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   Table of Contents - Current issue
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January-February 2021
Volume 32 | Issue 1
Page Nos. 1-137

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GUEST EDITORIAL  

Stay updated on recent advances in clinical dentistry during COVID-19 pandemic and beyond p. 1
Satheesh Elangovan, Donald A Curtis, Michael G Newman
DOI:10.4103/ijdr.ijdr_306_21  PMID:34269226
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EDITORIAL Top

Dental surveillance for Post-COVID mucormycosis p. 2
SM Balaji
DOI:10.4103/ijdr.ijdr_594_21  PMID:34269227
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Analysis of the association between polymorphisms in Vitamin D receptor gene and dental caries p. 3
GB Protyusha, B Sivapatha Sundharam
DOI:10.4103/ijdr.IJDR_189_19  PMID:34269228
Background: The influence of environmental factors on dental caries is a well-established fact; however, little is known about the impact of genetics on the caries process. Aims: This study was aimed to analyse the association between the vitamin D receptor (VDR) gene polymorphism and dental caries. It also compared the risk of dental caries between individuals with homozygous (tt and TT) genotype and heterozygous (Tt) genotype. Further, this study also aimed to compare VDR gene polymorphism by gender. Methodology: A total of 196 subjects were selected based on their decayed, missing, filled teeth (DMFT) index according to the WHO guidelines (1997), and were divided into two groups based on caries experience. The case group was further classified into low and high caries groups. The saliva samples were collected, DNA was extracted, and VDR Taq1 (T/C) gene polymorphism was analysed by polymerase chain reaction–based restriction fragment length polymorphism (PCR-RFLP) and visualized under 2% agarose gel. Results: There was no significant difference in the VDR Taq1 polymorphism and dental caries between the case and control group. However, further stratification showed a statistically significant difference based on caries experience in the study group. The heterozygous mutant genotype (Tt) was associated with a higher caries experience (62.1%) (P = 0.008) with the frequency of 't' allele being 77% as compared to 'T' allele (63.6%) in the high caries group. Conclusion: VDR Taq1 gene polymorphism does not seem to have a role in the incidence of dental caries in the studied population; however, it may have a role in the severity of the caries process.
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Distribution and molecular characterisation of Lactobacilli in the oral cavity of children p. 8
Sonu Singh Ahirwar, Sunil K Snehi, MK Gupta
DOI:10.4103/ijdr.IJDR_298_19  PMID:34269229
Background: Dental caries is a chronic and multifactorial disease mainly caused by microorganisms that are accumulated on soft and hard tissues of oral cavity. Lactobacillus is one of that kind, produces acid after metabolic breakdown of dietary sugar and reduces the pH of oral environment, resulting in teeth demineralisation or dental caries. Aim: The present study focuses on the distribution and characterisation of lactobacilli in the oral cavity of children which are associated with dental caries formation. Methods: Total 116 swab samples were collected from different age groups of children by swabbing the caries surface of teeth. Physiological, morphological and biochemical characteristics of Lactobacillus were analysed. Whole cell protein profiling using SDS-PAGE was also performed for their characterisation. Molecular characterisation of selected isolates was done using 16S-rRNA sequencing for identification. Results: Total 269 isolates were successfully isolated and identified by physiological and biochemical tests according to Bergey's Manual Systematic Bacteriology, which belongs to the seven species of Lactobacillus i.e., L. acidophilus, L. casei, L. delbrueckii, L. helveticus, L. plantarum, L. rhamnosus, L. salivarius. All the isolates were further differentiated by whole cell proteins profiling and species level identification was done by 16S-rRNA gene sequencing method. Conclusions: The present study, suggested that the occurrence of the species of Lactobacillus changes with the age of the individual, but L. rhamnosus (20.54%) and L. acidophilus (18.21%) were abundantly found in age group of 3-12 yr which could be the possible causative agent of dental caries formation in the children of Central India.
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Comparative evaluation of periodontal inflammatory conditions among gutka-chewers with and without prediabetes p. 15
Puneet Bhardwaj, Zoya Chowdhary, Vandana Sharma, Ravi Ladani, Sonamben Kishorchandra Modi, Sudhanshu Bhardwaj, Kasper D Hundal
DOI:10.4103/ijdr.IJDR_566_18  PMID:34269230
Background: The metabolic syndrome has become one of the major public-health challenges worldwide which include diabetes, prediabetes (raised blood glucose level), abdominal obesity, high cholesterol level, and high blood pressure. Periodontitis is described as a multi-factorial irreversible and cumulative condition and, is also the sixth complication of diabetes. Areca nut chewing has already been linked with the development of various cancers, and more recently with metabolic syndrome. Therefore, the purpose of the study is to investigate the association of periodontal inflammatory conditions among gutka chewing with and without prediabetes patients. Materials and Methods: There are about 50 pre-diabetic and 50 healthy patients, both males and females with the age range of 18 years to 45 years, were included in the study. They were then divided into 4 groups based upon gutka chewers and non-chewers i.e., pre-diabetic gutka chewers (PDC), pre-diabetic non-chewers (PDNC), healthy gutka chewers (HC), and healthy non-chewers (HNC). A complete demographic data was obtained along with clinical and radiographic parameters i.e. plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), marginal bone loss (MBL) were recorded. A statistical analysis was performed and Bonferroni adjustment post hoc test was performed for multiple comparisons. Results: The overall results suggested that the clinical periodontal parameters i.e., PD, PI, SBI and radiologic parameters i.e., MBL are significantly higher in prediabetes chewers compared with healthy chewers and healthy non chewers. Conclusion: The periodontal inflammatory conditions are worse in gutka chewers compared to non-chewers in healthy and pre-diabetic patients, concluding that the severity of periodontal inflammation is governed by hyperglycemia when compared to habitual gutka usage.
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Effects of smoking on oral health: Awareness among dental patients and their attitude towards its cessation p. 23
Archana B More, Anisha Rodrigues, Bhakti J Sadhu
DOI:10.4103/ijdr.IJDR_711_18  PMID:34269231
Context: Tobacco smoking is the leading cause of preventable premature mortality in the world. Smoking is also detrimental to oral health, causing unaesthetic tooth staining, bad breath, periodontal diseases, impaired healing of wounds, increased risk of dental implant failure, precancerous conditions and oral cancer. Aims: To assess the awareness of the effects of smoking on oral health among smokers in Mangalore city and to assess the smoker's willingness to quit smoking. Settings and Design: Cross-sectional study. Material and Methods: Data was collected from 140 participants. A cross sectional study was conducted using a self-administered questionnaire to determine the sociodemographic characteristics, awareness about the effects of smoking on oral health and their willingness to participate in smoking cessation programs and to quit smoking. Results: There was statistically significant difference found in the level of awareness of the smoking effects on oral cancer, on tooth staining and dental implants. However, it was observed that the upper socioeconomic class showed a comparatively higher level of awareness than the other classes. No significant differences were found in the level of awareness of the smoking effects on gum disease and on wound healing. One hundred and thirteen individual out of 140 expressed their willingness to quit smoking and also 78 respondents showed a positive attitude toward participation in cessation programs.Conclusion: Participants in this sample had some knowledge about the effects of smoking, but were not much aware of its effect on dental implants, requiring further education.
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Analysis of erythrocytes in oral submucous fibrosis – A morphometric study p. 27
Vijay Wadhwan, Arvind Venkatesh, Preeti Sharma, Sangeeta Malik, Chitrapriya Saxena
DOI:10.4103/ijdr.IJDR_718_18  PMID:34269232
Background: Oral submucous fibrosis (OSMF) is a chronic progressive scarring oral disease caused due to areca quid chewing. The constituents of areca nut can enter into the circulation by swallowing the liquid mixture of areca quid which evokes oxidative stress on RBC membrane integrity. Aims: To study the morphometric characteristics of erythrocytes under light microscopy and to assess the role of areca quid constituents on the morphology of circulating erythrocytes. Materials and Methods: Peripheral blood smears prepared from blood samples of 50 patients selected according to Lai's classification. Group I: Normal individuals (10 cases); Group II: Mouth opening > 35 mm (10 cases); Group III: Mouth opening 30-35 mm (10 cases); Group IV: Mouth opening 20-30 mm (10 cases) and Group V: Mouth opening < 20 mm (10 cases). The slides were stained with Leishman's stain and assessed by light microscopy. A total of 100 randomly selected RBCs from 5 different fields in each smear were selected and the RBC circumference was measured and tabulated. Statistical analysis and Results: Data was analyzed using GraphPad Prism 5.03 software. Tukey's multiple comparison test showed statistically significant difference (p < 0.05) between groups I and IV; I and V; II and IV; II and V; III and IV; III and V. Conclusion: These results suggest the possibility of cytotoxic effect of areca quid constituents on circulating erythrocytes in advanced cases of OSMF, which might result in microcytic anaemia.
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Estimation of occlusal vertical dimension using cephalometric angular reconstruction p. 31
Dileep Nag Vinnakota, Rekhalakshmi Kamatham
DOI:10.4103/ijdr.IJDR_783_18  PMID:34269233
Aim: To propose a new technique, based on cephalometrics for determining the vertical dimension of occlusion (VDO). Methods and Material: Thirty-five participants in the age range of 2022 years who met the inclusion criteria were recruited. Lateral cephalograms were obtained and tracing done. Five reference landmarks, Nasion (N), Anterior Nasal Spine (ANS), Porion (P), Gonion (G) and Gnathion (Gn) were marked and joined to form four angles, N-ANS-Gn, N-ANS-G, P-G-Gn and P-G-ANS; distance between ANS and Gn was considered as VDO in cephalogram (VDO-Ceph). The angles N-ANS-Gn and N-ANS-G; P-G-Gn, and P-G-ANS were correlated; two simple linear regression models were developed to predict N-ANS-Gn and P-G-Gn, using N-ANS-G and P-G-ANS, as independent variables. Using the formulae, the predicted angles, N-ANS-Gn and P-G-Gn were drawn and intersection marked as 'reconstructed point Gn'. The predicted VDO-Ceph values (distance between ANS and reconstructed Gn) were measured and correlated with actual values. Results: The angles N-ANS-Gn and P-G-Gn had a statistically significant positive correlation with N-ANS-G (r = 0.77, P < 0.001) and P-G-ANS (r = 0.83, P < 0.001), respectively. Using simple linear regression analysis, the following formulae were obtained: N-ANS-Gn (in degrees) = 1.271 N-ANS-G (in degrees) + 24.83 and P-G-Gn (in degrees) = 0.987 P-G-ANS (in degrees) + 35.93. The predicted and actual VDO-Ceph values showed no statistical significance difference (P = 0.92). Conclusion: By tracing four cephalometric landmarks, N, ANS, P, G; and using the angular reconstruction, it is possible to predict the location of Gn. Hence, during prosthetic replacement of lost teeth, this can be employed for the estimation of lost dimensions.
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Is the profession of dentistry losing its yesteryear's glory? An exploratory study from dental students' perspective p. 35
Vikram Simha Bommireddy, Viswa Chaitanya Chandu, Harish Chowdary Kommineni, Anu Vijaykumar, Srinivas Ravoori, Gayathri Spandana Neeli
DOI:10.4103/ijdr.IJDR_111_20  PMID:34269234
Introduction: The regard for dentistry as a profession has been declining over the recent years in light of the increasing number of dental students graduating per year with negligible improvement in the utilization of oral health care services. In this context, it is important to document the perceptions and apprehensions of the current dental students as these feelings would have an influence on the roles they assume as dentists in future. Aim: With this background, this study attempts to document the willingness of dental students from three South Indian states to re-choose dentistry given an opportunity. Materials and Methods: This cross-sectional survey was conducted among house surgeons from 12 dental institutions, 4 each from the southern Indian states of Andhra Pradesh, Telangana, and Tamilnadu. The semi-structured questionnaire used in this study consisted of five primary questions along with details on the participants' gender, type of admission. It aimed at documenting the willingness to re-choose dentistry given an opportunity, and the reasons for their willingness or otherwise. A total of 822 students constituted the final sample. SPSS version 20 software was used to analyse the data. Results: Majority of the study participants were from Tamil Nadu, not reported dentistry as their primary career choice, and demonstrated reluctance in re-choosing dentistry given an opportunity. A significantly higher percentage of dental students from Tamil Nadu reported dentistry as their first professional choice. This observation persisted in the response of students for the question on their willingness to re-choose dentistry. Conclusion: The study results demonstrate the declining interest and regard for dentistry among the current dental students with nominal variations between students from the three South Indian states.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Exploring the perceptions, attitude and experiences of adolescents, their parents and teachers towards sugar sweetened beverages consumption in the National Capital Region of Delhi p. 39
Manu Raj Mathur, Matthew Sunil George, Deepti Nagrath, Richard G Watt
DOI:10.4103/ijdr.IJDR_607_20  PMID:34269235
Objective: To understand perceptions, attitudes and experiences of school-going adolescents, their parents, teachers and school management towards sugar-sweetened beverages (SSBs). Design: An exploratory qualitative study was undertaken. Setting: The study was conducted in selected, mixed, unaided schools in the state of Delhi. Subjects: Students of classes 8 to 12th, principals of schools, teachers, parents and school canteen owners. Results: SSBs formed an integral part of the diet of adolescents due to its taste and role as a thirst quencher. Respondents had a fair knowledge of health effects of SSBs. However, they were not aware of the range of drinks that constitute SSBs. Respondents associated SSBs with positivity and happiness. Promotion of SSBs by sports and film stars was cited as a major driver influencing consumption of SSBs by young people. Conclusions: SSBs were readily available even though schools had put in measures to restrict their availability in the premises. Peer pressure emerged as a key factor that drove the consumption of SSBs. Advertisements for SSBs involved individuals who were considered role models and these focused on themes that were important for young people such as belongingness, machismo and friendship among others. On the contrary, health promotion messages around obesity or the consumption of SSBs hardly had any brand ambassador or the visibility of campaigns that promoted SSBs.
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Obstructive sleep apnea and periodontitis: A cross-sectional study p. 44
Suman Mukherjee, Sushama R Galgali
DOI:10.4103/ijdr.IJDR_534_19  PMID:34269236
Objectives: (1) To assess the risk of Obstructive Sleep Apnea (OSA) using a pre-designed questionnaire; (2) To assess the periodontal parameters like pocket probing depth (PPD) and clinical attachment loss (CAL) in the study subjects and (3) To determine the association between the shared risk factors of OSA and periodontitis. Background of the Study: Periodontitis is a microbially associated, host-mediated inflammatory disease that results in the loss of periodontal attachment. It has multifactorial etiology and has been linked to an array of systemic diseases. Though both periodontitis and obstructive sleep apnoea (OSA) share some common risk factors, the insight into the hypothetical speculative link remains vague. This study intended to probe into the association between periodontitis and OSA. Methodology: A cross-sectional study was conducted on 250 subjects. The subjects were explained the nature of the study and written informed consent was obtained for participation in the study. The patients were administered a STOP-BANG questionnaire following which the periodontal parameters were recorded. The data obtained was analyzed by descriptive and inferential statistics. Results: A statistically significant increase in PPD and CAL scores were seen with the increase in OSA scores. A significant moderate positive correlation was found between OSA scores and PPD [r = 0.58, P < 0.001] and CAL [r = 0.55, P = 0.001]. Males were at increased risk for OSA and periodontitis. Age, hypertension and BMI which are the risk factors for periodontitis were also significantly higher in subjects at high risk for OSA. Conclusion: This study found a moderate positive association between periodontitis and OSA.
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Knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai p. 51
Farhin A Katge, Devendra P Patil, Pooja J Khakhar, Manohar S Poojari, Paloni B Koticha
DOI:10.4103/ijdr.IJDR_613_18  PMID:34269237
Context: Dental trauma is a serious oral health problem that can impair function and aesthetics, which affects the overall quality of life in children. Aims: The aim of the present study was to identify the level of knowledge and awareness of school teachers regarding emergency management of dental trauma in school children of Navi Mumbai. The second objective was to correlate it with demographic characteristics and evaluate the need for oral health education programs for teachers. Settings and Design: The present study is a cross-sectional survey and involved the completion of a self-administered anonymous questionnaire by teachers. Materials and Methods: A total of 559 school teachers of primary and secondary sections completed the questionnaire comprising 19 questions. These included demographic data, knowledge regarding teeth most frequently affected by trauma, immediate action to be taken, awareness about storage media and the use of mouth guards. The questionnaire also assessed the willingness of teachers to participate in future training programs on dental trauma management. Data were statistically analysed using Chi-square test for any correlation. Results: Among 559 school teachers who completed the questionnaire, 75.3% were females and 24.7% were males. Merely 6.6% of them agreed to have received prior training in dental trauma management. The majority of teachers (87.5%) were willing to attend training programs on dental trauma management. Conclusions: The knowledge and awareness of school teachers about dental trauma management and storage media for avulsed teeth is poor. Overall, they have a fair knowledge of dental trauma management in school children.
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Effectiveness of tobacco cessation counselling and behavioural changes Using Multi Theory Model (MTM): A follow-up study p. 56
Vijay Kumar, Bhavna Sabbarwal, Amrita Jaggi, Pratibha Taneja
DOI:10.4103/ijdr.IJDR_904_19  PMID:34269238
Background: Effective tobacco cessation programs using advice and counselling, have helped a substantial proportion of people quit smoking. Effectiveness of this tobacco cessation counselling needs to be evaluated. Aim: The aim of the present study was to evaluate the effectiveness of tobacco cessation counselling and behavioural changes using Multi Theory Model (MTM). Setting and Design: A non-randomised uncontrolled trial was conducted on 100 tobacco users visiting dental college in Bangalore. Methods and Materials: A 28 item questionnaire multi-theory model (MTM) for health behaviour was administered at baseline, 2 weeks, 6 weeks and 12 weeks after providing standardized tobacco cessation counselling (TCC) intervention at baseline. Statistical Analysis: Data were analysed and comparison were made using repeated measure ANOVA and Bonferroni adjustment (p < 0.05). Results: A total of 64 participants completed the 12 week follow-up. The mean age was 44.3 ± 10.1 years and 75.8% were males. There was significantly increase in mean MTM behaviour change score from baseline (32.78 ± 4.8) to 2 weeks (52.37 ± 5.27), 6 weeks (49.81 ± 4.34) and 12 weeks (48.7 ± 3.50) (p < 0.001). Conclusion: There was increase in MTM model scores in subsequent follow up suggesting behavioural changes and overall effectiveness of the Tobacco cessation counselling (TCC) among tobacco users.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Osteotome-mediated sinus floor elevation using an in situ hardening biphasic calcium phosphate bone graft substitute compared to xenograft: A randomized controlled clinical trial p. 61
Ashish Kakar, Bappanadu H Sripathi Rao, Nikhil Deshpande, Shashikanth Hegde, Anil Kohli, Aditya Patney, Harsh Mahajan
DOI:10.4103/ijdr.IJDR_857_19  PMID:34269239
Aim: To assess osteotome-mediated sinus floor elevation (OMSFE) with simultaneous implant placement using an in situ hardening biphasic calcium phosphate (BCP) compared to xenograft as a control. Methods: Patient in need for sinus floor augmentation in one or both sinuses were selected for this randomised controlled clinical trial. Sites presenting a residual sinus floor height of 3–6 mm and eligible for OMSFE were randomly assigned to receive either BCP (test) or xenograft particles (control). CBCT scans were performed before and at the time of implant loading (180 days). The difference in sinus floor height gain between the two groups was set as the primary endpoint parameter for equivalence testing. The implant insertion torque (ITV) was recorded and Implant stability quotients (ISQ) was assessed upon implant placement, abutment connection (160 days) and implant loading (180 days). Results: A total of 54 sinus lifts were performed in 42 patients including 12 bilateral cases. Four implants failed (two in each group) and a total of six patients were lost to follow-up. Statistical analysis of sinus floor height revealed no significant differences (p < 0.05) between groups at baseline nor at 180 days after augmentation. There was no statistical difference in sinus floor height gain between the two groups as supported by the 90% confidence intervals of the difference between groups. Good primary implant stability was confirmed in both treatment groups by ITV and ISQ measurements. Conclusions: Within the limits of this study, it can be concluded that OMSFE using in situ hardening BCP particles results in equivalent sinus floor height gain than using xenograft particles but offers an easier application.
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GSTM1 null polymorphism and palmar dermatoglypics in oral leukoplakia p. 69
Lakshanika Yogesh, Nalini Aswath
DOI:10.4103/ijdr.IJDR_18_18  PMID:34269240
Background: An individual's risk towards development of cancer depends not only on environmental factors or extrinsic exposure to carcinogens but also on individual's genetic susceptibility. Aim: To determine two genetically established parameters such as prevalence of GSTM1 null polymorphism and analysis of Palmar dermatoglypics (PD) in patients with Oral Leukoplakia (OL) and Controls. Materials and Methods: Group I (cases) 30 patients with established histopathological diagnosis of OL and Group II (controls) 30 patients without any habits of tobacco, alcohol usage and without OL were selected. After informed consent, the palm prints were recorded using a Canon PIXMA MP250 scanner and 2 ml of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using Multiplex PCR. Results: There exists a highly significant difference in GSTM1 null polymorphism (p-0.002), Finger ridge patterns (arches- p-0.027, loops p-0.001, whorls p-0.001), hypothenar pattern (p-0.015), ATD angle (p-0.001), AB count (p-0.007) between cases and controls. Similarly, when analysing the GSTM1 null polymorphism with PD among cases, there exists a significant association between loops (p-0.001), AB count (p-0.058) and hypothenar pattern (p-0.076), respectively 43% of OL cases had alteration in both which implies that those patients are at a higher risk of developing cancer. Conclusion: Not all patients who smoke or chew tobacco develop cancer. This could probably be due to the individual's genetic susceptibility. Environment gene interactions, in the form of GSTM1 polymorphism, and carcinogenesis, share links that can help in the prediction of risk for oral cancer development, and use of such markers can aid in prediction of oral cancer susceptibility in exposed individuals. Palm prints once formed do not change throughout life and are not influenced by environment. It can also serve as genetic markers to predict the risk of occurrence of oral cancer.
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Assessment of salivary thiocyanate levels and pH in the saliva of smokers and nonsmokers with chronic periodontitis – A comparative study p. 74
C Naresh Kumar, Subramaniam M Rao, Ankur Jethlia, Chandra Shekhar Linganna, Manish Bhargava, Devendra H Palve
DOI:10.4103/ijdr.IJDR_387_19  PMID:34269241
Background: It has been speculated that the pathogenesis of diseases prompted by cigarette smoking includes oxidative damage by free radicals. Though, definitive evidence that smoking may cause the oxidative modification of target molecules in vivo is lacking. Therefore, the purpose of this study was to estimate and compare the levels of salivary Thiocyanate (SCN) and power of hydrogen (pH) in the saliva of smokers and nonsmokers with chronic periodontitis (ChP). Materials and Methods: A study population consisted of 60 male systemically healthy subjects in the age group of 20-65 years that was further divided into three groups: Group 1: 20 Healthy nonsmokers, who never smoked. Group 2: 20 nonsmokers with chronic periodontitis. Group 3: 20 smokers with chronic periodontitis. Unstimulated saliva was collected for at least 5 mins and clinical parameters; salivary pH and SCN thiocyanate levels were assessed using the spectrophotometric method. Statistical analysis was performed using SPSS Inc 21.0, Chicago, II, United States of America. Results: Data showed that the mean salivary SCN level, periodontal parameters were higher in smokers with chronic periodontitis as compared to nonsmokers with chronic periodontitis and healthy subjects (P < 0.05.) Post Hoc tests multiple comparisons Tukey Honest Significant Difference (HSD) among three groups were statistically significant (p < 0.05). Conclusion: Salivary thiocyanate levels remain increased by smoking in addition to the impact of periodontitis, and these results also indicated a significant change in the pH depending on the severity of the periodontal condition in smokers. Thus, the measurement of salivary thiocyanate may prove to be useful in the early detection of periodontal disease. The salivary pH shows significant changes and, consequently, relevant to the severity of the periodontal disease. Salivary pH may thus be used as a quick chairside diagnostic biomarker.
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Comparative evaluation of retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals-An In-Vitro micro-CT analysis p. 79
MV Mavishna, Kondas Vijay Venkatesh
DOI:10.4103/ijdr.IJDR_328_20  PMID:34269242
Objective: To compare and evaluate the retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals using micro-CT scanning. Materials and Methods: Forty-five maxillary molars with curved roots were selected after confirming with the Schneiders test. Teeth were decoronated near the cemento-enamel junction and moderate to severely curved canals were selected for the study using cone-beam computed tomography. All the samples were subjected to pre-operative micro-CT scanning. Cleaning and shaping were done using step-back preparation, obturation was done using lateral compaction technique, and homogeneous obturation was achieved. All the specimens were kept in 10 mL of phosphate buffered-saline solution at a pH of 8.4 for 48 h and transferred to a plastic container containing moistened foam with 10 mL of phosphate- buffered saline solution, and stored at 37 °C with 100% relative humidity for 4 months. Retreatment was performed for all the samples using Protaper universal retreatment files. Micro-CT scanning was performed to compare and evaluate the remaining sealer volume and resultant cracks formed in the root canal after retreatment. Results: The volume of sealer remaining in the root canal and the length of a crack within the groups were analysed using kruskal–Wallis test and among the groups using post-hoc scheffe test showed that more sealer present in the Diaproseal sealer followed by MTA Fillapex and Bioroot RCS and more crack length was seen in Diaproseal sealer followed by MTA Fillapex and no visible cracks were seen in Bioroot RCS, which had statistically significant results with a P value of < 0.05. Conclusion: Within the limitations of the study it was concluded that in-terms of retrievability, Diaproseal sealer was the best among the tested groups followed by MTA Fillapex and Bioroot RCS.
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Compliance of postoperative instructions following the surgical extraction of impacted lower third molars p. 87
Ramakrishna S Shenoi, Jignesh G Rajguru, Sargam R Parate, Pranav D Ingole, Sandeep R Khandaitkar, Jui S Karmarkar
DOI:10.4103/ijdr.IJDR_323_20  PMID:34269243
Introduction: The way postoperative care instructions are presented by the professional (verbal and/or written) is the key element that influences quality of treatment. Hence, the aim of the present study was planned to assess the patient's compliance with postoperative care instructions given in different forms following the surgical removal of impacted lower third molars. Materials and Methods: Forty patients scheduled to undergo surgical extraction of impacted lower third molars under local anesthetic were randomly assigned to one of two groups. Before surgery, basic demographic data about age, gender, deleterious habits were recorded. Group A (verbal postoperative care instructions) and Group B (verbal + pictorial postoperative care instructions) were given with a prescription of medication after the surgical removal of impacted lower third molars. Patient were recalled on 7th postoperative day for suture removal and asked to fill the closed-ended questionnaire. Results: Out of 20 patients in each group, one patient from Group A was eliminated as the patient did not turn for the follow-up visit. Therefore, result was based on 39 patients (19 males and 20 females) of age 28–41 years with a mean of 33.2 years (SD ± 3.3). The significance level was set at P < 0.05. The compliance of patients regarding gargling with lukewarm water and mouth opening exercises was seen more significantly in Group B (Pictorial + Verbal). Conclusion: Verbal instructions are inadequate due to difficulty in retention. Hence, a pictorial form of delivering postoperative instructions increases information retention which significantly increases pain relief without extending the analgesic consumption.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Development of strontium-doped nano hydroxyapatite dentifrice and compare its remineralising potential with a topical cream containing casein phosphopeptide- amorphous calcium phosphate – An In Vitro study p. 92
Ratheesh Rajendran, K Radhakrishnan Nair, Raghu Sandhya, Anandhu V Krishnan, Aadit Anilkumar, PV Rakhi
DOI:10.4103/ijdr.IJDR_238_19  PMID:34269244
Aim: To develop and evaluate the efficacy of synthesised strontium-doped nano hydroxyapatite dentifrice and compare its remineralizing potential with a topical cream containing Casein Phospho Peptide – Amorphous Calcium Phosphate, in remineralizing artificial carious lesion on enamel. Materials and Methods: Enamel specimens of 4 x 4 x 1 mm were prepared from 90 freshly extracted teeth. Specimens were divided into 3 groups of 30 samples each, based on the type of dentifrice applied that is a control group (Group I) and two experimental groups (Groups II, III). Surface topography and the calcium/phosphorous ratio of all sound specimen were evaluated using Scanning electron microscope and Energy Dispersive X-ray Analysis (SEM-EDAX). The samples in group I and each of the experimental groups were subjected to demineralisation and the calcium/phosphorous ratio of the demineralized specimen were analysed. The samples were then subjected to remineralisation using different agents in each group. Samples in the control group (Group I) were brushed with a conventional dentifrice. In the experimental groups, Group II topical cream with Casein Phosphopeptide and Amorphous Calcium phosphate (CPP-ACP) was used and in Group III laboratory synthesized Strontium-doped nanohydroxyapatite paste (Sr-nHAP), respectively for 28 consecutive days. The samples in the both the control and the two experimental groups were again subjected to SEM-EDAX analysis to analyse the calcium phosphorus ratio following remineralisation cycle. Groupwise comparison of the data was done with one way ANOVA followed by Tukeys Post hoc Test. Results: Both experimental groups (II, III) showed statistically significant remineralisation potential after demineralisation, compared to the control group I. Intergroup comparison showed that the samples in Group III showed the higher remineralisation potential than Group II and was statistically significant. Conclusion: Both CPP- ACP containing tooth cream as well as Sr doped nHAp showed remineralisation potential. Sr doped nanohydroxyapatite showed better remineralisation than CPP ACP and can be considered for enamel repair in incipient carious lesions.
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Stereomicroscopic analysis of microleakage, evaluation of shear bond strengths and adhesive remnants beneath orthodontic brackets under cyclic exposure to commonly consumed commercial “soft” drinks p. 98
Rohan Pulgaonkar, Prasad Chitra
DOI:10.4103/ijdr.IJDR_936_18  PMID:34269245
Objective: This study aimed to evaluate the effects of Coca-Cola®, Sprite®, and Maaza® on Microleakage, shear bond strength (SBS) and adhesive remnants underneath orthodontic brackets. Materials and Methods: A total of 192 human premolar teeth were used in this study. The sample was divided into four groups: Artificial saliva (control) [Group 1], Coca-Cola [Group 2], Sprite [Group 3] and Maaza [Group 4]. All the samples were stored in artificial saliva and immersed in their respective testing media (except the control group) for 15 minutes 3 times a day, separated by intervals of 8 hours. The immersion cycle was repeated for 15 days. After the immersion cycle, 24 teeth from each group were tested for SBS and adhesive remnant index subsequently. The remaining 24 teeth from each group underwent dyeing with methylene blue and were analyzed stereomicroscopically to evaluate microleakage underneath the brackets. Kolmogorov-Smirnov and Shapiro normality tests were performed and homogeneity of variance was tested with the Levene test. One-way ANOVA and Kruskal-Wallis tests were carried out separately for SBS, ARI and microleakage. Statistical analyses were performed using SPSS 20 for Windows (SPSS Inc., Chicago) software. Results: Coca-Cola showed a significant reduction in SBS and microleakage (p < 0.05) compared to the other groups. ARI did not show any significant differences between any groups (p > 0.05). The mean microleakage scores were higher for the gingival side of the brackets compared to the incisal side. Both Sprite and Maaza showed significant differences compared to artificial saliva, despite the SBS not being statistically significant (p > 0.05). Conclusions: A significant reduction of SBS was observed in Coca-Cola while increased microleakage was seen in all three drinks compared to artificial saliva.
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An In-Vivo cone-beam computed tomography analysis of root and canal morphology of maxillary first permanent molars in an Indian population p. 104
Ajinkya Pawar, Bhagyashree Thakur, Ricardo Machado, Sang W Kwak, Hyeon-Cheol Kim
DOI:10.4103/ijdr.IJDR_782_19  PMID:34269246
Background: The root and canal morphology of maxillary first permanent molars (MFPMs) is a very widely studied issue in endodontics. However, only one study has been conducted to date on this issue using cone-beam computed tomography (CBCT) in India, and the sample consisted of extracted teeth. Aim: To investigate the root and canal morphology of MFPMs in an Indian population, by using CBCT. Methods and Material: 487 bilateral MFPMs (974 teeth) were assessed and the root and canal morphology were determined according to Vertucci's classification. In addition, the prevalence of a second mesiobuccal canal in the mesiobuccal root (MB2) was correlated with gender, age and arch side. Results: Three roots were most commonly found in the MFPMs regardless of gender (P > 0.05), but this prevalence varied according to the side of the dental arch (P < 0.05). MB2 was present in 77.5% of 3-rooted teeth. Patients above 60 years had a higher incidence of these canals (84.7%) (P < .05). The occurrence of bilateral MB2 was 71.8% in 3-rooted MFPMs. Gender had no significant impact on the occurrence of bilateral MB2 in 3-rooted MFPMs (P > .05). The most common canal configuration was type IV (46.5%) and I (98.9%) in the mesiobuccal and distobuccal roots, respectively (P < .05). The prevalence of MB2 in 3-rooted MFPMs was higher in patients above 60 years of age. Conclusions: The root and canal morphology of MFPMs in an Indian population may have significant variations depending on the dental arch side and patient age.
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EPIDEMIOLOGICAL WORK Top

Prevalence of dental fluorosis and treatment needs among 11-14 years old school children in endemic fluoride areas of Haryana, India p. 110
Radhey Shyam, BC Manjunath, Adarsh Kumar, Ridhi Narang, Geeta Rani, Saumya Singh
DOI:10.4103/ijdr.IJDR_835_18  PMID:34269247
Introduction: Dental fluorosis is a major endemic oral disease characterized by hypo mineralization of enamel caused due to consumption of water containing high concentration of fluoride during developmental stages of teeth. Aim: To assess the prevalence of dental fluorosis among 11-14 years old school children in endemic fluoride areas of Haryana and to find their treatment needs. Materials and Methods: A cross-sectional study was conducted among 2200 school children in endemic fluoride areas of Haryana (India) for a period of six months. Dental fluorosis was recorded by the Thylstrup-Fejerskov index (TF index) given by Thylstrup A, Fejerskov O. Statistical Analysis: Data entry and analysis were performed using Statistical Package of Social Sciences (SPSS) software version 18.0. Chi square test was used to find association between TFI scores and gender, age categories. The level of significance was set at 0.05. Results: Prevalence of dental fluorosis (TFI) reached 96.6% with most children falling in TFI score 2, 3, 4 and 5 categories. Mean TFI score of study population was found to be 3.19 ± 1.551. There was significant difference found between gender and prevalence of dental fluorosis (P = 0.00). Conclusion: Our findings showed the increased prevalence of dental fluorosis in endemic fluoride areas with mild to moderate level of dental fluorosis.
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Incidence of grinspan syndrome among tribal and suburban population of Maharashtra – A cross sectional study p. 115
Lalitkumar P Gade, Snehal D Lunawat, Kiran S Jagtap, Sneha H Choudhary, Monica Mahajani, Vishwas D Kadam
DOI:10.4103/ijdr.IJDR_649_19  PMID:34269248
Background: Grinspan syndrome is characterised by presence of the triad: hypertension, diabetes mellitus (DM) and oral lichen planus (OLP). OLP, seen in hypertension and diabetes mellitus, is caused by drugs used to treat these diseases according to literature, however the incidence of this syndrome in India has not yet been reported anywhere. Hence the present study was conducted with the following objectives: (i) To determine the incidence of Grinspan syndrome amongst tribal and suburban study population of Maharashtra in different gender and age groups (ii) To correlate occurrence of OLP with DM type 2 and hypertension (iii) To find out the number of patients with OLP, DM type 2 and hypertension either alone or in combination. Methods and Material: The present study was conducted on 4681 new patients attending the routine outpatient department (O.P.D.) of the dental hospital between January 2017 and December 2018. Patients with OLP or DM (type-2) or hypertension or any combination of these diseases were included in the present study. Brief case history of each patient was recorded. Data thus collected were analysed using SPSS version 20 for Chi-square test. Results: Grinspan syndrome was found in 1.62% of the study population. Syndrome was seen in 1.02% of female and 0.59% of male. Maximum patient affected by syndrome were in 35-50 years of age group. Conclusions: Incidence of Grinspan syndrome was 1.62%, mainly seen in sub-urban females of 35-50 years and OLP seen in hypertension and diabetes mellitus has different etiology and is not caused by drugs used to treat these diseases.
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CASE REPORTS Top

Asymptomatic palatal mass: A case report p. 120
CV Divyambika, K Satish Srinivas, S Sathasiva Subramanian, S Elengkumaran, N Malathi
DOI:10.4103/ijdr.IJDR_853_18  PMID:34269249
Accidental detection of asymptomatic clinically suspicious lesions is a common occurrence in routine clinical examination of the oral cavity. In certain cases, these lesions may mimic benign lesions further adding to confusion. In this case report, we have discussed the case of a 51-year-old male patient with an asymptomatic palatal mass which was detected during a routine dental check-up and subsequently confirmed to be an adenoid cystic carcinoma (ACC) arising from the minor salivary glands. The patient underwent right partial maxillectomy followed by radiation therapy and has been disease-free for 6 years and is on follow-up. ACC is a malignant tumour of the salivary glands commonly occurring in the palate, characterized by a slow indolent growth phase, with a high predilection for late recurrences which can be local or systemic. This article describes the importance of recognizing this clinical entity as a differential diagnosis in the evaluation of asymptomatic palatal lesions to enable early diagnosis and institution of appropriate treatment to successfully treat the disease.
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Large odontome compressing inferior alveolar nerve – A case report p. 124
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.ijdr_115_21  PMID:34269250
A young female sought treatment for a painful swelling in the right mandibular posterior region for the past 1 month with severe halitosis and paresthesia of right lower lip. Past history revealed that #46 was impacted due to an odontogenic tumor and an unsuccessful attempt was made to remove the impacted teeth and the tumor. A warm, tender, mild extra-oral diffuse swelling with right side cervical lymphadenopathy present. Intra-orally, there was a missing crown of 46 with a diffuse, tender buccal cortical expansion with a draining sinus. Imaging studies revealed a radiopaque lesion with a well-defined and rounded radiolucent halo. A provisional diagnosis of acute suppurative osteomyelitis was made and the remaining roots along with the radio-opaque material removed in toto via an open approach method and the entire area reconstructed with autograft harvested from rib. Histopathologically lesion was diagnosed to be a complex composite odontome. The challenges of diagnosis and the implication are discussed.
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Massive gingival enlargement in a nine-year-old paediatric patient: A rare case report p. 127
Pallavi Chaubey, Saurav Chandra, Mohammed Ahsan Razi, Seema Qamar
DOI:10.4103/ijdr.IJDR_559_19  PMID:34269251
Gingival enlargement (GE) is a well-known clinical phenomena with the primary aetiology being plaque and poor oral hygiene. Many reasons for GE have been known. Most of the time good oral hygiene is sufficient to achieve normal healthy gingiva. GE is a heterogeneous group of disorder characterized by progressive enlargement of the gingiva with an increase in submucosal connective tissue elements. Some of them are inherited and iatrogenic while others are idiopathic. In this case, we report a case with massive idiopathic GE in a 9-year-old female child; treatment received, histopathological description and follow-up are discussed.
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A very rare case of bilateral capillary hemangioma of lower lip and face: A case report p. 131
Ujjwal A Ujala, NR Diwakar
DOI:10.4103/ijdr.IJDR_574_18  PMID:34269252
Hemangioma is a relatively common benign proliferation of blood vessel that primarily develops during childhood. It is a most common benign tumor of vascular origin is the region of head and neck. The common sites are lips, tongue, buccal mucosa, and palate in oral cavity. Due to aesthetic concern and appearance problems of the hemangioma of lower lip and face it requires appropriate management. This is a case report of a rare hemangioma of lower lip and face bilaterally with involvement of mandible, floor of mouth, oropharynx, anterior 2/3rd of tongue parotid/submandibular glands in a 46-years-old female along the course of facial artery bilaterally with arterial feeders from the facial artery bilaterally, and draining into the jugular veins. This type of case is being reported first time in English literature.
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Florid cemento-osseous dysplasia: A case report p. 134
Arush Thakur, Shuddhodhan Gaikwad, Jagdish Vishnu Tupkari, Easwaran Ramaswami
DOI:10.4103/ijdr.IJDR_754_18  PMID:34269253
Cemento-osseous dysplasia is non-neoplastic, reactive fibro-osseous lesions that affect the tooth-bearing areas of the jaws. Osseous dysplasia is further divided into three subtypes: Periapical osseous dysplasia, focal osseous dysplasia, and florid osseous dysplasia. We hereby, present a case of florid cemento-osseous dysplasia occurring in a 40-year old dentulous Indian woman. The patient presented with lesions involving the mandibular right and left quadrant.
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LETTER TO EDITOR Top

Surrogate reviewers p. 137
Nitesh Tewari, Morankar Rahul Gangadharrao, Vijay Prakash Mathur, Shubhi Goel
DOI:10.4103/ijdr.IJDR_685_20  PMID:34269254
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