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   Table of Contents - Current issue
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July-August 2020
Volume 31 | Issue 4
Page Nos. 501-667

Online since Friday, October 16, 2020

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EDITORIAL  

Dental practitioners and dental researchers in COVID-19 Highly accessed article p. 501
SM Balaji
DOI:10.4103/ijdr.IJDR_892_20  
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Acceptability of silver diamine fluoride as interim measure towards untreated dental caries and its impact on ohrqol among children with HIV: Pilot study Highly accessed article p. 502
AM Hiremath, V Anbu, S Kuduruthullah, E Khalil, Nesrine A Elsahn, SR Samuel
DOI:10.4103/ijdr.IJDR_58_20  
Background: Children with HIV are a special group with limited access to care and high prevalence of dental caries. Silver Diamine Fluoride (SDF) is approved universally for the management of asymptomatic carious lesions but research on the psychological impact of black staining is scarce. Aims: Effect of silver diamine fluoride (SDF) application as an interim caries management on the child's oral health-related quality of life of children with HIV over a period of 4 months until definitive care was provided. Settings and Design: A pilot study conducted among children with HIV in a care home. It was a pilot trial to check the acceptability of SDF among these children. Methods and Material: Forty-two children (12.3 ± 3.5 years) participated in this pilot study. Prevalence of caries (DMFT), candidiasis, gingival inflammation, and cervical lymphadenitis was evaluated. OHRQoL inventory (COHIP-SF) was completed by the students at baseline, immediately, 4 months after SDF application. Statistical Analysis Used: One-way ANOVA with post hoc Tukey HSD test. Results and Conclusion: Poor oral hygiene was universal and mean DMFT was 3.2 ± 2.5. OHRQoL was not significantly affected at baseline (26.2 ± 6.4), but immediately following SDF application, OHRQoL was significantly poor (48.7 ± 8.2), remained poor even after 4 months (42.6 ± 6.1). Emotional wellbeing was significantly impacted negatively following SDF application (p < 0.001); whereas oral health, functional wellbeing dimensions were not impacted. SDF should be used with caution among special children as the black discoloration of the teeth can cause emotional trauma and negatively impacting their OHRQoL while trying to improve the same.
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Oral health status and care of institutionalized elderly individuals in Lebanon Highly accessed article p. 507
Antoine Choufani, Marysette Folliguet, Nada El-Osta, Sahar Rammal, Mounir Doumit
DOI:10.4103/ijdr.IJDR_208_20  
Background: Oral health of the elderly is a major public health challenge. Data on oral health and dental care of the institutionalized elderly is lacking in Lebanon. Aims: (1) Assess the oral health of Lebanese people aged 65 years and over living in residential facilities; and (2) identify factors associated with poor oral status. Materials and Methods: A sample of 526 nursing home residents aged 65 years and older was randomly selected from 46 residential facilities. Information collected were sociodemographic characteristics, degree of autonomy regarding toilet use and nutrition, presence of chronic diseases and medications, dry mouth sensation, dental brushing, access to oral health and reasons of dental visits. A structured oral examination was conducted to gather data on DMFT index, oral hygiene indices modified gingival index, and the unmet need for prosthesis. Statistical methods included bivariate and multivariate analyses. Results: 55.9% of the participants were edentates, 41.4% used partial and/or complete dentures, and the minority used dentures with good hygiene. 15% of the dentate sample reported regular tooth brushing, 7% reported to have visited the dental office in the past 12 months, and 57% presented an unmet need for prosthesis. Oral health status was significantly related to age, smoking, daily tooth brushing, and autonomy (P < 0.05). Subjects with chronic diseases and consuming medications were more likely to have xerostomia. Conclusion: Oral health status is poor in the elderly institutionalized Lebanese population, which should promote a multidisciplinary team sharing responsibility for daily oral hygiene and access to dental treatment.
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Is Individual deprivation measures associated with dental anxiety and socioeconomic status of patients visiting dentists p. 515
R Sindhu, Shreya Rajaram, VV Bharathwaj, Raj Mohan, Sunayana Manipal, D Prabu
DOI:10.4103/ijdr.IJDR_802_18  
Aim: To assess the association between Individual deprivation measure with dental anxiety and socioeconomic status among patients visiting dentists in Chennai city, Tamil Nadu. Methods: A cross-sectional study was conducted among 50 patients aged 18-70 years who visited a private dental institution. Data on socio-demographics and detailed history about dental visits were obtained. Dental anxiety was measured using Corah Dental Anxiety Scale along with Individual deprivation measure questionnaire. Data were analysed using SPSS package 20. Descriptive statistics and one-way ANOVA were used for statistical analysis. Results: A total of 50 patients were enrolled in the study, 38% belonged to 31-40 years of age, 56% were male, 16% postponed dental visit due to dental anxiety, 54% belonged to upper middle class and 64% of the subjects had moderate anxiety. In all, 71.9% of the subjects with moderate anxiety were not deprived and 88.9% of upper middle class subjects were not deprived. Significant association was found between socioeconomic status and dental anxiety with Individual deprivation measure with a P < 0.05. Increasing socioeconomic status was associated with more deprivation and dental anxiety was higher among less deprived patients. Conclusion: Individual deprivation measure was associated with dental anxiety. Less deprived and higher socioeconomic class population had a significant higher dental anxiety.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

GCF and serum levels of omentin in periodontal health and disease of diabetic and non-diabetic individuals: A comparative study Highly accessed article p. 520
Shreya Bagwe, D Gopalakrishnan, Vini Mehta, Ankita Mathur, Krutika Kapare, Apeksha Deshpande
DOI:10.4103/ijdr.IJDR_796_18  
Background: Omentin is an adipocytokine secreted by visceral adipose tissue cells associated with the action of insulin-increasing, insulin-facilitated glucose uptake. Aim: The aim of this study was to compare and evaluate the levels of omentin in gingival crevicular fluid (GCF) and serum of periodontally healthy individuals and chronic periodontitis (CP) patients with and without type 2 diabetes mellitus (T2DM). Settings and Design: A hospital-based comparative study was conducted amongst 40 subjects of age group 30–50 years. Methods: Subjects were divided into four groups, group I (10 healthy individuals), group II (10 T2DM), group III (10 CP only) and group IV (10 patients with CP and T2DM). Clinical and systemic parameters assessed were gingival index (GI), plaque index (PI), probing pocket depth (PPD), periodontal attachment level (PAL) and glycated haemoglobin (HbA1c). Serum and GCF samples were collected and analysed for omentin levels using the enzyme-linked immunosorbent assay (ELISA). Results: Although the mean GCF omentin levels were highest in group I and lowest in group IV, it was not statistically significant. However, the serum omentin levels were statistically significant, showing the highest mean level in group I and lowest in group IV and serum levels were statistically significant. Also, the serum omentin levels had a negative correlation with HbA1c. Conclusion: The levels of omentin reflect the diabetic status of an individual, which suggests that omentin can be a potential anti-inflammatory marker and a therapeutic agent for conditions like CP and T2DM.
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Impact of dental operating microscope, selective dentin removal and cone beam computed tomography on detection of second mesiobuccal canal in maxillary molars: A clinical study p. 526
Kuzhanchinathan Manigandan, Periasamy Ravishankar, Krishnamoorthy Sridevi, Venkatesan Keerthi, Prakash Prashanth, Angambakkam Rajasekaran Pradeep Kumar
DOI:10.4103/ijdr.IJDR_353_20  
Introduction: Maxillary molars may frequently require root canal therapy and can have complex anatomy. It is important to locate and treat the second mesiobuccal canal to significantly improve prognosis. Aim of the Study: The purpose of this study was to evaluate direct vision, dental operating microscope (DOM), selective dentin removal under DOM, and cone beam computed tomography (CBCT) in clinical detection of second mesiobuccal root canal (MB2) in maxillary molars. Materials and Methods: A total of 122 maxillary first and second molars indicated for root canal treatment were included in our study. Following access cavity preparation, the presence of MB2 canal orifice was assessed in four stages. Stage I: with direct vision. Stage II: under DOM, Stage III: after selective dentin removal under DOM and Stage IV: teeth in which MB2 canal was not identified by Stage III were further investigated with CBCT. The number of canals identified during each stage was analyzed statistically. Results: Clinical detection of MB2 canal in our study was 90%, with 93% in maxillary first molar and 86% in maxillary second molar. 64% MB2 canals were located at Stage I (direct vision) which improved to 84% at Stage II (under DOM) and 90% at Stage III (selective dentin removal under DOM). CBCT investigation (Stage IV) further improved the identification of MB2 canal leading to overall prevalence of 93%. Conclusion: The results of our study demonstrated that MB2 canal can be clinically detected in up to 90% of maxillary molars by the use of DOM and selective dentin removal. CBCT investigation is indicated when MB2 canals are not clinically detected.
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Estimation and comparison of serum cotinine level among individuals with smoking and tobacco chewing habit p. 531
Manoj Prabhakar, Kavitha Bottu, B Sivapathasundharam
DOI:10.4103/ijdr.IJDR_558_18  
Aims and Objectives: The present study was aimed to estimate and compare tobacco exposure in smokers and chewers. The levels of cotinine, one of the constituents of tobacco were considered as indicative of tobacco exposure. Serum Cotinine levels in individuals with the habit of smoking and tobacco chewing were estimated and compared. Base line values of cotinine levels in normal subjects were established. Materials and Methods: The study groups comprised about 30 individuals with the habit of smoking (Group A); these 30 individuals with the habit of tobacco chewing (Group B), and 20 individuals who were never exposed to any form of tobacco as control group (Group C). Serum cotinine levels were estimated using a commercially available enzyme-linked immunosorbent assay in both test and control groups and the difference in the levels were compared. Results: In individuals with the habit of smoking, cotinine levels ranged between 11 ng/ml and 215 ng/ml with a mean concentration of 87.56. In tobacco chewers, the levels ranged between 11 ng/ml and 128 ng/ml with a mean concentration of 73.66. In control group, the levels ranged between 0.34 ng/ml to 2.5 ng/ml with a mean concentration of 0.93. Cotinine levels between smokers and tobacco chewers were compared and there was no statistically significant difference. Conclusion: Difference in serum cotinine levels between smokers and tobacco chewers is not significant. The fact that cotinine level is influenced by age of the individual, frequency and duration of the habit seems to be irrelevant from the results obtained from this study. Prospective studies considering all the factors and variables, with a preferable larger sample size can probably eradicate the chaos on the reliability of cotinine as a predictive biomarker for the amount of tobacco exposure.
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Comparative evaluation of wear resistance of CAD-CAM zirconia and cast cobalt chromium alloy for indirect restorations against human enamel - An In Vitro study p. 537
N Arul Kumar, Jayakrishnakumar Sampathkumar, Hariharan Ramakrishnan, Vallabh Mahadevan
DOI:10.4103/ijdr.IJDR_779_18  
Purpose of the Study: To comparatively evaluate the wear resistance of two different posterior indirect restorative materials against human enamel. Materials and Methods: Two different posterior indirect restorative materials of ten in each Group-I (Monolithic zirconia) (n = 10) and Group-II (Cast cobalt chromium) (n = 10) were formed into disc and used as a substrate for the wear test. Freshly extracted mandibular first premolars were used as a pin (antagonist) (n = 20). Pin-on-disc wear testing machine was used to simulate the masticatory parameters and evaluation of the wear parameters was done after 1,20,000 cycles, with load of 40N for specific duration. Data related to wear testing procedure were tabulated and evaluated. Results were statistically analyzed using Mann–Whitney test and Wilcoxon signed rank test. Results: Mean surface roughness value (Ra value) obtained for Group-I disc test samples showed no statistical significance (P value < 0.05). Mean wear rate value of test disc samples was statistically significant between Group-I and Group-II (P value < 0.05). Mean surface roughness value was statistically significant between Groups–I and II before and after wear test (P value < 0.05). Conclusion: From the results obtained, it was found that the Group-I (Monolithic zirconia) exhibited higher wear resistance than Group-II (cast cobalt chromium) and causes less wear to the opposing enamel antagonist.
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Dental problems among diabetics: A case control study from an Indian state p. 546
Bhola Nath, Shiv D Gupta, Ranjeeta Kumari
DOI:10.4103/ijdr.IJDR_346_19  
Background: Diabetes is a metabolic disorder, which affects almost all parts of body. Dental problems remain neglected among diabetics which could have negative impact on health and if untreated could lead to financial loss in treatment of diseases. Aims: To compare the risk, quality of life (QOL), and direct cost of dental problems between cases and controls. Methods: A hospital-based case control study in a tertiary care hospital of Uttarakhand, India. Results: The risk of comorbidities of dental problem was 1.8 times higher as compared with controls. Twenty-six percent of cases were found to be suffering from one or the other type of dental problems as compared with 16.4% among controls. The direct cost expenditure among cases was significantly higher as compared with controls. Limitations: The QOL scores and the cost of treatment obtained could be an overestimate as some of the participants with dental problems also had comorbidities related to other systems of the body. Conclusion: The risk of dental problems and the direct cost was reported to be significantly higher among cases as compared with controls.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Effects of chitosan oligosaccharide and calcium hypochlorite on E. Faecali dentinal biofilm and smear layer removal - SEM analysis p. 550
Gurveen Kaur, T Vinay Kumar Reddy, Kondas Vijay Venkatesh, Krishnan Mahalakshmi
DOI:10.4103/ijdr.IJDR_334_20  
Background: The complex structure and irregularities of root canal walls are liable for infection by several bacterial species. Thus, the use of irrigants and auxiliary chemical solutions associated with instrumentation is necessary for effective eradication of the biofilm as well as complete removal of the smear layer. Aim: To evaluate the effects of calcium hypochlorite and chitosan oligosaccharide (COS) in disinfecting Enterococcus faecalis root canal biofilm and smear layer removal with minimal erosion. Materials And Methods: A total of 70 mandibular premolars were decoronated at the cementoenamel junction. The samples were biomechanically prepared, sterilized in an autoclave, and incubated with E. faecalis (ATCC-29212) bacteria for 21 days. Cleaning and shaping were done till maximum apical file size of #45 K. Specimens were randomly divided into 4 groups: GROUP I: Control Group, GROUP II: 5% Sodium Hypochlorite (NaOCl) solution followed by 17% EDTA solution, GROUP III: 5% Calcium Hypochlorite [Ca(OCl)2] solution followed by 17% EDTA solution and GROUP IV: 5% Ca(OCl)2 solution followed by 1% COS. The samples were subjected to microbial count followed by smear layer removal under scanning electron microscope (SEM) at coronal, middle and apical third. Statistical Analysis Used: Kruskal–Wallis Test and post-hoc Scheffe's test. Results: It was observed that Group IV showed the lowest amount of CFU count/mL and the highest amount of smear layer removal with a statistically significant difference (P < 0.05) when compared with the other three Groups. Conclusion: 5% Ca(OCl)2 solution with 1% COS solution effectively removed the Enterococcus faecalis biofilm and smear layer from the root canals with minimal erosion.
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The solubility and water sorption properties of a combination of Ca(OH)2and propolis when used as pulp capping material p. 557
Nirawati Pribadi, Veronica Regina Rosselle, Nanik Zubaidah, Ira Widjiastuti
DOI:10.4103/ijdr.IJDR_422_19  
Background: Calcium hydroxide [Ca(OH)2] is a material used during pulp capping treatment, despite being readily soluble in both water and acid. In contrast, propolis constitutes a nontoxic resin which is not easily dissolved in water. Therefore, a combination of Ca(OH)2and propolis is assumed to be capable of increasing the mechanical properties of Ca(OH)2and to diffuse into the dentinal tubules. Objective: This research aimed to reveal the solubility and water sorption ability of a combination of Ca(OH)2and propolis as pulp capping material. Materials and Method: The samples comprised 18 Ca(OH)2and Ca(OH)2-propolis chips, 15 mm × 1 mm in dimension, all of which were stored in an incubator for 24 h at 37°C. Each sample was then divided into two groups: one dissolved in 50 mL of artificial saliva for 24 h at 37°C and another for 7 days before being weighed, dried, incubated, and weighed for a second time. The result of the reduction in mass divided by the volume of the samples was considered to constitute the level of solubility and water sorption. The difference between the solubility and water sorption ability was analyzed using an independent t-test with significant difference <0.05. Results: The solubility of Ca(OH)2-propolis is lower than that of Ca(OH)2 after immersion for 1 day (P = 0.001) and 7 days (P = 0.000). The water sorption ability of Ca(OH)2-propolis is no different than that of Ca(OH)2after immersion for 1 day (P = 0.088) and 7 days (P = 0.635). However, the water sorption ability of Ca(OH)2-propolis after 1-day immersion is higher than immersion for 7 days (P = 0.012). Conclusion: The solubility Ca(OH)2-propolis is lower than that of Ca(OH)2, but its water sorption is higher than that of Ca(OH)2.
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Sex determination from the pulp tissue of deciduous teeth exposed to natural soil and wet clay - A PCR study p. 562
Prachi Suman, R Manju, Veena A Shetty, Amitha M Hegde, Muthtamil , Shama Rao
DOI:10.4103/ijdr.IJDR_93_19  
Context: Dental tissue remains are the toughest, and chemically, the most stable tissue in the body. Its high resilience in the events of fire and bacterial decomposition makes them vital for DNA analysis by PCR method. Aims: Determination of sex of children through molecular analysis of pulp tissue of exfoliated deciduous teeth stored in different media and analyzed after a different time period. Settings and Design: Sixty samples of deciduous teeth were divided into three groups. Group IA and Group IIA were stored in natural soil and wet clay for 1 month, respectively. Group IB and Group IIB were stored in natural soil and wet clay for 6 months, respectively. Group III was analyzed immediately after extraction. Methods and Material: Sex determination was carried out in five steps: Pulp tissue removal, DNA isolation, DNA quantification, PCR amplification, Sex determination. X and Y specific chromosomes from each sample were amplified and compared. Statistical Analysis Used: Kruskal-Wallis test, Dunn's test, and Wilcoxon signed rank test. Results: Group III revealed the highest amount of DNA quantified. Amount of DNA quantified after 6 months of storage in natural soil and wet clay decreased in both the groups with the samples stored in wet clay showing a maximum decrease. Results of the PCR analysis also showed 100% accuracy rate in the samples of Group III. Conclusions: Sex determination from pulp tissue depends a lot on the quality and quantity of DNA extracted. Sex could be effectively determined among the samples evaluated immediately after extraction. This ability decreases as the storage condition changes and the time period increases. Samples stored in wet clay were found to show the least sex identification ability than dry soil.
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An In Vitro evaluation of biodegradability of stainless steel crowns at various salivary pH p. 569
K Anusha, E Sridevi, AJ Sai Sankar, M Sridhar, K Siva Sankar, K Harish Chowdary
DOI:10.4103/ijdr.IJDR_761_18  
Aim: To evaluate the biodegradability of preformed stainless steel crowns at varying salivary pH and the cytotoxic effect of leached out elements on fibroblasts. Methodology: A total of 243 stainless steel crowns were selected and were divided into 3 groups (I, II, III) based on Ph of immersion media. The pH of samples in group I, II, III were 4.3, 5.5 and 6.3 with 81 crowns in each group. Each group has 9 samples with 8 crowns in each sample. All samples were immersed in polyethylene bottles containing 10ml of artificial saliva and incubated at 37°C for 4 weeks. All the samples were analyzed on 1,7,14 and 21 days by atomic absorption spectrophotometer for the quantitative assement of Ni, Cr and Fe. Fibroblast tissue culture was used to assess the cytotoxicity of the samples. Statistical Analysis: Analysis of variance. Results: Maximum release of Ni, Cr, Fe ions were observed at pH 4.3 followed by pH 5.5 and least release of ions were observed at pH 6.3 from SS crowns. The cytotoxic results showed that the least cell viability of cells was seen at pH 4.3. Conclusion: With decrease in pH, there is an increase in ion release from stainless steel crowns and the mean release of nickel, chromium and iron were very much below the average dietary intake. But the allergic manifestations of ions like nickel can't be ruled out.
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Effect of modified NaOCl irrigation solution on bond strength of bioceramic-based root canal sealer to dentin p. 574
İrem Çetinkaya, Emre Bodrumlu, Mustafa M Ko&xs#231;ak, Sibel Koçak, Baran C Sağlam, Sevinç Aktemur Türker
DOI:10.4103/ijdr.IJDR_747_18  
Introduction: Biomechanical shaping and hermetic obturation play an important role in the success of root canal treatment. Aims and Objectives: This study aimed to examine the bonding strength of the bioceramics sealer to the dentin surface with or without core when irrigated with conventional NaOCl, modified NaOCl, EDTA, MTAD and distilled water. Materials and Methods: 120 single-root teeth dissected at the level of enamel-cement junction were grouped according to different irrigation and filling techniques; each group consisted 12 teeth. After final irrigation with NaOCl, modified NaOCl, EDTA, MTAD or distilled water, the samples were filled with bioceramic sealer. Samples with or without core were obtained; then 2 mm-thickness horizontal sections were made in the middle coronal and the middle third of the dentin and subjected to a push-out test. Results: Although bonding strength was the lowest when modified NaOCl was used, the highest bonding strength was reported with NaOCl in the present study. Bond strength values determined in the coronal third were found to be high compared to the middle third, although the difference was not statistically significant. In the groups without core, the resistance of the connection was found to be higher than in the core with a filled root canal (P < 0.05). Conclusion: Because the connection value of the bioceramic root canal sealer to the dentin using modified NaOCl was lower,it is recommended not to use the monoblock effect in canal filling in cases anticipated to be problematic. It would be more appropriate to use bioceramic paste without core in cases where a high attachment to dentin is desired
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Comparison of the efficacy of different Ni-Ti instruments in the removal of gutta-percha and sealer in root canal retreatment p. 579
Kaveh Nasiri, Karl-Thomas Wrbas
DOI:10.4103/ijdr.IJDR_946_18  
Aims: To evaluate and compare the efficacy of four rotary instrumentation systems in root canal retreatment and to determine retreatment time. Materials and Methods: To achieve the purpose of this study, canals of 60 distal roots in mandibular molar teeth were selected and randomly divided into four groups A, B, C and D (n = 15). Using step-back technique, the canals were prepared and filled with gutta-percha and AH Plus employing cold lateral compaction technique. The root filling material was removed with the following retreatment systems: Group A: Mtwo R, group B: D-RaCe, group C: ProTaper R and group D: R-Endo. In order to record retreatment time, a stopwatch was used. The samples were split longitudinally, examined under a stereomicroscope, photographed and assessed with AutoCAD software. Finally, the percentages of remaining filling material were calculated and the extracted data were analyzed using one-way ANOVA and Tukey HSD test. Results: All examined groups showed traces of remaining filling material within the canals. No statistically significant difference was found among the four groups in the coronal, middle, and apical thirds. The same result was obtained with regard to retreatment time (P > 0.05). However, within each one of the groups, significant difference was observed in the three regions (P < 0.05). Conclusions: Based on the findings of this study, none of the examined systems could completely remove root filling material from the root canals. However, they were all found to be effective in this regard. The most amount of remaining filling material was found in the apical third.
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Effects of haemostatic agents on bond strength – An In Vitro study p. 585
V Gokula Krishnan, Vignesh Kailasam, Arun B Chitharanjan
DOI:10.4103/ijdr.IJDR_559_12  
Aim: To evaluate and compare the effect of contamination with haemostatic agents like Tranexamic Acid (TA) and Ethamsylate, on the shear bond strength. Materials and Methods: There are about 100 extracted human premolars randomly segregated into four groups each consisting of 25 samples. Group I was bonded with Transbond, Group II was bonded with Transbond after blood contamination, while groups III and IV were bonded with Transbond after contamination with Tranexamic acid and the shear bond strength was measured. The data were compared by One- way ANOVA and Tukey (HSD) tests. Results: Group I had the highest shear bond strength (SBS) while Group II, where the teeth were contaminated with blood showed the least SBS values ANOVA indicated significant differences between the four groups (P <.05). Tukey HSD revealed that contamination with TA (Group III) had a statistically higher SBS that contamination with Ethamsylate (Group IV) (P <.05). Conclusion: Since tranexamic acid and ethamsylate reduces the bleeding when used during surgery, these haemostatic agents may be considered in bonding situations where blood contamination is anticipated.
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Antibacterial activity of a glass ionomer containing silver nanoparticles against Streptococcus mutans and Streptococcus sanguinis p. 589
Hamidreza Moshfeghi, Roza Haghgoo, Rokhsareh Sadeghi, Mohammad Niakan, Mohammad B Rezvani
DOI:10.4103/ijdr.IJDR_115_18  
Aim: Nano-sized metal particles exhibit special biological, chemical, and physical properties. The aim of this study was to evaluate the effect of incorporating silver nanoparticles into a resin-modified glass ionomer (GI) on its antimicrobial property. Materials and Methods: Antibacterial action of GI samples containing 0, 40, 80 ppm silver nanoparticles against standard strains of Streptococcus sanguinis and Streptococcus mutans were assessed by agar diffusion and direct contact tests. Data were analyzed using analysis of variance and Duncan test (P < 0.05). Results: Agar diffusion test showed no bacterial inhibition zone, but direct contact test exhibited significant antimicrobial activity against S. sanguinis and S. mutans in resin containing 80 ppm of nanosilver. Conclusion: Incorporation of a certain amount of silver nanoparticles into GI can increase its antimicrobial activity compared to the original material.
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SYSTEMATIC REVIEW AND META-ANALYSIS Top

Role of melatonin in periodontal disease - A systematic review p. 593
S Swarna Meenakshi, Sankari Malaiappan
DOI:10.4103/ijdr.IJDR_227_18  
Background and Aims: Melatonin is an indolamine that is primarily secreted by the pineal gland. It has immunomodulatory as well as antioxidant properties. It is a potent anti-oxidant that protects against inflammation and cellular damage caused by reactive oxygen species, also has potent angiogenic function that adds on to the benefits of melatonin. As a result of these actions, melatonin may be useful as an adjuvant in the treatment of various conditions in the oral cavity. The aim of this study is to systematically evaluate the role of melatonin in periodontal disease. Methods: An extensive review of the scientific literature was carried out using PubMed, Science Direct, Google Scholar and the Cochrane base. Research articles were collected upto December 2017. Results: Melatonin may have beneficial effects in certain inflammatory oral pathologies, mainly periodontal diseases where they inhibit bone resorption destroy reactive oxygen species, stimulates osteoblastic differentiation. Salivary melatonin could also act as a risk indicator for periodontal diseases. Conclusion: Many studies showed that the melatonin levels in GCF, Saliva, Serum of patients suffering from chronic periodontitis is lowered suggesting that may play a pivotal role in protecting the tissue from damage caused by oxidative stress. However, there exists no data on the concentration needed, method of application for potential benefits. Randomized clinical trials in this field are needed to fill the lacunae and better improve our understanding.
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Prevalence of traumatic dental injuries in India: A systematic review and meta-analysis p. 601
Nitesh Tewari, Vijay Prakash Mathur, Ishrat Siddiqui, Rahul Morankar, Ankita R Verma, Ravindra Mohan Pandey
DOI:10.4103/ijdr.IJDR_953_19  
Objective: The aim of this systematic review and meta-analysis was to estimate the prevalence of traumatic dental injuries (TDI) in India. The secondary objective was to evaluate the prevalence rate according to the differences in gender, age, regions, type of TDI and risk factors associated with TDI. Methods: The PubMed, LILACS, Web of Science, Cochrane, CINHAL, and Scopus databases, along with the Public Health Electronic Library, TRoPHI and DoPHER were searched from 1st March to 15thApril 2019 without any restriction of language and year of publication. The qualitative synthesis was done regarding the demographics, study methods, cause of trauma, geographic location, increased overjet and inadequate lip coverage. The meta-analysis was undertaken with STATA-14 software (USA). The pooled prevalence of TDI was calculated using data extracted from 48 studies included in qualitative synthesis and meta-analysis. A sub-group meta-analysis was done by extraction of the data for age groups of 6 years and >6 years. Results: The pooled prevalence of TDI in Indian population was 13 cases in 100 individuals. The prevalence of TDI for age groups of ≤6 was 15% (males, 15%; females, 16%) and for >6 years was 12% (males, 13%; females, 8%). The most common cause of TDI was falls, and most frequent location was home. The odds ratio for occurrence of TDI and inadequate lip-coverage was 3.35 and overjet greater than 3 mm was 3.53. Conclusions: The pooled prevalence of TDI was 13% and slightly higher in children less than 6 years of age. Inadequate lip coverage and increased overjet are the risk factors associated with TDI. Heterogeneity was observed among the studies in terms of design, variables recorded, sampling, study methods and statistical methods. Majority of them also suffered from moderate to high risk of bias.
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Autoimmunity and periodontal disease: Arguing a possible correlation p. 615
Giovanna Rosa Degasperi, Marina Vian Ossick, Sérgio Luiz Pinheiro, Augusto Etchegaray
DOI:10.4103/ijdr.IJDR_495_17  
Currently, there is a growing interest in studying systemic conditions associated with periodontal disease such as autoimmune disorders. Periodontal disease is a destructive inflammatory disease of the dental supporting tissues. The microorganisms associated with periodontal disease constitute diverse species that can colonize the oral cavity and influence the emergence or evolution of autoimmunity, characterized by a breakdown in the mechanisms of tolerance to self-antigens. Here, we reviewed and discussed a possible correlation between periodontal disease and autoimmunity, placing periodontal-pathogenic microorganisms as orchestrators of these pathological conditions.
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SHORT COMMUNICATION Top

Structure bound guide to access cavity preparation for molar root canal treatment p. 621
Sundaresan Balagopal, Charanya Chandrasekaran
DOI:10.4103/ijdr.IJDR_856_19  
A good access cavity preparation is the gateway to success in endodontic treatment. This article presents occlusal landmarks that can be used as the boundary for the endodontic access at the occlusal surfaces of maxillary and mandibular molars. Further this article gives a structure or landmark guided three simple stages of preparation to reach the pulp chamber. This assures an ideal access cavity reducing the risk of dentin gouging and eliminating iatrogenic deleterious events. All canal orifices will be within this boundary and can often be located easily.
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EPIDEMIOLOGICAL WORK Top

Knowledge and awareness of oral cancer patients regarding its etiology, prevention, and treatment p. 625
Sanjul Lakra, Gurkiran Kaur, Abhishek Mehta, Vivek Kaushal, Rajeev Atri, Sunder
DOI:10.4103/ijdr.IJDR_838_18  
Introduction: Assumption on part of healthcare workers that individuals suffering from oral cancer are usually aware of the reasons why they got the disease can lead to creation of a knowledge deficit group and may increase chances of relapse and complications in future. Methodology: An interview-based questionnaire study was conducted on 218 patients with oral cancer admitted for treatment at a Regional Cancer Centre (RCC) in north India. Questions were designed to assess their knowledge and awareness regarding etiology, treatment, and prevention of oral cancer. Results: The majority of the study participants were from lower and lower middle socioeconomic class. Most of them were not aware about early signs of oral cancer. Some of them were still continuing with the habit of tobacco consumption. Conclusion: There is an urgent need to improve the knowledge level of oral cancer patients for its primary and secondary prevention.
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Factors influencing the periodontal referral behaviour of the general dental practitioners to a periodontist: A cross-sectional survey p. 629
Kanathur Smitha, AR Pradeep, Devaraj Anvitha, Ishwar Pattar
DOI:10.4103/ijdr.IJDR_596_18  
Aim: In India, dental care scenario is unique and unequally available to the general population with both government-run hospitals and private dental clinics catering to the oral healthcare needs of the patients. There is lack of studies to address how periodontal diseases are managed in general dental practice in India. This study aimed to understand the periodontal referral patterns of general dental practitioners (GDP) to a periodontist in Karnataka state, India. Materials and Methods: This study employed a qualitative approach. Purposive samples of 400 referring dentists were interviewed using structured in-depth questionnaire. The questionnaire consists of a combination of selected response to the questions and close-ended questions, which was distributed to the GDPs of Karnataka state. Results: This survey shows deficient delivery of definitive periodontal treatment. Only 2% of the GDP reported that 80%–100% of their patients received scaling. Location of the practice appeared to have a major role in periodontal referral. Farther the location of the practice from district headquarters, poor was the referral. Clinical skill of the specialist appeared to have a major influence on the selection of specialist followed by academic qualification. Conclusion: This survey provides insight into the periodontal referral process by GDPs in India
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CASE REPORTS Top

Traumatic ulcerative granuloma with stromal eosinophilia p. 636
Aashka Sethi, Akanksha Banga, Ritika Raja, Reema Raina
DOI:10.4103/ijdr.IJDR_330_18  
Oral ulcers constitute one of the most common chief complaints of patients attending any dental practice. The cause of oral mucosal ulceration is generally attributed to acute or chronic trauma from local factors. However, oral lesions may be the initial manifestation of many systemic conditions. Moreover, a group of oral ulcerative lesions have been reported to exhibit vast numbers of eosinophils and known as Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE). We present two cases of oral ulcers which on microscopic examination exhibited numerous eosinophils from ulcerated epithelium to deep into the submucosa and an exuberant lymphoid proliferation. CD15 immunohistochemical marker was used in these cases to ease the identification of the eosinophils. We also highlight the differential diagnosis of TUGSE that may manifest as oral lesions, as an important diagnostic guide for clinicians in contemporary practice.
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An unusual case of polyostotic fibrous dysplasia—A case report p. 640
Kiran Suresh Jagtap, Nikita Rajendrakumar Patel, Poonam Hiray, Anjali Wadhwa
DOI:10.4103/ijdr.IJDR_409_18  
Fibrous dysplasia (FD) is a fibro-osseous lesion where normal bone and marrow is replaced with fibrous tissue, resulting in formation of bone that is weak and prone to expansion. It is classified according to the number of affected bones, and its association to endocrine alterations, that is, monostotic (80–85%), polyostotic forms (20–30%), and Albright's disease. Involvement of two or more bones is termed as polyostotic FD, a relatively uncommon condition. Here we report a rare case of polyostotic FD involving facial bones, orbital bones, sphenoid bone, and spine in a 21-year-old male patient.
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Cicatricial ectropion correction for a case of amniotic band syndrome p. 644
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_766_20  
Background: Amniotic band syndrome (ABS) or amniotic deformity, adhesions and mutilations (” ADAM” ) is a spectrum of rare congenital malformations related to an early phase of organogenesis. In the craniofacial region, ABS could manifest in several forms. A rare form of ABS with Tessier Cleft-9 associated with atypical Cleft-2 presenting with a cicatricial ectropion is reported and management of the condition is discussed. Key Points: ABS causing oro-facial deformities is increasingly being reported. Surgical management requires staged correction and is often challenging. As growth is dynamic, evolving problems should be anticipated. Frequent follow-up and early intervention could prevent unfavourable complications. Main Lessons Learnt: ABS has craniofacial components and it requires an adequate understanding of principles of growth and healing to plan corrective surgeries for such complicated and rare conditions.
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Rhinogenic contact point headache mimicking odontogenic pain: A case report and review of literature p. 647
Abhishek G Soni
DOI:10.4103/ijdr.IJDR_713_18  
Headache is a common clinical problem, and appropriate diagnosis and management are a challenge for oral physician. Any minor anatomical variation within the nasal cavity may lead to mucosal contact point, which may be an etiological factor for causing headache and often left behind by clinician during preliminary evaluation of patients with headache or facial pain, resulting in misdiagnosis and inappropriate treatment. This article is an attempt to present a case of rhinogenic contact point headache which may be mistaken for a toothache initially leading to incorrect diagnosis and irrelevant treatment. A thorough, accurate and comprehensive history taking and a complete clinical and general physical examination result in appropriate diagnosis of the clinical situation.
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Rhinocerebral maxillary mucormycosis: A palatal ulcer p. 652
D N S V Ramesh, Gulnaaz Anjum, Thriveni Rukmangada, Neelkanth Patil
DOI:10.4103/ijdr.IJDR_234_18  
Mucormycosis, caused by saprophytic fungi of the order Mucorales of the class zygomycetes, is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. Mucormycosis can result in an acute, rapidly advancing and occasionally fatal disease caused by different fungi typically found in the soil in association with decaying organic matter such as leaves, compost piles, or bread molds. Mucormycosis is not contagious and does not spread from person to person. We report a case of palatal perforation by rhino-maxillary mucormycosis in an immunocompromised patient. The patient was treated and had a good prognosis for such a fatal condition.
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Palatoradicular groove: The hidden predator and etiological factor – Advanced proposed classification and literature review p. 656
Nirma Yadav, Anand Kumar
DOI:10.4103/ijdr.IJDR_679_17  
Palatoradicular grooves are usually found on the palatal or lateral roots of maxillary central and lateral incisors. Since clinical identification of these grooves are inaccessible and arduous in routine oral hygiene practices and are susceptible alcoves for microorganism habituation and plaque accumulation, it may result in acute to severe periodontitis and, if untreated, periapical pathosis also. This paper discusses about a female patient who reported pus discharge in left upper lateral incisor. Based on history, clinical examination and IOPA (intra-oral periapical radiograph), a deep pocket of about 10–14 mm was noticed in the left upper lateral incisor. A timely investigation was made and was treated surgically with advanced modified procedures which include odontoplasty and restoration of the defect with Platelet Rich Fibrin. After follow up of 6 months, the patient reported no signs of disease progression, had good oral hygiene and the tooth remained to be vital.
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EMERGING TECHNOLOGY Top

Forensic endodontics and national identity programs in India p. 662
Navdeep Jethi, Karandeep Singh Arora
DOI:10.4103/ijdr.IJDR_187_19  
National identity programs like Aadhaar in India can play an unique role in identification of an individual and has numerous beneficial applications for the government and the citizens. The biometric records of finger prints and iris provided in the database can be useful for the forensic purpose. In unfortunate incidence of disasters, accidents, and criminal cases such as severe burnings, the identification of the victims is possible through dental profiling where fingerprint matching is not possible. Endodontic treatment includes the radiography for diagnosis of the lesion, during working length determination, obturation, and various other procedures. The variations in tooth anatomy and morphology, post-endo restorations, root canal fillings, and sometimes, endodontic mishaps are recorded in these radiographs. This record can play an important role in identification of a person in case of unfortunate happenings. So, it is suggested to include dental profiling in National Identification programs, and the purpose of this article is to highlight the role of root canal procedures in dental profiling.
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LETTER TO EDITOR Top

Virtual reality (VR) applications in dentistry: An innovative technology to embrace p. 666
Abid Haleem, Mohd. Javaid, Ibrahim Haleem Khan
DOI:10.4103/ijdr.IJDR_501_19  
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