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   Table of Contents - Current issue
Coverpage
November-December 2020
Volume 31 | Issue 6
Page Nos. 829-990

Online since Monday, March 22, 2021

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EDITORIAL  

COVID-19 vaccination, dentistry, and general public Highly accessed article p. 829
SM Balaji
DOI:10.4103/ijdr.ijdr_136_21  PMID:33753648
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Efficacy of T. Cordifolia (Guduchi) against plaque and gingivitis-A clinico-microbiological study p. 830
Shruti Nair, Pradnya Kakodkar, Sahana Hegde Shetiya, Neelima Dharkar, Changade Jayashree, Ladusingh Rajpurohit
DOI:10.4103/ijdr.IJDR_521_18  PMID:33753649
Objectives: The present study was conducted to assess the clinical efficacy (against plaque and gingivitis) and antimicrobial efficacy (against gram negative, gram positive and S. mutans counts) of T. cordifolia (Guduchi). Methodology: A nonrandomized before and after trial for 21 days of intervention was performed involving 17 participants. Plaque index, gingival index were recorded and saliva samples were collected at baseline, 13th day and 22nd day. Repeated measures ANOVA test was performed to compare the before and after results of the clinical parameters, i.e. score of plaque index and gingival index. Freidman's test was applied for comparison between the three intervals (for microbiological evaluation of colony counts). Results: There was statistically significant reduction inplaque score, gingival score, and colony forming units of gram negative organisms and S. mutans from baseline to 22nd day (P = 0.001). There was no significant reduction with gram positive organisms. Conclusion: This clinico-microbiological study concluded that twice rinsing of T.cordifolia decoction as mouth rinse in adjunct to scaling and routine brushing of teeth for 21 days shows anti-plaque, anti-gingivitis, and antimicrobial action against gram negative organisms and S. mutans.
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Association of oral health literacy with oral health behavior and oral health outcomes among adult dental patients p. 835
Jagadeeswara Rao Sukhabogi, Dolar Doshi, Madhuri Vadlamani, Vijay Rahul
DOI:10.4103/ijdr.IJDR_337_19  PMID:33753650
Aims: To evaluate the association of oral health literacy (OHL) with oral health behavior and oral health outcomes among dental patients in Hyderabad City. Settings and Design: Cross-sectional study among dental patients. Materials and Methods: A convenience sample of 605 adults >18 years of age visiting the out-patient Department of Public Health Dentistry of Government Dental College and Hospital, Hyderabad, were recruited. The five-item scale developed by Ishikawa was used to measure communication and critical OHL. Socioeconomic status was assessed using Modified Kuppuswamy's scale and questions for oral health behavior included frequency of toothbrushing, frequency of dental visit, and reason for visit. Dentition status, periodontal status, and loss of attachment were recorded according to World Health Organisation Survey methods. Statistical Analysis Used: Frequency distribution was done and association between the variables and predictors (oral health behavior and oral health status) of OHL was calculated using odds ratio. Results: The mean age of the study population was 31.5 + 11.2 years. None of the individuals' questions of OHL questionnaire had 50% response of strongly agree or agree. The oral health parameters of decayed and filled teeth emerged as a significant predictor for model 1 (adjusted by sex and age) and model 2 (adjusted by sex, age, and social class). Likewise, toothbrushing frequency was significantly associated with low OHL. Conclusions: This study shows a high prevalence of low OHL in the study population, with decayed teeth and filled teeth and oral health behavior like toothbrushing only once as a significant predictor for low OHL.
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Serum migration inhibitory factor levels in periodontal health and disease, its correlation with clinical parameters p. 840
Aruna Ganganna, Anitha Subappa, Purnima Bhandari
DOI:10.4103/ijdr.IJDR_896_18  PMID:33753651
Objectives: Periodontal infections are an important risk factor for systemic disease and are driven primarily by the cytokines. Migration Inhibitory Factor (MIF) is a key cytokine which mediates acute and chronic inflammation alongside, a molecular link between chronic inflammation and immune mediated conditions. Hence, the present study was carried to measure the serum MIF levels in periodontal health, disease and to correlate the levels with the clinical parameters. Material and Methods: Sixty subjects were divided into three groups (each group n = 20) based on the gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) as group I healthy; group II gingivitis; and group III chronic periodontitis. The serum MIF level was measured using quantitative sandwich enzyme immunoassay technique. Results: Highest level was detected in Group III with a mean of 71.8 ng/ml and the lowest in group I (6.1 ng/ml). Serum MIF levels did not correlate with the clinical parameters. Conclusion: Increased serum MIF levels in chronic periodontitis patients suggest its role as an inflammatory biomarker and may have a role in inflating the systemic inflammation. Summary: Serum Migration inhibitory factor can be used as an inflammatory marker for periodontal disease
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Residual antibacterial effect of calcium hydroxide combined with chlorhexidine gel as an intracanal medicament p. 846
Nawal A Al-Sabawi, Fatima A Mohammad, Njwan F Shehab
DOI:10.4103/ijdr.IJDR_359_19  PMID:33753652
Introduction: Bacterial elimination from the root canal system is considered as an essential factor for a successful endodontic treatment. Aims: To investigate both in vitro and in vivo efficacy of calcium hydroxide paste (CH) combined with 2% chlorhexidine gel (CHX) at various time intervals on Enterococcus faecalis (E.f) when used as an intracanal medicament (ICM). Materials and Methods: For the in vitro study, 45 single-rooted teeth were used. After instrumentation, roots were infected with E.f and then divided into three groups (gps) (15 n/gp) according to the time interval for the medicament to be left inside the canal (1 week, 2 weeks and 3 weeks). ICM used was 2% CHX combined with CH (CH + CHX). At the end of each time interval, the antibacterial effect was evaluated using the agar diffusion test. For the in vivo study, 45 single-rooted teeth were selected. After sterilisation and access opening, the first pre-treatment sample was taken, then after instrumentation second post-instrumentation sample was obtained. Later, teeth were divided into 3 gps (15 n/gp) (1 week, 2 weeks and 3 weeks) according to the time interval for the medicament to be left inside the canal. ICM used was 2% CH + CHX. After each period, the third post-medication sample was taken. ANOVA and Tukey post hoc tests were used for statistical analysis. Results: Both in vitro and in vivo studies have found that 2% of CH + CHX had a significant antibacterial effect for 1 week and 2 weeks. However, the antibacterial effect was significantly decreased after 3 weeks. Conclusions: CH + CHX can be used successfully for the reduction of E.f for 14 days when used as ICM.
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Evaluation of cessation services provided at a tobacco cessation clinic in a teaching dental hospital p. 852
Abhishek Mehta, Sofiya Ahmed, Aditi Verma, Ratika Kumar
DOI:10.4103/ijdr.IJDR_541_19  PMID:33753653
Background: Tobacco cessation interventions provided in a dental office or hospital settings are beneficial in helping patients to quit tobacco. Regular monitoring of these interventions is required to assess their success rate and factors hindering its improvement. This study evaluated cessation services provided through a Tobacco Cessation Clinic (TCC) established in a government teaching dental hospital in Delhi, India. Materials and Methods: Patients visiting the TCC from April 2016 to March 2018 were contacted to participate in this study. All the willing participants were administered a structured questionnaire telephonically or in person. The questionnaire focused on gathering information on patients' current tobacco use status, feedback on intervention provided at TCC and reasons for missing TCC appointments. Bivariate and multivariate analysis was performed to assess the effect of socio-demographic factors, nicotine dependence and interventions at TCC on current tobacco use status of participants. Results: Of the 309 participants, 60 (19.4%) reported complete tobacco abstinence and 78 (22.3%) reduced consumption by more than half from their first visit to TCC. Most of the participants (81.5%) were satisfied with the tobacco cessation interventions provided at the TCC. Multivariate analysis shows that odds of quitting were higher in participants with low tobacco dependence (OR 3.03, CI 0.98,9.35) and those who were satisfied with counselling method at TCC (OR 8.8, CI 2.05, 38.35). Conclusion: Interventions provided at our TCC were found beneficial by the study participants to reduce tobacco consumption or achieve total tobacco abstinence. A timely reminder can be provided to increase patients' compliance.
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Evaluation of remaining dentin thickness around the prepared root canals and its influence on the temperature changes on the external root surfaces during different heated gutta-percha obturation techniques p. 857
Sundaresan Balagopal, CM Bejoy Mony, Bahavathi Ananthan Hemasathya, M Nazrin, Vandana James, Anisha Sebatni
DOI:10.4103/ijdr.IJDR_508_19  PMID:33753654
Context: Temperature rise on external root surface has a deleterious effect on the periodontium. Aims: To compare and evaluate the temperature changes on the external root surfaces using three different heated gutta-percha obturation techniques and also to evaluate the effect of remaining dentin thickness (RDT) on the temperature rise during obturation. Settings and Design: In vitro study with a customized temperature measurement setup. Materials and Methods: Thirty decoronated human maxillary central incisors were cleaned and shaped using standardized method. RDT was measured using cone beam computed tomography. They were divided into three groups of 10 samples each. Group 1 was obturated by traditional warm vertical compaction, Group 2 using solid core obturation, and Group 3 by warm vertical compaction technique using GP heater in vibration mode. AH Plus sealer was used as cement sealer. During obturation, the temperature rise was measured using K-type thermocouples in the coronal, middle, and apical thirds. The highest temperature rise during the procedure was recorded. Statistical Analysis Used: Data were analyzed by one-way analysis of variance and post hoc Tukey's test. Results: Traditional warm vertical compaction had the highest temperature change followed by warm vertical compaction using GP heater in vibration mode and solid core obturation. Conclusion: There was a temperature rise on external root surfaces in the three techniques evaluated. Solid core obturation technique showed the least temperature change. There was no significance in the effect of RDT on temperature rise during obturation.
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Development and evaluation of a new oral health literacy instrument among telugu speaking population: The indian oral health literacy measure p. 862
Viswa C Chandu, Viswanath Vadapalli, Srinivas Pachava, Yamuna Marella, Vikramsimha Bommireddy, Srinivas Ravoori
DOI:10.4103/ijdr.IJDR_539_19  PMID:33753655
Purpose: Oral health literacy (OHL) is a relatively unexplored construct in the Indian context. Most of the few previous studies estimating OHL among different populations of India used instruments that were either previously validated in a different country or not tested for psychometric properties. With this background, the objective of this study was to develop an Indian oral health literacy measure and to evaluate the psychometric properties of the instrument among Telugu speaking population of Andhra Pradesh (IOHLM-T). Materials and Methods: The initial version of the instrument after evaluated for face and content validity was tested for psychometric properties among 200 adult patients visiting the outpatient department of SIBAR Institute of Dental Sciences. Predictive validity of the instrument was checked by the association between IOHLM-T score and oral health impact profile (OHIP-14), decayed-missing-filled teeth (DMFT) scores. Convergent validity was tested by assessing the correlation between IOHLM-T score and rapid estimate of adult literacy in dentistry (REALD-30) score. Statistical Analysis: SPSS version 20 software was used to analyse the data. Independent samples t-test, Pearson's correlation, one-way ANOVA and stepwise multiple linear regression were done to analyse the data. Results: IOHLM-T demonstrated good internal consistency reliability (Cronbach's alpha 0.75), convergent validity (r = 0.34 between Reald-30 and IOHLM-T scores) and predictive validity (significant negative correlation of IOHLM-T with OHIP-14 and DMFT scores). Conclusion: IOHLM-T demonstrates good face validity, content validity, predictive validity, convergent validity and internal consistency reliability and thus can be used among different populations in India after translation to the corresponding languages and evaluation of psychometric properties.
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Protective role of neutrophils in periodontal inflammation p. 872
Rajapriya Perumalsamy, Jaideep Mahendra, Little Mahendra, Meenakshi Sethuraman, Kavyasri , V Madhusudhan Rao
DOI:10.4103/ijdr.IJDR_106_19  PMID:33753656
Aim: The quantification of neutrophils in blood is done to primarily screen the patients with acute infections. On the other hand, the neutrophils have also shown the antimicrobial activity by allowing the host cells to perform the primary function of preventing the wounds from being infected. The aim of this study was to quantify the blood neutrophil count in patients with chronic gingivitis and chronic periodontitis and to compare with the healthy controls in order to assess the protective role of neutrophils in periodontal inflammation. Methods and Material: A total of 30 subjects in the age group of 30–55 years were selected. Based on the clinical examination, the subjects were divided into three groups Group I (healthy), Group II (chronic gingivitis) and Group III (chronic periodontitis). The clinical parameters such as modified gingival index (MGI) and clinical attachment level (CAL) were recorded. Two millilitres of venous blood was collected from each participant in all the groups and the differential neutrophil counts were obtained using the Neubauer's chamber under a light microscope. One way ANOVA test was used to calculate the mean and standard deviation for MGI, CAL and blood neutrophil count among various groups. Results: The mean neutrophil counts in the various study groups were 63.300, 64.100 and 60.800 in Group I, Group II and Group III, respectively. Though there was a decrease in the mean neutrophil count from Group II to Group III, there was no statistically significant difference between the groups. Conclusion: In our study, there was no significant increase in neutrophil count in chronic periodontitis as compared to healthy controls, thereby explaining the protective role of neutrophils in periodontal inflammation.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Retention and effectiveness of pit and fissure sealants placed with or without bonding agent in young permanent teeth: A randomized clinical trial with a year follow-up p. 877
Madhuri Bandi, Sreekanth K Mallineni, Sivakumar Nuvvula
DOI:10.4103/ijdr.IJDR_779_19  PMID:33753657
Background and Aims:The aim of this study is to evaluate the clinical efficacy of pit and fissure sealants (PFS) placed on young permanent teeth with or without the application of the bonding agent. Methods:Atotal of 100 permanent first molars from 25 children between 6-9 years of age were included and randomly allocated into 2 groups. In group A, the teeth received sealant with the bonding agent, and in group B, without a bonding agent. All the sealed teeth were evaluated for retention of the sealant at regular intervals of 3, 6, and 12 months. The difference in the retention rate with and without bonding was analyzed using Chi-square test. Results:After 12 months, the clinically acceptable retention rates for PFS placed with and without bonding agent were 80% and 72%, respectively. No statistically significant difference was observed in relation to marginal integrity, marginal discoloration, and anatomic form among the PFS placed with and without bonding agent (P > 0.05). Conclusions:Sealant application with bonding agent showed an increased retention rate than without the use of a bonding agent. However, an additional step of bonding may be excluded in children, as it did not show any statistically significant difference in clinical retention rate compared to PFS application without bonding.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Effect of calibration of a medical review monitor on the visibility of mandibular canal at dental implant sites: A cone beam CT study p. 883
Mustafa Alkhader, Malik Hudieb, Khalid Kheirallah
DOI:10.4103/ijdr.IJDR_420_19  PMID:33753658
Objectives: The aim of this study was to assess the visibility of mandibular canal (MC) on cone beam CT (CBCT) images using a medical review monitor under two different calibration modes. The effect of age, gender, and location of the dental implant site was also assessed. Materials and Methods: CBCT images of 428 dental implant sites were selected for the study. Images were displayed twice on a medical review monitor using two different calibration modes: standard and DICOM, and two observers evaluated the visibility of the MC using four-point scoring scale (1–4, poor to excellent). Cohen Kappa was used to assess intra and inter-rater reliability. Chi-square test was used to compare proportions of MC visibility by gender and location and one-way ANOVA was used to compare mean age and MC visibility. Results: Each observer classified the visibility of MC with a total agreement of 100% between DICOM mode and standard mode (Kappa = 1, P < 0.001 for each observer). In each mode, a strong agreement (inter-rater reliability) was detected between the observers (Cohen's kappa = 0.88 for both modes, P < 0.001) with a percent agreement of 95.3% for each mode. Gender and location were not statistically associated with MC visibility (P > 0.05). Age, however, was a significant predictor of MC visibility (P < 0.05). Conclusions: DICOM calibration had no added value over standard calibration for assessing the visibility of MC at dental implant sites on a medical review monitor. Only the age had significant effect on the visibility.
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Histochemical characterization of bone and cementum using modified gallego's iron fuschin stain and van gieson stain and its application in fibro-osseous lesions p. 888
Ruchika Sanket Agrawal, Jyoti D Bhavthankar, Mandakini S Mandale, Arush Thakur, Priya A Bhagde, Seema Salve
DOI:10.4103/ijdr.IJDR_889_18  PMID:33753659
Objectives: Fibro-osseous lesions (FOLs) of the jaws exhibit an overlapping histomorphologic spectrum with respect to nature of calcifications. Sometimes these calcifications may be difficult to characterize as bone and cementum on routine Hematoxylin and Eosin (H&E) staining. This causes difficulty in assessing the origin and diagnosis of these lesions. Thus the study aimed to characterize bone, cementum, and hard tissue components in FOLs using special stains. Method: The study included a histochemical evaluation of 20 samples of bone and cementum and 12 cases each of fibrous dysplasia (FD) and ossifying fibroma (OF). Three consecutive sections of each tissue were stained with H and E, modified Gallego's iron fuschin stain and Van Gieson stain. H and E and modified Gallego's iron fuschin stained sections were analyzed under light microscope whereas Van Gieson stained section was analyzed under polarizing microscope. Results: It was found that cementum stained red and bone stained greenish-yellow in color. The calcifications seen in fibrous dysplasia stained greenish-yellow in color. Three cases of OF showed greenish-yellow calcifications and nine cases showed reddish calcifications. Polarization study of bone showed lamellar pattern and tooth cementum showed quilt pattern. Four cases of FD showed lamellar pattern and eight cases showed haphazard pattern. In OF, three cases showed lamellar pattern and nine cases quilt pattern. Conclusion: Calcifications having lamellar pattern and greenish-yellow color suggest their osteogenic origin thus having aggressive nature and requiring aggressive treatment. Calcifications having quilt pattern and reddish color suggest periodontal ligament origin thus having less aggressive behavior and less extensive treatment.
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Effect of local propolis irrigation in experimental periodontitis in rats on inflammatory markers (IL-1β and TNF-α) and oxidative stress p. 893
Khadeeja M Ali, Ziwar Saleh, Jalal Jalal
DOI:10.4103/ijdr.IJDR_909_19  PMID:33753660
Aims: The present study aimed to investigate the efficacy of local use of propolis (PRO) as a monotherapy or adjunctive therapy to scaling and root planning (SRP) in the treatment of ligature-induced periodontitis (LIP) in rats by evaluating inflammatory markers and oxidative stress. Settings and Design: The present study was carried out at Hawler Medical University, College of Dentistry, and the animals used in the study were rats that were housed in an animal facility at the College of Medicine. The experimental part of the study was carried between December 2016 and August 2017. Subjects and Methods: In total, 125 rats were equally divided into 5 groups of 25 animals: the control group (C) with no experimental periodontitis or treatment (gp1), LIP treated by local irrigation with a vehicle (dimethyl sulfoxide + physiological saline solution) group (gp2); LIP treated by SRP with vehicle irrigation group (gp3); LIP treated by local irrigation with 10% PRO extract group (gp4); and LIP treated by SRP with 10% PRO extract irrigation group (gp5). Experimental periodontitis was induced by placing a silk ligature around the cervix of the mandibular incisor for 4 weeks. After removal of the ligature, SRP was performed in gp3 and gp5. Five rats from each group were euthanized on days 0, 3, 7, 14, and 21 after local treatment. Intracardiac blood samples were obtained for analysis of the inflammatory cytokines interleukin-1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) and oxidative stress, which were represented by the expression of serum malondialdehyde (MDA). Statistical Analysis Used: Data were analyzed statistically by analysis of variance followed by Tukey's test (P < 0.05). Results: Gp5 demonstrated significantly lower IL-1β, TNF-α, and MDA serum levels than the other treatment groups at all experimental time points (P < 0.05). No significant differences were found when PRO was used as a monotherapy (P > 0.05). Conclusions: Local use of a PRO extract was effective as an adjunctive treatment with SRP in a rat model of experimental periodontitis via anti-inflammatory and antioxidative activities.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Qualitative and morphological evaluation of the mandibular bone using computed tomography p. 899
Smita R Priyadarshini, Pradyumna K Sahoo, Shayari Niyogi, Swati Patnaik, Sanat K Bhuyan
DOI:10.4103/ijdr.IJDR_259_19  PMID:33753661
Context: Determining the amount of cortical and cancellous bone present in the mandible is an important criterion for the selection of proper implant size and reduction of post implant placement complications. It becomes difficult to manage the presence of lingual undercuts when there is perforation of either the buccal or lingual cortical plates. Computed tomography (CT) images of the mandible can reduce the risk of complications by evaluating the thickness of cortical and cancellous bone in the mandible. Aims: Evaluate thickness of the buccal and lingual cortical plates and cancellous bone. Gender variation in the cancellous bone and cortical bone thickness. Determine the shape of the mandible. Settings and Design: A retrospective study was conducted using the CT scan images of pathologies pertaining to the Head and Neck region. Methods and Material: CT scan images of 30 patients, comprising of 22 males and 8 females. The mental foramen was considered as the anatomical landmark and the vertical marking was considered at a height of 20 mm from basal bone. The thickness of both cortical and cancellous bone was noted 6 mm anterior to it and 18 mm posterior. The shape of the buccal and lingual cortical bone was also considered. Statistical Analysis: Statistical analysis was done using Student's t-test or Chi-square test. Results: The mean thickness of cortical bone was more in anterior mandible than posterior mandible and cortical bone density was thickest at height of 20 mm, whereas for cancellous bone, it was highest at 5 mm from the basal bone, thickness. Buccal concavity, type A (68.2%), was the most common in the anterior region for males, followed by round shape, type C (56–58%) in the posterior region. For females, type C (25–31%) in the posterior region and lingual concavity, type B (18–30%) were the most common types in the anterior region. Conclusions: Lingual concavity may pose serious problems in cases of perforations during implant placement. Lingual cortical plates were thicker than the buccal cortical plates and it is concave anterior mandible. Thus, CT imaging can help in characterizing the quantity and morphology of the mandible.
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Pancytokeratin immunostained tumor buds and cytoplasmic pseudofragments are reliable early predictive variables for regional lymph node metastatic risk assessment of oral squamous cell carcinoma p. 904
SV Sowmya, Roopa S Rao, Kavitha Prasad
DOI:10.4103/ijdr.IJDR_101_19  PMID:33753662
Context: The 5-year survival rate in patients with cervical lymph node metastasis is reported to be 20–36% post surgery as compared to 63–86% in patients without nodal involvement. This necessitates assessing the metastatic potential of OSCC patients. Objectives: To evaluate the role of Pancytokeratin immunostained tumour buds and cytoplasmic pseudofragments with other histopathological and immunohistochemical variables in predicting metastatic risk of Oral Squamous Cell Carcinoma (OSCC). Settings and Design: Retrospective study on archival tissues of OSCC available from the Department of Oral Pathology and Microbiology. Methodology: Totally, 40 samples of 117 histopathologically diagnosed OSCC samples were selected that displayed metastatic risk variables like invasive tumour front pattern, lymphovascular invasion, tumour buds and cytoplasmic pseudofragmentation and were grouped into 20 each of metastatic and non-metastatic OSCC. 5 normal oral mucosa samples were included in the control group. The 45 tissues were stained with congo red to assess tumour - associated tissue eosinophilia (TATE) and immunohistochemically evaluated for tumour budding and cytoplasmic pseudofragmentation using pancytokeratin, proliferation (Ki-67), microvessel density (MVD)(CD31) and lymphatic vessel density (LVD)( LYVE-1). Statistical Analysis: Pearson's Chi square test and Man Whitney U test were used and analysed by Statistical Package for the Social Sciences (SPSS) software version 20.0. Results: Metastatic OSCC showed significantly high number of tumour buds (p = 0.001), cytoplasmic pseudofragments (p = 0.008), higher tumour grade (p = 0.038), lymphovascular invasion (p = 0.008) and LVD (p = 0.013), aggressive invasive tumour front pattern (p = 0.001) compared to non-metastatic OSCC. Conclusion: Pancytokeratin immunostained tumour buds, cytoplasmic pseudofragments and higher LYVE-1 expression may be used as independent predictors for OSCC metastasis. This study highlights the importance of recognizing the early metastatic risk variables that navigates the surgeon in planning appropriate therapy for OSCC.
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Proximity of the roots of maxillary posterior teeth to the floor of maxillary sinus and cortical plate: A cone-beam computed tomography assessment p. 911
Shikha N Goyal, Freny R Karjodkar, Kaustubh Sansare, Mohd Saalim, Sneha Sharma
DOI:10.4103/ijdr.IJDR_871_18  PMID:33753663
Introduction: The purpose of the study is to assess the vertical and horizontal relationship between the roots of maxillary posterior teeth and neighboring structures like the floor of the maxillary sinus and cortical plates using cone-beam computed tomography (CBCT). Method and Materials: 100 CBCT scans of the patients from the Indian population were analyzed. Vertical and horizontal relationship between the roots of maxillary posterior teeth and the floor of the maxillary sinus was divided into 4 types and 3 types, respectively. Distances between the root apices and the floor of the maxillary sinus and cortical plate was measured for each root and results were formulated. Results: In total 365 teeth were assessed, 185 first molar and 180 second molar. It was found that the roots of first molar and second molar usually had type 2 (root apices in close contact with the floor of maxillary sinus) and type 3 (roots projecting laterally into the sinus, but its apices are outside the sinus border) vertical relationship respectively with the floor of maxillary sinus. The deepest portion of the floor of the maxillary sinus was most commonly seen projecting between buccal and palatal roots. The mean distance between the cortical plate and root was highest for the distobuccal root of second molar i.e., 1.20 mm SD = 0.97. Conclusion: The distobuccal root of the first molar and mesiobuccal root of the second molar are closest to the sinus floor, hence clinician should be extra cautious while working on these roots during endodontic or surgical procedures in the Indian population.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Antimicrobial Capacity of a Hydroxyapatite–Lysozyme–Lactoferrin–Lactoperoxidase Combination Against Streptococcus mutans for the Treatment of Dentinal Caries p. 916
Sérgio L Pinheiro, Caio C da Silva, Lucas A da Silva, Marina P Cicotti
DOI:10.4103/ijdr.IJDR_474_18  PMID:33753664
Context: Hydroxyapatite has shown to regenerate the mineralized layer of dentin, whereas the combination of the enzymes lysozyme, lactoferrin, and lactoperoxidase may exhibit antimicrobial properties against oral pathogens. Aims: To evaluate a combination of hydroxyapatite and lysozyme, lactoferrin, and lactoperoxidase for the treatment of dentinal caries by measuring viable Streptococcus mutans. Settings and Design: Laboratory study with experimental groups. Methods and Material: Carious lesions in 20 permanent third molars were treated with a combination of hydroxyapatite and the enzymes lysozyme, lactoferrin, and lactoperoxidase. Carious dentin was collected and homogenized in a vortex shaker. After homogenization, five decimal dilutions were performed. Three aliquots of 25 μL of each dilution were seeded onto the surface of mitis salivarius bacitracin (MSB) medium. All plates were incubated in anaerobic jars. After incubation, the viable bacterial count was determined. S. mutans counts were obtained before and 24 h, 1 month, and 6 months after treatment. Statistical Analysis Used: Descriptive statistical analysis and the Kruskal–Wallis test, supplemented by the Student–Newman–Keuls test. Results: A significant reduction in S. mutans counts was observed 24 h after sealing with a combination of hydroxyapatite, lysozyme, lactoferrin, and lactoperoxidase as compared to counts after 1 month and after 6 months (P < 0.05). Conclusions: The combination of hydroxyapatite with lysozyme, lactoferrin, and lactoperoxidase may be an alternative for S. mutans control in dentinal caries.
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The effect of fennel seeds on pH of saliva – A clinical study p. 921
Rajkumar Manohar, Akila Ganesh, N Abbyramy, R Abinaya, SK Balaji, S Banu Priya
DOI:10.4103/ijdr.IJDR_185_19  PMID:33753665
Context: Saliva is an oral fluid that gives a protective effect against dental caries. Chewing of fennel seeds after food is a common culture in the Indian Sub-continent. A review of previous studies on fennel seeds showed that some of them have an anti-microbial efficacy, but there are no extensive data available on the effect of chewing fennel seeds on the pH of saliva. Aim: The aim of the study was to record the baseline pH of saliva and to record the changes in salivary pH after chewing fennel seeds. Setting and Design: The study was carried out in the Department of Public Health Dentistry, Sri Ramachandra University, Chennai, prior to which a pilot study was carried out. Subjects and Methods: Voluntary enrolment of 30 individuals was done. A written and informed consent was obtained from the individuals prior to the study. The pH of the saliva was recorded by placing the standardized salivary strip below the tongue in the oral cavity and colour changes were matched with the pH scale colour chart within about 15 sec. The subjects were asked to chew fennel seeds for 5 min. Salivary pH was measured immediately after chewing (SP2) at 0 min and the experiment was repeated for 5 min (SP3), 10 min (SP4), 15 min (SP5) and 30 min (SP6). Statistical Analysis: The data was gathered and analysed using paired t test. Results: There was an increase in salivary pH from baseline (SP1) to 0 min (SP2) was found to be highly significant (P = 0.000). The mean salivary pH reduced to 7.64 ± 0.06, 5 min after chewing the seeds (SP3) and the drop in pH was found to be highly significant (P = 0.000). The subsequent drop in pH from 10 min (SP4), 7.50 ± 0.05 to 15 min (SP4), 7.38 ± 0.05 to 30 min (SP4), 7.24 ± 0.05 were found to be highly significant as well (P = 0.000). Conclusion: Chewing of fennel seeds increases the pH of saliva, thus making it a suitable anti-cariogenic agent.
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Effect of different home-bleaching techniques for a regular or an extended time on enamel properties p. 924
Marianna Sorizini Ferreira De Miranda, Amal Elzubair Eltom, Sérgio de Souza Camargo, Gustavo Miranda Rocha, Cesar dos Reis Perez
DOI:10.4103/ijdr.IJDR_791_19  PMID:33753666
Context: The side effects of bleaching products are still incompletely known. Aims: This work aims to evaluate the effects of bleaching regimens on colour variation, microstructure, roughness, composition and nanohardness of human dental enamel until 8 weeks. Settings and Design: Twenty teeth were cross-sectioned to obtain eighty enamel fragments (50 × 50 mm) divided into four groups: CN (control Negative-artificial saliva), CP10 (10% carbamide peroxide), HP10 (10% hydrogen peroxide), and WS (whitening strips-10% hydrogen peroxide). Methods and Material: Roughness (atomic force microscopy–AFM and 3-D surface scanning), morphology (confocal laser scanning microscopy–CLSM and AFM), hardness and elastic modulus (nanoindentation), and composition (Raman microspectroscopy) were analysed before the therapy and after 4 and 8 weeks. Colour measures were performed weekly. Statistical Analysis Used: Two-way ANOVA with repeated measures (P < 0.05). Results: Bleaching stabilizes after 3 weeks for HP10 and after 4 weeks for CP10 and WS. Roughness evaluation showed statistical difference for HP10 after 8 weeks for Sa and Sq, for HP10 and WS after 4 weeks and for CP10 after 8 weeks. The same occurred for hardness and elastic modulus. The morphological evaluation demonstrated the most significant effects after 8 weeks of treatment for HP10 and WS. Composition analysis revealed modifications in peaks related to the organic content spectra (protein) with an increase in detection after 4 weeks, followed by a decrease after 8 weeks. Conclusions: H2O2-based products caused morphological and compositional alterations on enamel.
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SYSTEMATIC REVIEW AND META-ANALYSIS Top

Evolution of dental implants through the work of per-ingvar branemark: A systematic review p. 930
Sunil Kumar Mishra, Ramesh Chowdhary
DOI:10.4103/ijdr.IJDR_587_18  PMID:33753667
Purpose: This systematic review has been undertaken to highlight the unforgettable contributions of Prof. Brånemark Per-Ingvar (PI). It could be understood that reviewing his work would give an idea of growth of this treatment modality. Materials and Methods: An electronic search on the PubMed/Medline, Ebscohost, and Cochrane database was done using search term “Brånemark PI” to identify his publications. Articles published in English and only related to implants and osseointegration were included. Screening of the titles and abstracts were done according to inclusion criteria and suitable studies were included in the review. Results: The initial literature search resulted in 187 articles, out of which 92 articles were excluded due to not meeting the inclusion criteria and 16 articles excluded due to non-availability of even abstract also. A total of 79 articles were finally included in this review. Conclusion: Brånemark PI had a great vision of future; who considered edentulism as equal to amputation and came up with the concept of osseointegrated implants to overcome them. The innovations of Brånemark had assured the world that it is very much possible to provide implant-supported prosthesis in any situations for the rehabilitation of the individuals.
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Association between black stains and early childhood caries - A systematic review p. 957
Sharath Asokan, Kirthi R Varshini, PR Geetha Priya, V Vijayasankari
DOI:10.4103/ijdr.IJDR_327_20  PMID:33753668
Objective: To systematically review the association between black stains and early childhood caries. Methods: Seven electronic databases and hand search were carried out using keywords on black stains and early childhood caries. Articles published in English from January 1947 to January 2020 were included. A total of 38,686 articles were retrieved, and 38,645 duplicate and irrelevant records were removed. Among the 41 articles obtained, 21 articles were excluded after screening the title and abstracts. Fifteen articles were excluded after analyzing the full text. Finally, five articles with cross-sectional study designs were included in this review. Quality analysis was carried out using a modified Newcastle–Ottawa scale. Results: All the five articles included in this review had a low risk of bias. Two articles showed a significant negative association and one article showed a significant positive association between black stains and early childhood caries. Conclusion: Cross-sectional design and heterogeneity of the included articles provide an ambiguous opinion on the association between black stains and early childhood caries. More of longitudinal studies following rigid methodology is needed to establish the association between black stains and early childhood caries.
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SHORT COMMUNICATION Top

Prevention of dental caries by regular overnight application of a low-concentration fluoride gel loaded in a custom tray in patients undergoing radiotherapy for head and neck cancer: A preliminary study p. 963
Sakiko Soutome, Souichi Yanamoto, Madoka Funahara, Yumiko Kawashita, Masako Yoshimatsu, Maho Murata, Toshiyuki Saito, Masahiro Umeda
DOI:10.4103/ijdr.IJDR_138_20  PMID:33753669
Background:</bold> Some studies have reported topical application of 1.0%–2.0% fluoride gel in a custom tray for 4–5 minutes every day for the prevention of radiation-related dental caries. However, in Japan, the concentration of fluoride used by patients is limited to less than 0.15%. The efficacy of a low-concentration fluoride gel in a custom tray for the prevention of radiation-related dental caries has not been investigated. <bold>Methods and Material:</bold> In this preliminary study, we enrolled 13 patients with head and neck cancer who underwent radiotherapy. They wore a custom tray containing 0.145% sodium fluoride gel during sleep every night and were examined for newly developed dental caries 1 year later. <bold>Results:</bold> No new dental caries were found in the 13 patients 1 year after radiotherapy, and no adverse events were observed. <bold>Conclusions:</bold> We conclude that low-concentration fluoride gel in a custom tray during sleep could prevent radiation-related dental caries, and we plan to conduct a multi-center phase III randomized controlled trial to examine the efficacy of this method for the prevention of radiation-related dental caries.
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EPIDEMIOLOGICAL WORK Top

The mean overjet in libyan children and the relationship between increased overjet and incisors trauma p. 967
Suleiman M O. Ergieg, Varma R Sudhir, Thoms O Shibu, Salem A Fanas, Mathew Ashok
DOI:10.4103/ijdr.IJDR_361_19  PMID:33753670
Aims and Objectives: The aim of this study was to assess the mean overjet in school-going Libyan children and to examine the relationship between increased overjet and permanent incisor's trauma. Materials and Methods: This study is a part of a cross-sectional investigation of aspects of dental health of 2015 school going Libyan children aged between 6 and 16 years old of both genders from both rural and urban areas. Overjet was measured as the horizontal distance in millimetres between the upper and lower incisors. Trauma to permanent incisors was assessed according to Elli's Classification. Results: SPSS version 20.0 for percentages was used for statistical analysis. The relationship between increased overjet and incisor trauma was tested using the Chi-square test at 0.05 significance level. The overjet measurement ranged from -2 mm to 8 mm with the mean overjet of 3.062 (1.23, SD). The prevalence of incisor trauma was statistically significantly higher in children with increased overjet (P < 0.0001). Conclusion: The average mean overjet value in Libyan children is between 2 mm and 3 mm and below or above these values, considered decreased or increased, respectively. Traumatic injuries to permanent incisors significantly increased with increased overjet.
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Prevalence of mandibular fractures p. 971
T Saravanan, B Balaguhan, A Venkatesh, N Geethapriya, Goldpearlinmary , A Karthick
DOI:10.4103/ijdr.IJDR_286_18  PMID:33753671
Aim: The aim of this study was to determine the etiology, dissemination of mandibular fractures among different age, gender, and to determine the frequency of anatomic distribution in patients who reported to our institution from February 2015 to September 2015. Materials and Methods: All patients who fulfilled the selection criteria and had mandible fracture were selected for the study. The values were subjected to Z and Chi-square tests. Results: Out of 50 patients, 44 were male patients (88%) and 6 were female patients (12%). We found a peak occurrence of fractures in young adults, with mean age of 36 years. In case of etiology of fracture, road traffic accident was the most common (72%) and parasymphysis was most frequently involved site (n = 13.26%). Conclusion: In this study, the prevalence of mandibular fracture was more prevalent in male patients, especially during the third decade of life. The most common cause was road traffic accident and the more frequently affected region was parasymphysis of the mandible.
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CASE REPORTS Top

CBCT evaluation and surgical management of an unusual cystic lesion: A case report p. 975
Reshma Raj, Ravi Veeraraghavan, Parvathy Kumaran, Arun M Xavier, Balagopal R Varma, Medhini M Menon
DOI:10.4103/ijdr.IJDR_470_19  PMID:33753672
This is a case of swelling originating from dens invaginatus associated with lateral incisor, misdiagnosed as a globulomaxillary cyst. The initial diagnosis of globulomaxillary cyst was made solely from radiographs by observing a reverse pear-shaped radiolucency between the lateral incisor and cuspid. The results following pulp testing and Cone Beam Computed Tomography (CBCT) evaluation revealed the endodontic origin of the lesion, which entailed the treatment carried out by surgical enucleation and apicoectomy. This also details the clinical and diagnostic dilemma as well as conflicts associated with the diagnosis and management of the cystic lesion.
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Large hemangioma of the tongue p. 979
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_950_20  PMID:33753673
Hemangiomas are the most common benign vascular tumours, often reported in very young. Though the head and neck regions have high predilection, intra-oral hemangiomas (IH) are very rare. In spite of numerous treatment options, the IH are ideal candidates for surgical exoneration. The reasons for this are manifold. This manuscript intends to present a case of IH arising in the tongue along with subsequent macroglossia. The treatment and surgical strategy based on cardinal principles of macroglossia corrections are described. A note on the challenges associated with treatment is presented.
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Endoscopic assisted removal – An aesthetic approach to impacted third molar tooth in the orbital floor p. 983
Sunanda D Dhivare, Smita K Nagle, Radhika G Sonate, Sumit A Maheshwari, Ankur M Walli
DOI:10.4103/ijdr.IJDR_476_18  PMID:33753674
A third molar displaced in the orbital floor is a very rare sighting. The usual surgical approach to such a case is the Caldwell Luc procedure that has its own complications. Here in this article, we present a 17-year-old male patient with third molar displaced in the orbital floor with egg shell thin anterior wall. The aim of the article is to report the unusuality of the case and to emphasize the endoscopic assisted approach to the orbital floor through a relatively small sub-labial incision. Endoscope aids in preserving the integrity of vital structures, facial aesthetics and complete eradication of the disease with faster recovery. Though, endoscopic approach requires requisite expertise, it is a learnable skill and can be mastered with ease.
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Paediatric unicystic ameloblastoma – A report of 2 cases p. 987
Spoorti Kulkarni, Subhalakshmi Sen, Chetana Chandrashekar, Venkadasalapathi Narayanaswamy, Raghu Radhakrishnan
DOI:10.4103/ijdr.IJDR_670_18  PMID:33753675
Unicytic ameloblastoma is a variant of ameloblastoma encompassing about 6% of ameloblastomas. They represent cystic lesions that reveal clinical and radiographic features of a cyst, but the histopathological features demonstrate a typical ameloblastomatous epithelium lining the cyst. Plexiform unicystic ameloblastoma, a variant of unicystic ameloblastoma refers to the pattern of proliferation where one or more nodules of ameloblastomatous epithelium project from the cystic lining into the lumen demonstrating an edematous plexiform pattern. The lesion is seen more commonly in the third and fourth decades of life with less than 10% of cases being reported in the first decade. Here, we report two cases of unicystic ameloblastoma in paediatric patients. This report also aims to provide an insight on the pathogenesis and treatment aspects of this distinct entity.
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