aaswin Kaur Tuli
September-October 2011, 22(5):698-705
DOI:10.4103/0970-9290.93459  PMID:22406716
Vaccine is the name applied generally to a substance of the nature of dead or attenuated living infectious material introduced into the body with the object of increasing its power to resist or get rid of a disease. Vaccines are generally prophylactic, i.e. they ameliorate the effects of future infection. One such vaccine considered here is the "Periodontal vaccine". Till date, no preventive modality exists for periodontal disease and treatment rendered is palliative. Thus, availability of periodontal vaccine would not only prevent and modulate periodontal disease, but also enhance the quality of life of people for whom periodontal treatment cannot be easily obtained. The aim of the research should be development of a multispecies vaccine targeting the four prime periodontal pathogens, viz. Porphyromonas gingivalis, T. forsythus, T. denticola and A. comitans. Success is still elusive in case of periodontal vaccine due to the complex etiopathogenesis of the disease.
  3 7,899 921
An innovative technique for customizing the stock acrylic resin ocular prosthesis
Tushar K Mowade, SP Dange
September-October 2011, 22(5):716-718
DOI:10.4103/0970-9290.93463  PMID:22406720
The loss of an eye is a traumatic and common event. The psychological effects of losing an eye are frequently more difficult to deal with than its functional loss. This article describes the management of a child patient with anopthalmic socket, by an innovative technique of customizing the stock acrylic resin ocular prosthesis to get improved esthetics, accurate location of iris-pupil complex and exact fit in the defect.
  3 2,350 166
Defining the role of Oral Physicians
Eswar Nagaraj
September-October 2011, 22(5):620-621
DOI:10.4103/0970-9290.93444  PMID:22406701
  2 3,529 348
Comparison of apical sealing and periapical extrusion of the ThermaFil obturation technique with and without MTA as an apical barrier: An in vitro study
Satish Kumar, SJ Deshpande, Ajay Singh Rao
September-October 2011, 22(5):622-626
DOI:10.4103/0970-9290.93445  PMID:22406702
Aim: The aim of the study was to compare the conventional ThermaFil obturation technique and ThermaFil obturation with mineral trioxide aggregate (MTA) as an apical barrier, with regard to apical sealing and extrusion. Materials and Methods: Twenty extracted human canines were instrumented using a crown-down technique and divided into two groups. The experimental group was obturated using ThermaFil obturation with MTA as an apical barrier and the control group was obturated using the conventional ThermaFil obturation technique. AH Plus sealer was used in both the groups. Apical extrusion was recorded. Teeth of both the groups were coated with nail polish, except for the apical 3 mm. After 24 h, they were suspended in black India ink for 48 h. Canines were decalcified, rendered transparent, and linear dye penetration was measured under ×40 stereomicroscope. Results: There was a significant extrusion noticed in conventional ThermaFil obturation technique. Frequency of extrusion of sealer and/or gutta-percha was supposed to be evaluated using χ² test, but since the values of the samples of ThermaFil plus MTA group were zero, statistical analysis could not be conducted, whereas linear dye leakage was calculated with Mann-Whitney U test because the distribution was abnormal. Conclusion: Although ThermaFil plus MTA group showed microleakage, extrusion of sealer and the core material was prevented in comparison with conventional ThermaFil obturation technique. It is advantageous to use MTA as an apical plug as there is no fear of apical extrusion and the root canal system can then be packed three dimensionally against this barrier using any thermoplasticized gutta-percha obturation technique.
  2 4,641 229
New generation of color bonding: A comparative in vitro study
Rajkumar Maurya, Tulika Tripathi, Priyank Rai
September-October 2011, 22(5):733-734
DOI:10.4103/0970-9290.93472  PMID:22406729
Background: Newer available composite resin adhesives have chromatic agents that change their color during setting from pink to colorless. It has an advantage of easy flash removal thus reducing the amount of plaque accumulation and helping patients to maintain better hygiene. Aim: The aim of the present study was to compare shear bond strengths of light-cure orthodontic bonding agents, namely glass ionomer (FujiOrthoLC, GC Orthodontics), conventional composite resin (Transbond XT, 3M Unitek), and color-changing composite resin (Transbond Plus, 3M Unitek) with conventional etch and self-etch primer (Transbond PlusSEP, 3M Unitek). Materials and Methods: Maxillary premolars (n=300) were bonded on the facial surface in five groups. The INSTRON machine was used for shear bond strength testing. Statistical Analysis: Comparison of the mean rank among the groups was done by Kruskal-Wallis one-way analysis of variance (ANOVA). To determine the mean difference among groups, the Mann-Whitney test with Bon Ferroni adjustment was applied. Observations: It was observed that light-cure conventional composite resin with the conventional etchant group had the highest and glass ionomer resin adhesive had the lowest shear bond strength. There was no statistically significant difference between conventional composite used with conventional etchant and color-changing composite resin used with conventional etchant or with self-etch primer. Conclusion: Considering the advantages of a color-changing composite and self-etch primer especially in patients having high DMFT scores or physically and mentally compromised patients unable to maintain their hygiene properly, it was concluded in the present study that it would be the most suitable material for direct bonding.
  2 2,851 175
eRME - Rapid Maxillary Expansion in the economic way
Sonali Mahadevia, Nozar Daruwala, Krishnamurthy , Malay Vaghamshi
September-October 2011, 22(5):734-734
DOI:10.4103/0970-9290.93473  PMID:22406730
Aim and Objectives: Rapid Maxillary Expansion constitutes a routine clinical procedure in orthodontics, involving separation of mid-palatine suture which is usually done with help of the Hyrax screw. However, because of its high cost, the use has been limited, especially in institutions. So, the purpose of this study was to construct an economical device which can expand the maxillary arch in growing patients. Materials and Methods: Six patients having constricted maxilla and posterior skeletal crossbite were randomly selected from the Department of Orthodontics. A unique, easy and simple alternative device for expanding the maxillary arch called economic Rapid Maxillary Expander (eRME) has been fabricated at about one-tenth the cost of the conventional Hyrax. Pre- and post-treatment effects were statistically tested by using paired t-test at 0.05 level of significance. Results and Conclusion: The study results showed an average expansion in canine, premolar and molar regions of 4.4 mm, 6.8 mm and 9.4 mm, respectively, having significant difference pre-and post-treatment. Thus, it shows that maxillary expansion is efficiently possible with the application of this newly constructed device named eRME. This appliance also acts as a fixed retainer to avoid relapse, hence negating the need for a separate retainer.
  2 7,201 242
In vitro wear of Ionofil Molar AC quick glass-ionomer cement
Farida Abesi, Hengameh Safarcherati, Javad Sadati, Hossein Kheirollahi
September-October 2011, 22(5):731-731
DOI:10.4103/0970-9290.93468  PMID:22406725
Aim: The aim of this study was to evaluate the three-body wear-resistance of one type of restorative glass-ionomer cement (GIC). Materials and Methods: Specimen including conventional GIC (Ionofil Molar AC Quick: IMACQ), hybrid ionomer (Fuji II LC), and composite resin (Heliomolar) were tested in a wearing machine. In this machine, a 6 kg load was applied via pressable chromium-cobalt bar at 5,000, 10,000, 20,000, 40,000, 80,000, 120,000 cycles. Specimen weight was measured by an electronical weight balance before and after each cycle. Data were analyzed using one-way analysis of variance (ANOVA) followed by a t-test, and a paired t-test at P≤0.05. Results: The highest weight loss has been found in Fuji II LC, then in GIC IMACQ and the least wear rate has been reported in heliomolar composite in all cycles except 120,000 cycles. In 120,000 cycles, the highest weight loss was seen in GIC IMACQ, then Fuji II LC, and finally heliomolar composite. There was a statistically significant difference in weight loss between GIC IMACQ and heliomolar composite (P=0/001). Conclusion: The wear rate of GIC IMACQ was between those of heliomolar composite and Fuji II LC glass ionomer in all cycles except 120,000 cycles. The most important advantage of this new-generation glass ionomer is its good manipulability and also high wear-resistance compared to the hybrid ionomer. Therefore, it is suggested that it can be used as restorative material in class I restorations in primary teeth.
  2 2,795 97
Root coverage using epithelial embossed connective tissue graft
T Ramakrishnan, Manmeet Kaur, Kriti Aggarwal
September-October 2011, 22(5):726-728
DOI:10.4103/0970-9290.93466  PMID:22406723
In periodontal practice, root coverage after marginal soft tissue recession requires daily clinical decisions. Numerous longitudinal human studies have been presented to support the efficacy and predictability of different mucogingival surgical techniques for root coverage. Over the years, root coverage procedure using the subepithelial connective tissue graft with variations has emerged as the favorite surgical technique. In the case presented in this report, subepithelial connective tissue graft with embossed epithelium was used to cover Miller's class II gingival recession in the upper right canine. The design is such that embossed epithelium exactly fits the recession site and the connective tissue portion is tucked below the gingival margin of the recipient site. In this technique, coronal advancement of flap is not needed. Wider zone of attached gingiva at the recipient site was achieved by this technique.
  2 3,675 238
"Rx - The mistakes we make!!": A short study
Arun Rathnam, Nidhi Madan
September-October 2011, 22(5):684-687
DOI:10.4103/0970-9290.93457  PMID:22406714
Context: There is concern regarding the irrational production, prescription and use of drugs in India. Aim: This study aimed to describe the quality of prescriptions by dental practitioners of one particular college in a short period of time. Materials and Methods: A survey of all prescriptions dispensed from the various departments of K.L.E.S.'s Institute of Dental Sciences, Belgaum, Karnataka, was conducted by collecting them from the patients exiting the college premises. The prescriptions were photocopied and handed back to the patients. The samples were collected over a period of 7 days. The samples were then analyzed for their content based on an ideal prescription format and the results were tabulated. Results: The findings of the study suggest that most of the prescriptions given are woefully inadequate in content. Conclusions: It can be concluded that a clear policy about the standard of prescriptions and periodic internal monitoring is the answer for quality prescriptions. Computerization of the prescription format is also a thought-provoking alternative.
  1 4,064 282
Promoting ISDR to divisional status in IADR
SM Balaji
September-October 2011, 22(5):619-619
DOI:10.4103/0970-9290.93443  PMID:22406700
  - 2,128 117
Changes in peripheral innervation and nociception in reticular type and erosive type of oral lichen planus
Siriporn Chattipakorn, Jitjiroj Ittichaicharoen, Samreung Rangdaeng, Nipon Chattipakorn
September-October 2011, 22(5):678-683
DOI:10.4103/0970-9290.93456  PMID:22406713
Background: Oral lichen planus (OLP) is a chronic inflammatory lesion in oral mucosa. Reticular (OLP-R) and erosive (OLP-E) types of OLP are the common forms that have been found in dental clinics. The aim of this investigation is to determine the correlation between neurogenic inflammation and nociception associated with OLP-R and OLP-E. Materials and Methods: The oral mucosal lesions from six patients with OLP-E, four with OLP-R and three with noninflamed oral mucosa, which represent normal mucosa, were identified by morphometric analysis of nerve fibers containing immunoreactive protein gene product (PGP) 9.5. The level of inflammation was measured with hematoxylin and eosin staining and the level of nociception was analyzed with visual analog scale measurement. Results: We found that 1) an increase in peripheral innervation was related to the size of the area of inflammatory cell infiltration from both OLP-R and OLP-E; 2) the pattern of PGP 9.5-immunoreactivity among OLP-R and OLP-E was not significantly different (P=0.23); and 3) the correlation between nociception and an increase in PGP 9.5-immunoreactivity was not found in OLP-E and in OLP-R. Conclusions: Our findings suggest that an increase in peripheral innervation may lead to increased inflammation, which is part of the immunopathogenesis of OLP. Differences in nociception between OLP-R and OLP-E arise from the pathogenesis of each lesion, not from the differences in peripheral innervation.
  - 2,198 115
Trismus as a first presenting complaint in a case of myasthenia gravis
Sibu S Simon, Arun Paul Challu, Rabin K Chacko
September-October 2011, 22(5):729-730
DOI:10.4103/0970-9290.93467  PMID:22406724
The initial presentation of myasthenia gravis as trismus is very rare and no previous reports have been found in the literature. A 35-year-old male presented to the outpatient unit of our department with inability to clench well and to open his mouth. Physical examination revealed that he had clinical findings consistent with the signs and symptoms of myasthenia gravis. He was immediately referred to a neurologist, who confirmed that he was in an advanced stage of myasthenia gravis with severe deficit to his respiratory muscles and he was promptly treated. He is presently on a maintenance drug therapy. To our knowledge, this is the first reported case of myasthenia gravis whose initial presentation was trismus. This case presents a rare but important diagnosis that should be added to the differential diagnosis of trismus.
  - 2,568 115
Prosthetic rehabilitation of large nasal septal defect with an intranasal stent: A clinical report
Mukesh Kumar Goyal, Shelly Goyal
September-October 2011, 22(5):719-722
DOI:10.4103/0970-9290.93464  PMID:22406721
Nasal septal perforation is a common complication of many nasal diseases such as congenital, infectious, trauma, and iatrogenic, and rarely may occur as a complication of systemic diseases, etc. The symptoms of uncorrected nasal septal perforations include crusting, epistaxis, difficulty in breathing, nasal twang in speech, postnasal discharge, foul-smelling, rhinorrhea, and hyposmia. Large nasal defects cannot be closed by hard acrylic resin nasal septal obturators because of the problems in access and path of insertion. However, obturation can be achieved by fabrication of a nasal stent that engages one of the nasal cavities. This clinical report describes prosthetic management of a patient with large nasal septal defect following septal surgery complication with an intranasal heat-processed acrylic resin stent. The stent is rendered patent for comfortable breathing, improves speech, is esthetically acceptable, dense and hygienic. These nasal stents indirectly separate the two nasal cavities with effective obturation of large nasal septal defects.
  - 5,028 139
Mandibular fracture in an 18-month-old child
Vivek Kumar Adlakha, Vishal Bansal, Preetika Chandna, Abhay Agarwal
September-October 2011, 22(5):723-725
DOI:10.4103/0970-9290.93465  PMID:22406722
Facial trauma in a child can be a greatly distressing experience for the parents as well as the child, causing uncontrollable crying in the child and panic and fear in the parents. Facial injuries in children are less common than in adults. This case report describes the management of symphysial fracture of the mandible in an 18-month-old girl. The fracture was reduced under general anesthesia and then stabilized with an acrylic cap splint, utilizing circummandibular wiring.
  - 3,017 182
Displacement of endodontic instruments in inferior alveolar canal
Nitasha Gandhi, Sumir Gandhi, Saurab Bither
September-October 2011, 22(5):736-736
DOI:10.4103/0970-9290.93476  PMID:22406733
Endodontic instrument breakage is a common occurrence during root canal treatment but the displacement of the separated instrument into the inferior alveolar canal is rare and has never been reported. We hereby present an unusual case of displacement of a separated instrument in the inferior alveolar canal and its retrieval by a simple technique.
  - 4,673 167
Benign hyperplasia of duct-associated lymphoid tissue: Report of a case and review of literature
Venkatesh Vishwanath Kamath, Jagdish Belur
September-October 2011, 22(5):737-737
DOI:10.4103/0970-9290.93477  PMID:22406734
Focal lymphoid tissue is ubiquitously present in the oral mucosa and serves as a barrier for entrapment of antigens. The mucosa-associated lymphoid tissue is generally dispersed and sometimes associated with the ducts of the minor salivary glands. Proliferation of the duct-associated lymphoid tissue (DALT) is rarely reported, though probably of common occurrence. We report a case of benign hyperplasia of DALT in the buccal mucosa of a 58-year-old male. The histogenesis and pathological implications of this tissue are discussed and the need for recognition of this entity is stressed.
  - 2,419 67
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