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   Table of Contents - Current issue
Coverpage
September-October 2020
Volume 31 | Issue 5
Page Nos. 669-827

Online since Friday, January 8, 2021

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EDITORIAL  

Post COVID-19 fungal and microbial infections Highly accessed article p. 669
SM Balaji
DOI:10.4103/ijdr.IJDR_1056_20  PMID:33433501
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Evaluation of the remineralisation potential of bioactive glass, nanohydroxyapatite and casein phosphopeptide-amorphous calcium phosphate fluoride-based toothpastes on enamel erosion lesion –An Ex Vivo study Highly accessed article p. 670
Hafsa Suryani, Paras Mull Gehlot, Mysore Krishnaswamy Manjunath
DOI:10.4103/ijdr.IJDR_735_17  PMID:33433502
Background: Erosion, a dynamic process with periods of demineralisation and remineralisation, has become a common problem in modern societies, owing to changes in life style and dietary habits. Although fluorides have been included in toothpastes that claim to prevent demineralisation and aid remineralisation, their ability to remineralise is limited by low concentration of calcium and phosphate ions available in saliva. Hence, a new paste based on casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), nanohydroxyapatite and bioactive glass (BAG) were introduced. Aim: To evaluate and compare the effects of BAG, nanohydroxyapatite and CPP-ACPF pastes on surface microhardness of demineralised enamel. Materials and Methods: 48 enamel specimens were randomly divided into five groups: Group I positive control - intact specimens and Group II - demineralised specimens. The test groups, Group III, IV and V, comprised CPP-ACPF, nanohydroxyapatite and BAG, respectively. The test specimens were demineralised with 0.1% citric acid followed by remineralisation using either of the three prepared slurries. The specimens were subjected to pH cycling regime for 15 times. The remineralisation potential of the specimens was studied by evaluating the surface microhardness. One specimen from each group was analysed under SEM. Data was tabulated and analysis performed by one way ANOVA and post hoc Scheffe test. Results: Statistically significant difference was found between the negative control and three test groups based on microhardness evaluation. Nanohydroxyapatite had the least remineralising potential as compared to CPP-ACPF and BAG. Conclusion: Comparatively, BAG and CCP-ACPF paste showed better remineralising potential.
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Efficacy and feasibility of usage of hand signals during dental procedure among students in a Dental Institute in Maduravoyal, Chennai: A cross-sectional study Highly accessed article p. 678
R Vignesh, Indra Priyadarshni, T Sukanya
DOI:10.4103/ijdr.IJDR_38_19  PMID:33433503
Objective: To assess the efficacy of the usage of hand signals during a dental procedure among students in a dental institute. Methods: 268 students and their allotted patients from a dental institute were taught about hand signals (DentiSign) that can be used for communication during dental procedures. During the first dental visit, a pretested questionnaire was provided to students, before and after the treatment procedure, to assess the change in fear and anxiety in their patients. This protocol was followed for the second consecutive visit. The questionnaires were collected and subjected to statistical analysis. McNemar's test was used to analyze the responses for the questionnaire before and after treatment during the first and second visits. Results: By the end of the first visit, 45.75% students felt that using hand signals can make patients feel comfortable and 35.68% students felt that the practitioner will be able to understand patients' fear and anxiety, which were statistically significant. By the end of second visit, the response increased significantly to 92.17% and 94.66%, respectively. A reduction in treatment time was also perceived by the students but was not statistically significant. Conclusion: Use of hand signals during dental treatment can be an option in reducing anxiety and fear for the patients. They can also help in effective communication during the treatment procedure and may help in reducing treatment time.
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Evaluation of mucoadhesive dexamethasone sodium phosphate gel in the treatment of arecoline-induced oral submucous fibrosis in wister albino rats: A cross-sectional study Highly accessed article p. 685
Vijaybhaskar C Desai, Sidramappa B Shirsand, Arati Malpani, Suresh Hiremath
DOI:10.4103/ijdr.IJDR_685_19  PMID:33433504
Aim: The present work aimed to prepare an oral mucoadhesive gel of dexamethasone sodium phosphate to serve the purpose of treating oral submucous fibrosis by incorporating the drug in a polymeric matrix to facilitate the localisation of the drug at the absorption site, to prolong drug delivery and to provide patient convenience. Materials and Methods: The formulations F1, F2 and F3 were prepared using 2, 2.5 and 3% of carboxymethyl cellulose sodium, formulations F4, F5 and F6 were prepared using 2, 2.5 and 3% of hydroxypropyl methylcellulose, respectively, and formulations F7, F8 and F9 were prepared using equal mixtures of carboxymethyl cellulose sodium and hydroxypropyl methylcellulose in the concentrations of 1, 1.25 and 1.50%, respectively. The prepared formulations were subjected for screening of physicochemical parameters, viz, homogeneity, grittiness, viscosity studies, spreadability, extrudability, mucoadhesive strength, pH, drug content uniformity, in vitro drug diffusion, Fourier transform infrared spectroscopy spectral analysis and stability studies. Results: Among the nine formulations prepared, the formulation F8 containing 1.25% carboxymethyl cellulose sodium, 1.25% hydroxypropyl methylcellulose having a mucoadhesive strength of 12.600 ± 0.01 g and drug release of 88.473 ± 0.457% was considered as the promising one and was further used for in vivo study. Conclusion: Oral application of the gel for 4 months in arecoline-induced oral submucous fibrosis rats showed more than 80% reduction in fibrosis. The histopathological results supported these findings.
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A qualitative research analysis of gender-based parities and disparities at work place experienced by female dentists of Vadodara, India Highly accessed article p. 694
Ramya R Iyer, Rajesh Sethuraman, Medha Wadhwa
DOI:10.4103/ijdr.IJDR_586_18  PMID:33433505
Aim: To assess the gender-based parities and disparities at work place experienced by female dentists of Vadodara, India. Materials and Methods: In-depth face-to-face qualitative semi-structured interviews in English were conducted among 12 female dentists of Vadodara. Female dentists working with one/more male colleague or auxiliary were selected through purposive sampling. Interviews were conducted as per Kvale's principles and recorded using a digital voice recorder. Transcribed data was analyzed using Giorgi's phenomenological analysis. Results: The recurring themes identified were: (a) Striking work–family balance (b) Dependence on male authority for instating work discipline (c) Male dentists' hostility to “woman in power” concept (d) Male dentists' superiority in technical skills (e) privileges for women dentists. Conclusions: There is a need to improve the work environment of women dentists. Social support, sensitivity among male colleagues, and generous institutional policies will enable increased contribution from women to the profession.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Comparative evaluation of flexural fracture resistance of mandibular premolars after instrumentation with four different endodontic file systems: An In Vitro study p. 701
Gaurav L Aidasani, Sanjyot Mulay, Anamika Borkar
DOI:10.4103/ijdr.IJDR_102_18  PMID:33433506
Background: Under axial loading, there is stress concentration around the cervical areas especially in the premolars because of their location in the arch. Aim: To evaluate and compare flexural fracture resistance of mandibular premolars after instrumentation with ProTaper®Universal, ProTaper Next®, OneShape®, and WaveOne® endodontic file systems. Methods: Seventy-five mandibular premolar teeth with single straight canals were divided into five different groups (n = 15): Group A: Control, Group B: ProTaper Universal (PTU), Group C: ProTaper Next (PTN), Group D: OneShape, Group E: WaveOne. The teeth were instrumented as per the manufacturer's instructions. After obturation and core placement, the teeth were placed in a customized jig mounted on a universal testing machine where force was applied at 45° on the buccal cusp and the force required to fracture the teeth was noted. Results: Amongst all the instrumented groups, WaveOne showed the highest resistance to fracture (1065.56 ± 175.05) and the control group was 1104.13 ± 188.42. All groups showed a significant difference in the fracture load values with the control group. However, there was a statistically significant (P < 0.05) difference seen with WaveOne vs PTU and WaveOne vs OneShape. Conclusions: Root canals instrumented with reciprocating motion have better flexural fracture resistance than continuous rotary motion. Mandibular premolars when instrumented with ProTaper Universal and OneShape endodontic files showed similar fracture resistance, proving that dentin removal does not depend on the number of files used.
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Influence of personality traits on the intensity of maximum voluntary bite force in adults p. 706
Sulthan I R. Khan, Dinesh Rao, Anupama Ramachandran, Baskaran V Ashok
DOI:10.4103/ijdr.IJDR_517_19  PMID:33433507
Purpose: To determine the Maximum voluntary bite force among patients having different personality traits. Methods: In total, 323 patients were given the big-five inventory (BFI) questionnaire to fill and allotted to the various personality traits. The patients in the Agreeableness (n = 62) and Neuroticism traits (n = 62) were included in the study. They were categorized into groups as Group 1a – Neuroticism male (41 patients) and Group 1b – Neuroticism Female (21 patients) and Group 2a – Agreeableness male (26 patients) and Group 2b – Agreeableness female (36 patients). Highest value of the maximal voluntary bite force (MVBF) was recorded using FlexiForce sensor (B 201) (Tekscan, USA). The statistical data were analyzed by independent t-test (P < 0.05). Results: The mean bite force values for Neuroticism male was 778.66 N, Agreeableness male was 699 N, Neuroticism female was 686.24 N, and for Agreeableness female was 565.47 N. Statistically significant differences in the bite forces between the male and female groups of both the groups with the males showing significantly higher bite force values in both groups was seen. Also, the bite force in Neuroticism male was significantly higher than Agreeableness male and bite force in Neuroticism female was higher than Agreeableness female. Conclusion: In this study, the highest bite force was seen in Neuroticism males. Additionally, this study infers that personality has significant influence on the quantum of bite force. Thus, personality assessment of the patient can assist the clinician in planning the appropriate treatment.
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A comparison between visual, digital photography and polarizing filter photography for shade selection p. 712
Kasturi C Kelkar, Easha Singh Dogra, Vinaya Bhat, D Krishna Prasad, Chethan Hegde
DOI:10.4103/ijdr.IJDR_286_19  PMID:33433508
Aim: There is an increased awareness for aesthetically pleasing restorations among patients in current practice. Due to variability in the natural tooth colour, shade selection becomes an intricate procedure. The aim of this study is to determine which of the three named methods is more accurate for shade selection in aesthetic dentistry. Materials and Methods: Two VITAPAN classical shade guides were used for this study. Nine shades were selected from the first shade guide (A1, A2, A3.5, B1, B2, B3, C1, C2, C3) and the number was concealed. Ten selected participants were asked to identify each concealed shade with the second shade guide. Canon 5D camera with ISO 200, shutter speed 1/100 sec, F22 was used for capturing images of the second shade guide. Photoshop CS3 Software was used for developing the digital shade guide. The participants were asked to match the shades from the first shade guide with the prepared digital shade guide. The third photographic shade guide was prepared using a polarised filter on the Canon 5D camera with the same settings. The participants were asked to match shades with the prepared photographic shade guide. Results: Total observations made during the study were 270. Cross table statistical analysis (Chi-square test) done using SPSS 20.0 showed statistically significant difference between conventional and digital photography (P = 0.049). Analysis between digital photography and polarizing filter photography did not reveal a significant association (P = 0.181). Conclusion: Digital photographic method was most accurate among the three shade selection methods. It can be used to obtain aesthetic results.
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Effectiveness of curcumin mouthwash on radiation-induced oral mucositis among head and neck cancer patients: A triple-blind, pilot randomised controlled trial p. 718
Swikant Shah, Hemamalini Rath, Gaurav Sharma, Surendra Nath Senapati, Ekagrata Mishra
DOI:10.4103/ijdr.IJDR_822_18  PMID:33433509
Introduction: Radiation-induced oral mucositis (RIOM) is considered the most severe non-haematological complication affecting almost every head and neck cancer patient during the course of radiotherapy (RT). Curcumin, a herbal agent present in Indian spice 'Turmeric' has anti-inflammatory, immunomodulation and wound healing properties. The objective of this pilot randomised controlled clinical trial was to compare the effectiveness and safety of 0.1% curcumin (freshly prepared using nanoparticles) and 0.15% benzydamine mouthwash on RIOM among 74 head and neck cancer patients scheduled to receive RT. Materials and Methods: Assessment of RIOM was carried out using WHO criteria once in a week for 6 weeks. Both modified intention to treat (MIT) and per protocol (PP) analysis were carried out to test the null hypothesis of equal effectiveness on prevention and severity of RIOM. Results: As far as the onset of RIOM is concerned, MIT analysis showed that the instantaneous risk of getting the onset of RIOM was 50% lower (hazard ratio 0.5) in curcumin. Onset of RIOM was also significantly delayed (mean = 19.56, median = 21) in the test group by 2 weeks. But in 'PP' analysis, no significant difference was observed between two preparations and almost all patients experienced the onset. Both the mouthwashes were equally effective in preventing the occurrence of severe form of RIOM in PP analysis after dichotomisation of severity score (≥3 and ≤2). Conclusion: Though both the mouthwashes were not able to completely prevent the onset of RIOM and reduce the severity of RIOM, use of 0.1% curcumin mouthwash was able to significantly delay the onset of RIOM (Clinical trial registration no. CTRI/2018/04/013362).
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Correlation and comparison of dactyloscopy and palatoscopy with blood groups – An institutional study p. 728
Monika Sisodia, Sushma Bommanavar, Rajendra Baad, Nupura Vibhute, Uzma Belgaumi, Vidya Kadashetti
DOI:10.4103/ijdr.IJDR_368_18  PMID:33433510
Background: The most crucial evidence that is left behind at the crime scenarios that might narrow down the suspect pool are lip prints and fingerprints. These are undoubtedly the most reliable and valuable evidence till date in the court of law. One more biological record that remains unchanged throughout the lifespan of a person is the blood group. Aim and Objectives: To study, correlate and compare cheiloscopy and dactyloscopy with blood group among dental students in the Western Maharashtra population. Materials and Methods: A total of 200 dental students with age groups ranging between 18–25 years were included in the study. Lip print pattern, fingerprint pattern and ABO blood groups were collected and compared. SPSS version 20.0 was used to analyse the data. Results: There was a statistically significant correlation between lip prints and ABO – Rh (χ2 37.56, P < 0.05) as well as between fingerprints and ABO-Rh blood groups (χ2 30.6, P < 0.05).Conclusion: Hence, this study concluded that fingerprints–ABO blood group and lip prints–ABO blood groups are valuable evidence that can be relied upon in forensic investigations for the identification of the suspect in crime.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Occurrence of micronuclei in exfoliated buccal mucosal cells in mobile phone users: A case-control study p. 734
B Rashmi, Sudarshan Kumar Chinna, Charlotte Rodrigues, D Anjaly, Praveen Kumar Bankur, Karthik Kannaiyan
DOI:10.4103/ijdr.IJDR_634_18  PMID:33433511
Introduction: The use of mobile phones has increased enormously all over the world especially among young people. This technology is based upon electromagnetic radiation in the microwave frequency range [radiofrequency (RF) waves and microwaves]. The radiation frequency and modulation standards vary in the range of 300–2100 MHz, depending on the region in the world. Aim and Objectives: To detect the presence of micronuclei in exfoliated buccal mucosal cells of mobile phone users as well as to carry out a quantitative analysis of micronuclei in exfoliated buccal mucosal cells of mobile phone users. Material and Methods: A cross-sectional study was carried out in 100 individuals, out of which 50 were included under the test group and 50 under the control group. Buccal mucosal smears were obtained from each subject. Staining was done using papanicuolau (PAP) stain and the slides were examined for the presence of micronuclei. Results: The mean duration of mobile phone usage in years was 5.32 years for the exposed and 2.42 years for the control. Mean duration of mobile phone usage per day in the test group was 94.8 min and 12.4 min in the control group. The frequency of micronucleated cells (MNC) in test and control groups ranged from 0 to 16 and 0 to 2 respectively. The data obtained were statistically analyzed using Student t-test and significant results were obtained at 0.0001 level. Conclusion: Our study concluded that there is an increased frequency of micronuclei in mobile phone users which is related to carcinogenesis.
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Expression of epithelial glycoprotein (EGP40) in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC) p. 738
Kenniyan Kumar Srichinthu, GS Kumar, Harikrishnan Prasad, Muthusamy Rajmohan, Krishnamurthy Anuthama, Thuckanaickenpalayam Ragunathan Yoithapprabhunath
DOI:10.4103/ijdr.IJDR_929_18  PMID:33433512
Aim: To study the expression of Epithelial Glycoprotein (EGP40) in various grades of Oral Epithelial Dysplasia namely mild, moderate and severe epithelial dysplasia and in various grades of Oral Squamous Cell Carcinoma (OSCC) namely well, moderate & in poorly differentiated squamous cell carcinoma. Material and Methods: This laboratory study comprised of 47 samples in which 27 samples were of three different grades of OSCC, Well (n=10), Moderate (n=10) and Poorly differentiated (n=7) and remaining 20 samples were of three different grades of dysplasia [Mild (n=7), Moderate (n=8), Severe dysplasia (n=5)]. All the 47 cases were subjected to immunohistochemical staining to evaluate the expression of EGP40. Chi square was used to analyze the significance of differences in different grades of oral epithelial dysplasia & in different grades of OSCC. Results: The percentage of EGP40 immuno positivity was increased from mild to severe dysplasia and the percentage of EGP40 immuno positivity was increased from well to poorly differentiated carcinoma No statistical significance was observed in the immunoreactivity and in the intensity of expression between various grades of oral epithelial dysplasia and oral squamous cell carcinoma. Conclusion: The epithelial cell adhesion molecule can be considered as an early marker for predicting malignant transformation of dysplastic epithelial lesions and used as a marker in predicting the OSCC prognosis.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Comparative evaluation of tooth surface roughness caused by three different powered toothbrushes and a novel manual toothbrush –An SEM and AFM study p. 743
Monika Loitongbam, Ranjana Mohan, Zoya Chowdhary, Shalabh Mehrotra
DOI:10.4103/ijdr.IJDR_163_18  PMID:33433513
Background: Toothbrush is the most frequently used tool for mechanical plaque control. Variety of manual and powered toothbrushes are available in the market, and it is often a dilemma for a common man that which one to choose among the wide range. Thus, the purpose of the present study was to evaluate and compare the tooth surface roughness caused by three different powered toothbrushes. Method: In total, 160 samples comprising of 80 enamel and cementum each were equally and randomly divided into four groups: Group 1 multi-directional powered toothbrushing; Group 2 oscillating/rotating/pulsating powered tooth brushing; Group 3 sonic powered tooth brushing; and Group 4 manual tooth brushing. They were further sub-divided equally into Control and Test. The Test samples were brushed for 2 min every day for a period of 1 month. The prepared samples were evaluated for surface roughness using scanning electron microscope at 1000 × magnification and atomic force microscope at the nanoscale. Result: A statistically significant difference was seen in the enamel and cementum roughness between multi-directional tooth brush group and sonic (P = 0.00); multi-directional tooth brush group and manual tooth brush group (P = 0.00); oscillating tooth brush group and sonic group (P = 0.00); oscillating tooth brush group and manual tooth brush group (P = 0.00); and sonic group and manual tooth brush group (P = 0.00). Conclusion: The surface microroughness caused by tooth brushing was found to be least using multi-directional and oscillating/rotational/pulsating powered toothbrush, followed by sonic powered toothbrush and maximum in manual toothbrush.
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Comparative evaluation of shear bond strength between fifth, sixth, seventh, and eighth generation bonding agents: An In Vitro study p. 752
A Sri Ganesh
DOI:10.4103/ijdr.IJDR_635_19  PMID:33433514
Aim: To evaluate and compare the shear bond strength of composite resin to dentin using eighth generation dental adhesive (G-Premio Bond) with fifth, sixth, and seventh generation dentin adhesives. Materials and Methods: A total of 64 freshly extracted non-carious, intact human premolar teeth were selected. Class V cavity was prepared by using high speed hand piece. The prepared samples were randomly divided into four experimental groups (n = 16). Group I: Adper single Bond 2 [fifth generation] (ASB-5), Group 2: Clearfil SE [sixth generation] (CSE-6), Group 3: Single Bond Universal [seventh generation] (SBU-7), Group 4: G-Premio Bond [eighth generation] (GPB-8). Bonding agents were applied according to the manufacturer's instructions and light cured. Then, the Nano composite Filtek Z350 was placed in a two layer increment using Teflon Jig (2 × 2 × 2 mm) and was light-cured for 40 s. Shear bond strength was tested by a universal testing machine. This study was carried out by using Tukey HSD post-hoc test where P ≤ 0.05 was considered as a statistical significant. Results: The highest value of shear bond strength was obtained from G-Premio Bond (eighth generation) showed statistically significant difference when compared to seventh generation bonding agent. However, there is no statistical significant difference between eighth and fifth, sixth generation. Conclusion: The study concluded the G-Premio Bond (eighth generation) showed effective shear bond strength than other bonding agents. This bonding agent is compatible with self-etch without use of primer which gives highly long lasting esthetic, wear resistant, and it is ideal for hypersensitive tooth.
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Effect of inciso-cervical position of wire-composite splint on the mobility of an avulsed permanent tooth: A cadaveric model study p. 758
Mohammad Atif, Nitesh Tewari, Vijay P Mathur, Kalpana Bansal, Morankar R Gangadharrao
DOI:10.4103/ijdr.IJDR_901_19  PMID:33433515
Introduction: The wire composite splint as a general rule is placed on the middle third of labial surface of the tooth. This is due to ease of application, better isolation, and fewer chances of contamination. However, these assumptions are opinion-based, with no scientific evidence to support them. In addition, to best of our knowledge no research has been carried out to evaluate the effect of position of wire splints on the mobility of the affected tooth and anchor teeth. Aim: The aim of this study was to evaluate the effect of the cervico-incisal position of splinting wire on the mobility of a replanted tooth and anchor teeth in a cadaveric model. Methodology: Three cadavers (one female, 45 years old and two males, each 40 years old) were included in the study. periotest S was used to assess physiologic-tooth-mobility in three cadavers at baseline and after “extraction-replantation-wire-composite” splinting-protocol. Results: Greatest splint effect for horizontal-mobility was found to be 9.33 ± 0.57 for Cadaver-I (incisal-third), whereas it was highest (3.66 ± 2.51) for vertical-mobility in Cadaver-II (cervical third). Conclusion: Middle third position of wire composite splint have lowest splint effect on both horizontal and vertical mobility of replanted teeth, thus rendering the most favorable position for the establishment of physiologic mobility.
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Development of a membrane for guided tissue regeneration: An in vitro study p. 763
Ramon C Fernandes, Mário Igor Damasceno, Gabriel Pimentel, Juliano S Mendonça, Maria V Gelfuso, Sérgio L da Silva Pereira, Vanara F Passos
DOI:10.4103/ijdr.IJDR_244_19  PMID:33433516
Aim: The aim of this study was to develop an alternative low-cost membrane for use in guided tissue regeneration (GTR). Setting and Design: In vitro study. Methods and Material: In this study, a membrane prepared from a 335 mm sized opening nylon substrate, covered in aqueous resin derived from chitosan, was compared with a commercial material, a non-degradable expanded poly (tetrafluoroethylene). Nylon substrate samples 2.0 × 2.0 cm were covered by aqueous resin based on diluted chitosan solution into 1:05 or 1:10 by spin coating technique to produce from 06, 10, and 15 layers. The surfaces of these membranes were observed using optical microscopy. The physical properties were measured by hydration superficial energy measurements (ΔG) and a tensile test machine. Statistical Analysis: Statistical analysis was performed using the Student's t test at a significance level of 5%, using the BioEstat 2.0 program. Results: The Δ G values of the nylon membrane covered by the 1:05 of chitosan with 15 layers were close to the commercial membrane's Δ G values. The tensile strength values of the nylon membrane covered by the 1:05 of chitosan with 15 layers were higher than the commercial membrane's (115.826 MPa, P < 0.05). Conclusion: Therefore, the membrane developed shows some favorable physical properties that could qualify it as a material candidate for use in guided tissue regeneration.
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Esterase like activity of Enterococcus faecalis and Lactobacillus casei on microhardness and weight loss of resin luting cements p. 768
Gopal SreeVidya, Durvasulu Archana, Udayakumar Prithika, Elangovan Sivapriya, Bollina Tejaswi, Angambakkam Rajasekaran PradeepKumar
DOI:10.4103/ijdr.IJDR_747_20  PMID:33433517
Introduction: Gap-free/continuous cement margins have been considered important for the longevity of indirect dental restorations. Bacterial species have demonstrated esterase-like activity that can cause biodegradation of resin composites. Aim: The aim of this study was to evaluate the effect of the esterase-like activity of E. faecalis and L. casei on three resin luting cements. Settings and Design: In-vitro study materials and three resin luting cements tested were: Variolink N, Rely X U200 and Panavia F2.0. E. faecalis and L. casei suspensions and supernatants were assessed for enzymatic activity by bacterial esterase activity assay. Circular samples of resin luting cements were exposed to suspensions of E. faecalis and L. casei for 7 and 28 days followed by testing for solubility, microhardness and bishydroxy propoxy phenyl propane (BisHPPP) release. Results: E. faecalis and L. casei both demonstrated esterase-like activity. Bacterial suspensions had significantly increased enzymatic activity than supernatant solutions (P < 0.05). There was no significant reduction in microhardness or increased weight loss in all three cements after incubation in E. faecalis and L. casei for 7 and 28 days. BisHPPP release signifying resin degradation was seen after 7 and 28 days of incubation in E. faecalis and L. casei. Conclusion: Within the limitations of this in vitro study, E. faecalis and L. casei demonstrated esterase-like activity. BisHPPP release was evident in all three cements after 7 and 28 days. However, the bacterial strains did not significantly reduce the microhardness or cause weight loss of the tested resin luting cements (Variolink N, Panavia F2.0 and Rely X U200) after 7 and 28 days of incubation.
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SYSTEMATIC REVIEW Top

Post-operative pain after using sodium hypochlorite and chlorhexidine as irrigation solutions in endodontics: Systematic review and meta-analysis of randomised clinical trials p. 774
Christine M Martins, Nathália E da Silva Machado, Bianca V Giopatto, Victor E de Souza Batista, Juliane A Marsicano, Graziela G Mori
DOI:10.4103/ijdr.IJDR_294_19  PMID:33433518
Context: Is it possible that the irrigating solutions can have the potential to cause post-operative pain? Unfortunately, the current literature does not provide clear guidance. Aim: The purpose of this systematic review and meta-analysis was to comprehensively review two different irrigation solutions (sodium hypochlorite and chlorhexidine) regarding the post-operative pain after endodontic treatment. Settings and Design: This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Material and Methods: This search was conducted in the PubMed/MEDLINE, SCOPUS and Cochrane Library databases until February 2018 to answer the In [(Population) what is the effect of (Intervention) on (Outcome), compared with (Comparison) Intervention] (PICO) question: could sodium hypochlorite cause more post-operative pain than chlorhexidine in teeth subjected to endodontic treatment? The primary outcome was overall post-operative pain after 24 h. Results: After applying the inclusion and exclusion criteria, three randomized clinical trials fulfilled the eligibility criteria, and two were subjected to the meta-analysis. There was no difference in post-operative pain between the tested irrigating solutions. Conclusions: There are few studies published in the current literature; therefore, additional randomized clinical studies are required to on this topic to help clinicians make the best decision concerning treatment.
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SHORT COMMUNICATION Top

Hard tissue formation in odontogenic lesions associated with impacted tooth: Plausible pathogenesis p. 782
Arush Thakur, Pooja Siwach, Ruchika R Agrawal
DOI:10.4103/ijdr.IJDR_874_18  PMID:33433519
Odontogenesis is a complex process, which involves the molecular interaction between the epithelium and ectomesenchyme called as epithelium mesenchymal interaction (EMI). Reduced enamel epithelium (REE) after tooth formation protects enamel from coming in contact with adjacent ectomesenchyme. Also, REE acts as a source of origin for odontogenic lesions, during the process of development of a lesion, disruption in REE may occur and lead to formed enamel coming in contact with adjacent ectomesenchyme leading to the formation of cementum like calcifications. REE may play a role in pathogenesis of hard tissue formation in odontogenic lesions.
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EPIDEMIOLOGICAL WORK Top

Epidemiological study on prevalent risk factors and craniofacial skeletal patterns in obstructive sleep apnea among South Indian population p. 784
Parvathy Ghosh, NK Sapna Varma, VV Ajith, Rahul D Prabha, Manu Raj
DOI:10.4103/ijdr.IJDR_224_19  PMID:33433520
Context: Obstructive sleep apnea (OSA) is a condition affecting the upper airway among a vast number of people around the world. Aims: To determine the prevalent risk factors of OSA and its association with craniofacial skeletal pattern. Settings and Design: Cross-sectional, community-based study. Materials and Methods: In the first stage, questionnaire and physical examination were done for 1000 subjects between 20 and 70 years of age. Subjects were categorized as snorers and non-snorers. Snorers were further grouped as high-risk and low-risk snorers. In the second stage, polysomnography (PSG) was done for randomly selected high-risk subjects. Craniofacial skeletal pattern of OSA-diagnosed subjects were compared with non-OSA subjects using lateral cephalograms. Statistical Analysis: Analysis was performed using IBM SPSS 20. Independent sample t-test was used. A P value < 0.05 was considered as statistically significant. Results: The study population represented the following: high-risk snorers: 22.4%, low-risk snorers: 13.9%, and non-snorers: 63.7%. Excessive daytime sleepiness was present in 7.7%. Among high-risk, 80 underwent PSG, and 75 were diagnosed as OSA (94%) and 5 non-OSA subjects. Increased body mass index and neck circumference were statistically significant. Cephalometric evaluation showed difference in maxillomandibular relationship, narrowing of airway space, and inferiorly displaced hyoid. Conclusion: OSA is a major public health problem. Obesity is a strong predictor for OSA. Thus, high-risk subjects for sleep apnea could be identified using routine clinical examination, investigations, and anthropometric parameters.
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CASE REPORTS Top

Post-traumatic pseudo joint formation at the angle of mandible - A case report p. 791
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_949_20  PMID:33433521
Nonunion post-mandibular fractures are relatively uncommon. They pose severe challenge in terms of treatment and quality of life. The cause for pseudo-union is multi-dimensional. Removal of the cause or treating the same is an absolute need to provide correct treatment. Successful correction of a case of pseudo-union of fractured mandible occurring after two previous treatment attempts is presented. The possible explanation for the pseudo-union as well as the precautions to be taken to prevent such occurrence is discussed.
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Achondroplasia: A form of disproportionate dwarfism - A case report p. 794
KV Swathi, G Maragathavalli
DOI:10.4103/ijdr.IJDR_303_19  PMID:33433522
Achondroplasia is a genetic disorder that is due to mutation of fibroblast growth factor receptor (FGFR3) gene and it results in dwarfism. It is inherited as an autosomal dominant trait. The classical clinical features seen are disproportionate dwarfism, rhizomelic shortening (proximal limbs), short fingers and toes with trident hands, large head with prominent forehead (frontal bossing), small mid face with flattened nasal bridge, spinal kyphosis or lordosis, varus (bowleg), and valgus (knock knee) deformities. Oral findings include macroglossia, tongue thrust swallowing pattern, posterior crossbite, anterior open bite, anterior reverse overjet, etc., This case report present the features and oral treatment protocol for Achondroplasia.
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A maxillofacial prosthetic obturator using precision attachments p. 799
Prajna P Shetty, Ramesh Chowdhary, Pooja P Shetty
DOI:10.4103/ijdr.IJDR_123_18  PMID:33433523
The majority of maxillary defects can be rehabilitated with pedicled flaps. However, when there are very large resections of the maxilla and flap success is questionable, then the defect may be obturated with a conventional hollow bulb clasp retained obturator or implant retained obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of a conventional obturator and in case of recurrence the success of implant is questionable. A precision attachment becomes the silver lining. They have been used to retain obturator for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator's aesthetic advantages. This clinical report describes the successful prosthetic rehabilitation of maxillary defects with an obturator retained using two different extracoronal resilient precision attachments. Attachment retained prosthesis provides a successful closure for the defect but also better esthetics, retention, better tolerability and better mastication and speech.
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Mural unicystic ameloblastoma with multifarious histopathological patterns: An exquisite case report p. 803
Sahanaz Praveen Ahmed, Nandhini Gunasekaran, Preethi Arunachalam, Ramesh Kumar Annasamy
DOI:10.4103/ijdr.IJDR_55_19  PMID:33433524
Ameloblastoma is a true benign neoplasm of odontogenic epithelial origin mostly seen in the mandible. After odontoma, it is the second most commonly seen odontogenic neoplasm. Ameloblastoma comprises of several clinical, radiological and histological varieties, making it the most significant odontogenic neoplasm. Among these, the unicystic type is the least explored due to the fewer numbers of reported cases. Clinically and radiographically, it represents a cyst, but displays classic ameloblastomatous epithelial lining part of the cyst cavity, with or without intraluminal and/or mural tumor growth. We present an unusual case of unicystic ameloblastoma showing mural proliferation with mixed histological pattern [Plexiform, Follicular and Acanthomatous] of the mandible in a 32-year-old male.
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An unusual variation of radicular dentin dysplasia: A rare case report with review of literature p. 807
Arun K Patnana, Vinay K Chugh, Ankita Chugh
DOI:10.4103/ijdr.IJDR_372_19  PMID:33433525
Dentin dysplasia (DD) is a rare autosomal dominant disorder of dentin development, which is generally divided into two types based on the clinical and radiographic appearance of the affected dentinal tissues: Type-I (Radicular DD) and Type-II (Coronal DD). This paper reports the case of a 17-year-old female patient with both classical and atypical features of radicular DD in the permanent dentition. The present case shows clinically normal appearing crowns, localised mobility in the maxillary teeth, completely obliterated pulp chambers, widened root canals without any obliterations and the presence of multiple periapical radiolucencies. The clinical and radiographic findings observed in this present case report are different from those reported in the past literature, which suggests that the present case could be a variation of radicular DD.
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Usefulness of advanced-platelet rich fibrin (A-PRF) and injectable-platelet rich fibrin (i-PRF) in the management of a massive medication-related osteonecrosis of the jaw (MRONJ): A 5-years follow-up case report p. 813
Amerigo Giudice, Alessandro Antonelli, Danila Muraca, Leonzio Fortunato
DOI:10.4103/ijdr.IJDR_689_19  PMID:33433526
Medication-related osteonecrosis of the jaw (MRONJ) is a recurring complication resulting from the long-term therapy with bisphosphonates or antiresorptive drugs such as denosumab or antiangiogenic drugs. This paper describes a 5-years follow-up case of Stage 3 of MRONJ (AAOMS) in a 69-year-old patient treated with piezosurgery and topical application of platelet-rich fibrin (PRF). Medical treatment included antibiotic therapy and a topical treatment with PRF in solid and liquid form. This treatment showed initially the reduction of pain and leakage exudate and a complete wound healing in 25 days. The Injectable-Platelet Rich Fibrin (i-PRF) injections led to a complete resolution of oro-cutaneous fistulas in 50 days showing its ability of releasing growth factors and chemotaxis agents involved in tissue repair mechanisms. Preparation simplicity and the low cost of PRF allow to consider this method as an excellent alternative treatment for the healing of tissues in MRONJ patients.
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Root resection - Exploring ways beyond extraction p. 819
Monika Pal, Santhosh Kumar, G Pratibha
DOI:10.4103/ijdr.IJDR_91_18  PMID:33433527
One of the crucial challenges that any present-day general dentist confronts is the treatment determination between extracting a tooth and placement of a dental implant or by conserving the natural tooth with an interdisciplinary approach. The rising concern amongst the patients towards preserving their dentition has driven the clinicians towards providing treatment options that are more appropriate and conservative and at the same time does not hamper its functional needs. This report highlights one such way of preserving the periodontally compromised natural tooth with just resecting the diseased part of it and also conserving the proprioceptive capacity of the tooth. One-year of regular follow up and maintenance paving way to a healthy periodontium and complete resolution of mobility concerning the affected tooth is described. This report also provides information on root resection in a mandibular molar as a viable and a definitive treatment modality, providing better access to the remaining tooth structure and thereby enabling successive prosthetic rehabilitation.
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LETTERS TO EDITOR Top

Industry 4.0 and its applications in dentistry p. 824
Abid Haleem, Mohd Javaid
DOI:10.4103/ijdr.IJDR_904_18  PMID:33433528
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A case of temporomandibular joint pain in a competitive weight lifter p. 826
Tulika Wakhloo, Sagrika Shukla, Ashi Chug
DOI:10.4103/ijdr.IJDR_80_19  PMID:33433529
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