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   Table of Contents - Current issue
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January-March 2019
Volume 10 | Issue 1
Page Nos. 1-181

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EDITORIAL  

The Pursuit of originality makes us all the same! Highly accessed article p. 1
GM Sogi
DOI:10.4103/ccd.ccd_410_19  
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REVIEW ARTICLE Top

Traumatic bone cyst of mandible: A case report of rare entity and review of literature Highly accessed article p. 3
Sukhvinder Bindra, Gargi Jadaun, Harshvardhan S Jois, Prabuddh Sen
DOI:10.4103/ccd.ccd_489_18  
The traumatic bone cyst was first described by Lucas in 1929 and later by Rushton. A solitary bone cyst (SBC) is a nonneoplastic osseous lesion affecting ≥95% of the metaphyses of long bones such as the proximal humerus and femur. The incidence of cyst affecting the jaws is 1% of all the cyst. About 89% of the lesion occurs in the mandible and 11% in the maxilla. Majority of the lesions occur in the posterior mandible, especially in the premolar–molar region. In this case report, we are presenting one such case of multiple lesions of SBC in mandible with systematic review of the literature.
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ORIGINAL ARTICLES Top

In vivo comparative evaluation of esthetics after microabrasion and microabrasion followed by casein phosphopeptide–amorphous calcium fluoride phosphate on molar incisor hypomineralization-affected incisors p. 9
Ranu Bhandari, Seema Thakur, Parul Singhal, Deepak Chauhan, Cheranjeevi Jayam, Teerthesh Jain
DOI:10.4103/ccd.ccd_852_17  
Background: Molar incisor hypomineralization (MIH) is an esthetic setback for the patient as well as for the dentist, treatment options for MIH includes minimally invasive techniques like microabrasion which has a limited literature of its effect. Furthermore, the effect of remineralizing such as casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) agent on MIH-affected teeth is minimally studied. Aim: Comparative evaluation of the esthetic after microabrasion and microabrasion followed by Tooth Mousse Plus on hypomineralized incisors of MIH-affected patients. Settings and Design: The study was a randomized clinical trial. Materials and Methods: The study comprised Grade I MIH patients in the age strata of 7–16 years having lesions on incisors. As per inclusion criteria, 46 lesions were divided into two groups of microabrasion and microabrasion followed by CPP-amorphous calcium fluoride phosphate (ACFP). Photographs were obtained before treatment, just after treatment, and 6 months after treatment. The photographic evaluation was done using the CIE L*a*b* scoring method. Statistical Analysis Used: ANOVA and posthoc Tukey's test were applied to compare the difference in lightness ΔL and total color change ΔE of these two groups. Results: In microabrasion group, the overall change in ΔL of white tooth discoloration came −0.9 standard deviation (SD) 7.3. In microabrasion followed by CPP-ACFP group, statistically significant difference was found between both these groups with P value of P ≤ 0.001. Conclusions: Microabrasion followed by the remineralizing agent can improve the esthetics of white tooth discoloration with time.
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A clinical and radiographic evaluation of the efficacy of nanohydroxyapatite (Sybograf) versus bioactive calcium phosphosilicate putty (Novabone®) in the treatment of human periodontal infrabony defects: A randomized clinical trial p. 16
Sravani Koduru, Suchetha Aghanashini, Sapna Nadiger, SM Apoorva, Divya Bhat, Bhavana Puvvalla
DOI:10.4103/ccd.ccd_52_18  
Aim: The aim of this study is to compare and to evaluate clinically and radiographically the bone regeneration and the amount of bone fill (BL) between nanocrystalline hydroxyapatite (Nc-HA) (Sybograf™) and bioactive synthetic NovaBone Putty in the treatment of intrabony component of periodontal osseous defects. Materials and Methods: Twenty sites in 20 patients, within the age range of 25–55 years, showing intrabony defects were selected and divided into Group I (Nc-HA) and Group II (Bioactive synthetic NovaBone Putty). All the selected sites were assessed with the clinical and radiographic parameters such as plaque index, gingival index, sulcus bleeding index, probing pocket depth, clinical attachment level, gingival recession, and radiographic BL. All the clinical and radiographic parameter values obtained at different intervals (baseline, 3, and 6 and 9 months) were subjected to statistical analysis. Results: A statistically significant reduction in pocket depth of 4.400 ± 0.843 mm (Group I), 3.800 ± 0.789 mm (Group II) and gain in clinical attachment level of 6.2 mm (Group I), 5.9 mm (Group II) were recorded at the end of the study. A slight increase in gingival recession was observed. The mean percentage changes in the amount of radiographic BL of Group II and Group I were significant, However, when compared between the groups, there is no significant difference in BL observed. Conclusion: Both the graft materials appear to have nearly comparable effects, with nanocrystalline hydroxyapatite (Sybograf™), displaying slightly superior effect over bioactive glass especially in relation to clinical parameters. However, long-term, controlled clinical trials are required to confirm these findings.
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Fluoride and thyroid function in children resident of naturally fluoridated areas consuming different levels of fluoride in drinking water: An observational study p. 24
Naseemoon Shaik, Raghavendra Shanbhog, B Nandlal, HM Tippeswamy
DOI:10.4103/ccd.ccd_108_18  
Background: Literature shows association between systemic fluorides and endocrine disorders especially related to thyroid, with lack of clarity. Aims and Objectives: The aim and objective of this study was to estimate serum triiodothyronine (T3), thyroxin, thyroid-stimulating hormone (TSH), fluoride, calcium, phosphate, and alkaline phosphatase levels among children with normal nutritional status and optimal iodine intake residing in three different ranges of drinking water fluoride levels. Materials and Methods: The present double-blinded, observational trial comprised of 293 children aged between 9 and 13 years consuming naturally fluoridated water of three different ranges: Group I: 0.01–0.6 parts per million (ppm), Group II: 0.7–1.2 ppm, and Group III: 1.3–1.8 ppm. For each child's demographic data, body mass index and Clinical Fluorosis Index were recorded along with serum T3, T4, TSH, fluoride, calcium, phosphate, and serum alkaline phosphatase levels. Data were analyzed using Chi–square test, Kruskal–Wallis test, and repeated measures ANOVA with SPSS 23. Results: For serum TSH levels, 40% of children in Group I had deranged levels followed by Group III (20%) and Group II (16%). For serum T4 levels, 24% of children of both Groups I and III had deranged levels followed by Group II (20%). Intergroup correlation of drinking water fluoride levels to the number of deranged serum T3, T4, and TSH of the children showed nonsignificant association. Serum T3, calcium, phosphate, and alkaline phosphatase levels in all children showed values falling within normal range. Conclusion: According to the present study results, long-term intake of fluoridated drinking water (0.02–1.4 ppm) did not show effect on the thyroid function in children with normal nutritional status and optimal iodine intake.
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Lesion sterilization and tissue repair in nonvital primary teeth: An In vivo study p. 31
Ponnudurai Arangannal, Gomagal Muthiah, J Jeevarathan, P Sankar
DOI:10.4103/ccd.ccd_124_18  
Aim and Objective: The aim of this study is to evaluate the clinical and radiographic success of endodontic treatment of nonvital primary teeth using lesion sterilization and tissue repair (LSTR) therapy. Materials and Methods: A sample size of 40 primary molars from 34 children of 3–10 years of age were selected for the study. Nonvital primary molars were treated using LSTR technique with a combination of antibacterial drugs comprising ciprofloxacin, metronidazole, and doxycycline with propylene glycol as vehicle. The procedure was completed in a single appointment. Only analgesics were prescribed postoperatively. Postoperative evaluation was done after 1, 3, 6, and 12 months. Results: Clinical signs and symptoms got resolved in the 1st-month follow-up itself and continued in the subsequent visits. Radiographic evaluation showed a gradual improvement in success rates through the 12-month follow-up period. Conclusion: LSTR technique can be considered as an alternative treatment option for nonvital primary teeth avoiding a course of systemic antibiotics to the children. Doxycycline can be used in the drug combination instead of minocycline which also gives higher clinical and radiographic success.
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Association between marginal bone loss and bone quality at dental implant sites based on evidence from cone beam computed tomography and periapical radiographs p. 36
Amir Eskandarloo, Reza Arabi, Mohsen Bidgoli, Faezeh Yousefi, Jalal Poorolajal
DOI:10.4103/ccd.ccd_185_18  
Objective: The aim of this study was to assess bone quality in patient's preoperative cone beam computed tomography (CBCT) and their relation with marginal bone loss at implant placement sites over follow-up periods. Materials and Methods: In this retrospective cross-sectional study, 100 implants were evaluated. The implants had been placed in the maxillary and mandibular edentulous areas. Bone quality at implant placement sites was measured on preoperative CBCTs and then classified by two observers according to Lekholm and Zarb classification. Marginal bone height was then measured on periapical radiographs obtained at baseline and then 6, 12, 18, 24, and 30 months' follow-up periods from a reference point (implant shoulder) to the bone-implant interface. The relation between bone quality and bone loss was assessed. ANOVA was used to compare mean difference among groups and Pearson correlation coefficient to assess the correlation between observers. All statistical analyses were performed at 0.05 significance level using Stata 11 software (StataCorp, College Station, TX, USA). Results: Of 100 implants, 48 were placed in the maxilla and 52 in the mandible. There was no significant difference between bone quality and the mean bone loss at follow-up periods. Using Pearson's correlation coefficient, it was shown that with an increase in bone quality, marginal bone loss was decreased at follow-up periods. Conclusions: The results confirmed that during the follow-up periods, less bone loss was observed in implant areas with higher bone quality and CBCT is a reliable tool for assessing bone quality at implant placement sites and estimation of subsequent treatment prognosis.
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Assessment of salivary flow and anxiety in patients rehabilitated with implant-supported prostheses p. 42
Agda Marobo Andreotti, Marcelo Coelho Goiato, Mariana Vilela Sônego, Emily Vivianne Freitas da Silva, Daniela Micheline Dos Santos
DOI:10.4103/ccd.ccd_198_18  
Background: The aim of this study was to verify, through self-assessment questionnaires, the influence of implant-supported prosthesis in salivary flow and anxiety of patients rehabilitated with them. Materials and Methods: Visual analog scale (VAS) questionnaire about xerostomia and State-Trait Anxiety Inventory were applied before (T1) and after 2 days (T2) and 3 weeks (T3) of prostheses installation. The study included patients rehabilitated with implant-supported prostheses containing three or more dental elements. A total of 17 patients were evaluated. Results: In VAS questionnaire, there was a significant increase in the difficulty of speaking and swallowing with dry mouth. The other VAS questions showed no statistically significant difference, indicating no changes in patients' salivary flow. Conclusions: It was concluded that the installation of implant-supported prostheses does not lead to major changes in patients' perception about their salivary flow and psychological state, causing no improvement or worsening in the characteristics evaluated.
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Evaluation of the effect of fluoride-containing luting cements on titanium and its effect on the shear bond strength p. 47
Kondumahanti V N. Avinash, Vahini Reddy, Jayakar Shetty, HC Nitin
DOI:10.4103/ccd.ccd_207_18  
Context: The most appropriate luting agent for titanium crowns is yet to be determined. Commonly used cements for luting titanium restorations give off leachable ions which may cause surface interaction with the titanium. Aims: The purpose of this study was to determine the shear bond strength of four grades of commercially pure titanium and Ti 6Al 4V with different cements and to examine for any surface physical changes. Settings and Design: The three luting cements, i.e., zinc polycarboxylate cement, glass ionomer cement, and zinc phosphate cement, were used to evaluate their effect on titanium. Ni Cr was used as a control. Methods and Material: The metal rods were milled to discs of 6 mm diameter and 4 mm height. Freshly extracted maxillary first molars, mounted in resin blocks, were sliced horizontally at occlusal third of the tooth. The discs were cemented to the sliced surface of the tooth with the three luting cements. The models were subjected to the shear bond strength test. Statistical analysis used: The data collected were analyzed statistically with one way ANOVA. A representative specimen of each group was observed under a scanning electron microscope. Results: The mean values ranged from 0.31 to 15.6 MPa. The shear bond strength values of the zinc polycarboxylate cement group were significantly high (P < 0.05). Corrosion of the titanium alloy luted with zinc polycarboxylate cement was observed. Conclusions: Cementation with zinc polycarboxylate cement provided high shear bond strength, but showed corrosion on titanium.
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A study to evaluate the efficacy of honey in the management of dry socket p. 52
Arsalan Ansari, Sanjay Joshi, Aarti Garad, Bhupendra Mhatre, Saching Bagade, Rushika Jain
DOI:10.4103/ccd.ccd_283_18  
Background: Natural products have been used for several years in folk medicine. Honey was used to treat infected wounds as long ago as 2000 years before bacteria was discovered to be the cause of infection. It has been reported from various clinical studies on the usage of honey as a dressing for infected wounds that the wound become sterile in 3–6 days. Aim: This study aimed to find out the efficiency of naturally occurring honey in alveolar osteitis. Methodology: Fifty patients of dry socket were selected from the outpatient department of oral and maxillofacial surgery. A diagnosis of dry socket was made clinically. Honey was used as a dry socket dressing in all these patients. Parameters such as mucosal edges, pain, and formation of granulation tissue were assessed in the postoperative period for a week. Statistical Analysis Used: Analysis was done by paired t-test method using SPSS software version 17. Results: In this study, there was a significant reduction in inflammation, hyperemia, and mucosal edges that resulted in the reduction of pain and discomfort to the patient. There was no side effect of honey observed in our study, so it can be used as an alternative for the management of dry socket. Change in distance between mucosal edges when compared from the day of clinical presentation to 5th day postplacement was statistically significant (P < 0.001). Conclusions: There are no side effects of honey. Excess use of eugenol can lead to necrosis of bone. Thus, honey can be used as a medicament for the management of dry socket.
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Comparative evaluation of the masking ability of lithium disilicate ceramic with different core thickness on the shade match of indirect restorations over metallic substrate: An In vitro study p. 56
Priyadarshini Thilagar, Jayakrishnakumar Sampathkumar, Chitra Shankar Krishnan, Hariharan Ramakrishnan, Hariharan Ramasubramanian, NS Azhagarasan
DOI:10.4103/ccd.ccd_301_18  
Purpose: The purpose of this in vitro study was to comparatively evaluate the masking ability of lithium disilicate ceramic with different core thickness on the shade match of indirect restorations over metallic substrate. Materials and Methods: A total of 30 heat pressed lithium disilicate ceramic discs of low translucency were fabricated with diameter 10mm and thickness of 1 mm, 1.3 mm and 1.6mm with each thickness consisting of 10 samples to be used in the study. Thirty Ni-Cr metal discs of diameter 10mm were used to simulate metallic substrates .The colour difference of the lithium disilicate ceramic disc before and after cementation were measured using CIE LAB system. Results: The mean colour difference (ΔE) of Group I,Group II, Group III before cementation with the Ni-Cr metal discs was 17.32,13.01 and 11.73 respectively. The mean colour difference (ΔE) of Group I,Group II, Group III after cementation with the Ni-Cr metal discs was 16.32,12.10, 11.05 respectively. Conclusion: The mean colour difference of the three groups were found to be more than the clinically acceptable perceptibility threshold (ΔE < 3.3) indicative of reduced masking ability of all the three groups of ceramic discs over metallic substrate used in this study.
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Dentinal adaptation of warm thermoplastic obturating material and cold thermoplastic obturating material: An In vitro study p. 64
Swadhin Raghuwanshi, Pradeep Jain, Pallav Mahesh Patni, Sanket Hans Pandey, Hemalatha Hiremath, Shabdika Baghel
DOI:10.4103/ccd.ccd_312_18  
Introduction: The objective of endodontic obturation is to provide a complete seal along the length of the root canal system, thereby ensuring the healing and sustained health of the periradicular tissue. Root canal obturation involves the three-dimensional filling of the entire root canal system and is a critical step in endodontic therapy. Gutta-percha has universally been accepted as the gold standard for root canal filling materials. However, it lacks bonding to the internal tooth structure resulting in the absence of complete seal. Aim: The aim of the present study is to compare the dentinal adaptation of warm thermoplastic obturating material and cold thermoplastic obturating materials. Materials and Methods: Thirty single-rooted, anterior noncarious human teeth extracted for periodontal or orthodontic reasons were used for the study. The samples were stored in distilled water until obturation. The specimens were then randomly divided into three groups of ten specimens each: Control group – Cold lateral condensation with AH Plus, Group I – Endosure with AH Plus®, and Group II – GuttaFlow® 2 with master cone. The obturation for each group was done following manufacturer's instructions. Under On-demand software, the area of voids at the level of 3 mm, 5 mm, and 8 mm from the apex was observed for all the samples. The obtained results were submitted for statistical analysis. Results: The result in the present study showed that Endosure provides a better consistent seal as compared to cold lateral condensation, or GuttaFlow 2 techniques. Conclusion: Mean void value was maximum for GuttaFlow 2 group, followed by cold lateral condensation, Endosure. Though there was a difference in the mean void values, it was not statistically significant except between Endosure and GuttaFlow 2. The result in the present study showed that Endosure provides a better seal as compared to cold lateral compaction, GuttaFlow 2 or Endosure technique.
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Mandible: An indicator for sex determination – A three-dimensional cone-beam computed tomography study p. 69
Anas Salem Albalawi, Mohammad Khursheed Alam, Sudhakar Vundavalli, Kiran Kumar Ganji, Santosh Patil
DOI:10.4103/ccd.ccd_313_18  
Background: Mandible is considered as one of the stronger bones of skull available for gender identification. Mandibular measurements can be used for the identification of gender either on dry mandible or through panoramic radiography or cone-beam computed tomography (CBCT). Aim: To determine the gender from mandibular measurement using CBCT. Materials and Methods: The Morphometric analysis was performed on 200 CBCT scans of the subjects using OnDemand 3D software (Seoul, Korea). Morphometry of mandibular is measured by estimation of the angles formed at different locations on mandible to predict the gender. Statistical analysis was performed; independent samples “t-” test was used to compare the mean values between males and females. Discriminant function analysis was used for gender prediction. Results: The subject's age ranged from 18 to 60 years with an equal number of males and females. The mean angle formed by the intersection of lines from the left and right gonion to menton in males was 129.9 ± 11.9 and it was 126.7 ± 12.6 in females. The mean linear distances from the right gonion to menton in both males and females were 86.8 ± 5.3 and 82.6 ± 6.2, respectively. The mean linear distances from the left gonion to menton were 49.5 ± 5.1 in males and 47.7 ± 3.9 in females. The mean linear distance from the right gonion to left gonion was 47.7 ± 4.4 in males and 46.6 ± 4.2 in females. The Box's M statistics was applied to verify the applicability of mandibular measurements in gender prediction. The values indicate that gender can be predicted using these four variables, which is statistically significant (P = 0.000). The overall prediction accuracy of this model was 67%, with 66.7% in males and 67.3% in females being correctly classified. Conclusion: The angle formed by the intersection of lines from the left and right gonion to menton (Gn-M0) helps provide anthropological data, which can be used in dental and medicolegal practices.
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Assessment of salivary flow rate and antioxidant levels in ectodermal dysplasia patients: An In vivo study p. 74
Aravind Mohanan, Balagopal R Varma, Suresh Kumar, Parvathy Kumaran, Arun Mamachan Xavier
DOI:10.4103/ccd.ccd_358_18  
Aims: To assess the salivary flow rate levels and total antioxidant levels in ectodermal dysplasia (ED) patients and to compare with normal individuals. Materials and Methods: Unstimulated saliva sample of control and case were collected from the mouth to a pre-weighed Eppendorf tube using a Pasteur pipette for 4 min. Stimulated saliva of case and control was also collected after chewing paraffin wax for 30 s. Both the Eppendorf tubes were weighed again after collection of both the saliva samples. The flow rate was calculated as difference of weight of the tube divided by time (4 min). Both unstimulated and stimulated saliva was also separately collected for estimation for total antioxidant levels. Statistical analysis: For intergroup comparison, Mann–Whitney test was used, and for intragroup comparison, Wilcoxon signed-rank test was used. Results: In the intergroup comparison of both the salivary flow rate and total antioxidant levels, there was no statistically significant difference; however, there was statistically significant difference in the intragroup comparison of salivary flow rate and total antioxidant levels in case group. Conclusions: There was a diminished unstimulated salivary flow rate in ED group, but stimulated salivary flow rate was significantly high and the total antioxidant levels in unstimulated saliva of the case group were significantly higher than the stimulated antioxidant levels.
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Comparative evaluation of efficacy of green tea mouth rinse and green tea gel on the salivary streptococcus mutans and Lactobacillus colony count in 12–18-year-old teenagers: A randomized clinical trial p. 81
Maryam Haji Ahmadi, Leila Sarrami, Afsaaneh Yegdaneh, Alireza Homayoni, Zohreh Bakhtiyari, Nasrin Danaeifar, Najmeh Akhlaghi
DOI:10.4103/ccd.ccd_368_18  
Aims: Green tea is an antibacterial agent with no significant side effect. This feature makes green tea safe for children to use. The purpose of this study was to compare the effectiveness of green tea gel and mouth rinse on salivary level of Streptococcus mutans and Lactobacillus of teenagers aged 12–18 years. Subjects and Methods: In this randomized controlled clinical trial study, 30 children aged 12–18 years were included in the study according to the inclusion criteria and were randomly divided into two groups. Participants in mouth rinse group were asked to rinse their mouth with 0.5% green tea mouthwash twice a day for 2 weeks. In the gel group, participants were requested to brush their teeth with 0.5% green tea gel twice a day for 2 weeks. After 4 weeks of washout period, mouthwash group applied the gel and the gel group rinsed the mouthwash for 2 weeks and with the same instruction as mentioned. Colony count of S. mutans and Lactobacillus was determined before and after intervention and data were analyzed using t- test. Results: According to the independent t- test, there was no significant difference in the salivary levels of S. mutans before and after intervention regarding age and gender (P = 0.33). Results from paired t-test showed significant decrease in the mean count of S. mutans and Lactobacillus colonies in both groups before and after intervention (P < 0.001). Conclusions: Green tea gel and mouthwash contribute to a significant reduction of salivary levels of S. mutans and Lactobacillus colonies, with a greater effect of mouthwash than the green tea gel, which was not statistically significant.
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Momentousness of the mental loop: A comparative study p. 86
Ramya Katyayani Kastala, Chaya Manoranjini David, Namitha Jayapal
DOI:10.4103/ccd.ccd_391_18  
Background and Purpose: To assess the anterior (aAL) and caudal (cAL) extensions of Anterior loop (AL) of Inferior alveolar nerve (IAN) using Digital Panoramic (DP) and Cone Beam Computed Tomography (CBCT) for its presence and dimensions in various age groups, genders, right and left sides of the mandible and between dentulous and edentulous patients. Methods: A 1-year retrospective comparative study between DP and CBCT to assess the extensions of AL of IAN was conducted on individuals referred to a private imaging center located in Bengaluru, South India. 360 mandibular sites were examined using DP and CBCT to assess the presence and dimensions of AL. Results: Results showed higher frequency of AL in CBCT compared to DP. Also there was a decreasing frequency of AL with increasing age and an insignificant difference in frequency between males and females. Bilateral looping was most common, aAL was more frequent on the left side and cAL on the right of the mandible. Statistically higher frequency in dentate group compared to edentulous. A decreasing mean value with increasing age and higher mean values in CBCT than DP. No significant difference in mean values among males and females or between the dentulous and edentulous groups. Higher mean values in CBCT compared to DP on the left side of the mandible compared to the right. Conclusion: Choosing mental foramen as reference for termination of IAN could result in injury to AL; low sensitivity and specificity of DP compared to CBCT in assessing frequency and extent of AL underlines its inadequacy, while CBCT can be performed with comparable resolution, to accurately analyze AL.
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Comparison of conventional techniques and higher imaging modalities in the evaluation of relation between the third molar and inferior alveolar nerve canal: A pilot study p. 93
Vathsala Patil, Keerthilatha M Pai, R Vineetha, KV Rajagopal, Winniecia Dkhar
DOI:10.4103/ccd.ccd_430_18  
Context: Mandibular third molars are the most commonly impacted teeth, and their surgical removal can be associated with inferior alveolar nerve (IAN) injury. To avoid the deleterious complication of nerve injury on patients, a thorough visualization of IAN and its localization are essential. Aims and Objectives: The aims and objectives of this study were to evaluate the efficacy of two conventional localization techniques in determining the relationship of mandibular third molars to IAN and to assess its reliability in comparison with computed tomography (CT). Settings and Design: Panoramic radiograph (PR) was taken using Kodak 8000C Digital Panoramic and Cephalometric system. Intraoral periapical radiographs (IOPAs) were taken using Kodak 2200 Intraoral X-ray machine. CT scan images were taken using multidetector CT scans. Materials and Methods: Two IOPAs (0° and −20° vertical angulation) and PR and CT scan images of thirty mandibular third molars were taken. Two combinations were used (i) a combination of two IOPAs and (ii) a combination of PR and IOPA (−20°). Tube-shift localization technique was applied to both these combinations to derive the relation between third molar and IAN canal as “in contact,” “separate,” “buccal,” “lingual,” and “in line with the apex” and the results were compared with CT images. Statistical Analysis: Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using SPSS software version 15.0. Results: The combination of PR and IOPA radiographs showed 14 teeth to be in contact with IAN. This gave a sensitivity of 100%, specificity of 94.1%, PPV of 92.9%, and a NPV of 100% in determining the relation as “in contact” or “separate.” 78.3%, 85.7%, 94.7%, and 54.5% were the sensitivity, specificity, PPV, and NPV in localizing it as “buccal,” “lingual,” or “in line with apex.” These results were better than that of the combination of the two IOPAs. Conclusions: Localization using PR and IOPA could better deduce the relation between IAN and mandibular third molar.
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Prevalence of community-associated methicillin-resistant Staphylococcus aureus in oral and nasal cavities of 4 to 13-year-old rural school children: A cross-sectional study p. 99
Anil Kumar Patil, Srinivas Namineni, Sampath Reddy Cheruku, Chandana Penmetsa, Sarada Penmetcha, Sreekanth Kumar Mallineni
DOI:10.4103/ccd.ccd_452_18  
Aim: This study aimed to investigate the oral and nasal prevalence of community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA) in 4 to 13-year-old rural schoolchildren. Materials and Methods: A total of 100 children aged 4 to 13 years were randomly selected and divided into ten groups based on their age (Group 1 = 4-year-old children to Group 10 = 13-year-old children). From each participating child, sampling was done from the anterior nares and dorsum of the tongue. All samples were inoculated into Baird–Parker agar medium and HiCrome™ MeReSa agar medium for the isolation of SA and MRSA. Both the culture plates were checked for the presence of SA and MRSA and overall SA and MRSA carriage. The distribution of SA and MRSA was evaluated. Descriptive statistics were performed using SPSS software (version 17.0). Results: Overall SA in 4–13 years' age group was 47%, while CA-MRSA was 35%. On the tongue, 16 children had concomitant MRSA and SA, while only 23.8% (n = 20) of the children comprised the presence of SA when MRSA was absent (P < 0.001). In the nasal cavity, 30 children had concomitant MRSA and SA, while only 21.4% (n = 15) of the children had the presence of SA when MRSA was absent (P < 0.001). When tongue and nose were assessed, 11 children encompassed concomitant MRSA and SA, while only 16.9% (n = 13) of the children had the presence of SA when MRSA was absent in both sites (P < 0.001). Conclusion: A significant relation was found between nasal SA and CA-MRSA carriage, with oral SA and CA-MRSA carriage. The study concludes that oral cavity is possibly as important as the nasal area as a zone of SA and MRSA. Dentists dealing with pediatric population should take proper precautions to prevent cross contamination of SA and MRSA in the dental clinic.
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Prediction formula of permanent canine and premolar eruption in mixed dentition patients at Universitas Airlangga, Dental Hospital Surabaya, Indonesia p. 105
Irwadi Djaharu'ddin
DOI:10.4103/ccd.ccd_464_18  
Background: The eruption of permanent canine, first and second premolars need to be predicted because they are erupted last, before the eruption of permanent first and second molars, in order to estimate the available space in orthodontic treatment. Aim: This study aimed to predict the eruption of permanent canine, first and second premolars in mixed dentition. Materials and Methods: A cross sectional clinical observation was conducted in 21 subjects of 13 males nad 8 females with the age range of 8-12 years old. Their panoramic radiographs were used to create a prediction formula of permanent canine and premolars. The independent variables of this research are age, weight, height, birth weight, birth height, period of breastfeeding, and vertical distance of eruption. Data were analyzed by coefficient of multiple correlation followed by multiple linear regression analysis. Results: The prediction formula is as follows: Y = −5107 + 1645 X1+ 078 X2, where Y is the time of eruption, X1is the height, and X2is the vertical distance of eruption. Conclusion: The prediction formula is useful for serial extraction in orthodontic treatment. It is also useful for forensic odontology, especially in the determination or identification of ages. It is recommended to be implemented in the science of development, especially in orthodontics and forensic odontology.
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The combined effect of bioactive glass and platelet-rich fibrin in treating human periodontal intrabony defects – A clinicoradiographic study p. 110
Deepshika Saravanan, Saravanan Rethinam, Kavitha Muthu, Ambika Thangapandian
DOI:10.4103/ccd.ccd_507_18  
Background: Platelets are richest source for cytokine and growth factors which are two important components for the re-establishment of bone and maturation of the soft tissue. Aims and Objective: The additive effect of PRF along with a synthetic bone graft material in treating human intrabony periodontal defects has been evaluated in this study. The appropriate use of platelet-rich fibrin (PRF) as an alternate comfortable graft material to restore the lost periodontal tissues has been well documented and has given clinically promising outcome. Materials and Method: Platelet-rich fibrin (PRF) is prepared from patient's own blood which is autologous in nature. Perio Glas (PG) is an easy to use synthetic absorbable osteostimulative as well as osteoconductive bone graft material. The selected 30 sites were randomly divided into two groups such as Test (15 sites using PRF) and Control (15 sites without PRF). Results: At the end of Six months, the post-operative evaluations revealed significant reduction in PPD and gain in CAL. Radiographic evidence of bone formation was also noticed. The incorporation of PRF with synthetic bone graft (perioglas) produces effective and rapid periodontal regeneration with improved healing in intrabony osseous defects. The PRF group showed a mean Radiographic Defect Fill (RDL) of 1.24 ± 0.04 compared with 0.79 ± 0.07 of control group which is statistically significant. Conclusion: This combination technique can be used as an alternate grafting modality for the treatment of intrabony periodontal defects with satisfactory clinical consequences.
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Persica chewing gum effects on saliva fluoride concentration and flow rate: A triple-blind randomized clinical trial p. 117
Shiva Mortazavi, Abolfazl Aslani, Mehrnoush Babaee, Maryam Hajiahmadi
DOI:10.4103/ccd.ccd_509_18  
Context: Dental caries is a prevalent disease worldwide. Salvadora persica or Miswak could be a source of fluoride and has caries preventive effects. Aims: The aim of this study was to compare saliva fluoride concentration and flow rate after using Persica and sodium fluoride chewing gums. Settings and Design: In a triple-blind crossover randomized trial, 44 healthy volunteers (21–25 year old) were recruited according to the inclusion criteria and were randomly allocated into two groups (22 each). Participants and Methods: This study was performed within two sets of trial with a 10-day washout period. Participants (subjects) were followed a running period and matched for trial confounders. Saliva samples were collected under controlled conditions at similar time (11 am) within baseline, 5, 10, 20, and 45 min intervals preceded by 5-min chewing of Persica or sodium fluoride chewing gum. Saliva samples were analyzed for fluoride ion using hexamethyldisiloxane diffusion method. Statistical Analysis Used: Saliva flow rate (ml/min) and mean fluoride concentration (ppm) during different time periods in two types of gum were compared using ANOVA-repeated measures (P < 0.05). Results: The difference in total means of stimulated saliva flow rates between two Persica and sodium fluoride gum intervention groups was statistically significant (P = 0.048); however, difference of fluoride concentrations was not statistically significant (P = 0.244). Conclusions: Chewing Persica containing gum released fluoride ions in saliva and increased saliva flow rate comparable with sodium fluoride chewing gum use as a gold standard.
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Indonesian mangosteen fruit (Garcinia mangostana L.) peel extract inhibits Streptococcus mutans and Porphyromonas gingivalis in Biofilms In vitro p. 123
Armelia Sari Widyarman, Sammy H Lay, Izharie Putri Wendhita, Eugene E Tjakra, Felix Indrawan Murdono, Ciptadhi Tri Oka Binartha
DOI:10.4103/ccd.ccd_758_18  
Background: Streptococcus mutans and Porphyromonas gingivalis are caries and periodontal disease-related bacteria. The mangosteen fruit (Garcinia mangostana L.) peel contains flavonoids, tannins, saponins, and xanthones that have antibacterial properties. Aims: The aim of this study is to analyze mangosteen peel extracts' ability to inhibit S. mutans and P. gingivalis has biofilms growth in vitro. Materials and Methods: Mangosteen peel extract effects on the S. mutans ATCC-3198 and P. gingivalis ATCC-3327 in biofilms growth were evaluated by a crystal violet biofilm assay. Each bacterium was inoculated into a brain–heart infusion broth for 24 h at 37°C anaerobic conditions. A volume of 200 μL (107 colony-forming unit/mL) of bacterial suspension were distributed in microplate wells and incubated for 24 h. Mangosteen peel extracts with different concentrations were added into biofilm wells. Biofilm without treatment was used as negative control. Biofilm mass was calculated by 0.5% crystal violet staining, and optical density was measured at 600 nm using microplate reader. All obtained data were statistically analyzed using one-way analysis of variance test with P < 0.05 set as the level of significance. Results: The results showed that mangosteen peel extract could inhibit the growth of S. mutans and P. gingivalis in biofilms significantly compared to the negative control (P < 0.05). The most effective concentration and incubation time for inhibiting biofilm growth was 100% in 6 h for S. mutans and 100% in 24 h for P. gingivalis. Conclusion: Mangosteen peel extract is effective at inhibiting S. mutans and P. gingivalis biofilms, and this antibiofilm agent can be an alternative therapy in preventing caries and periodontal disease. Future studies are needed to explore this effect.
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SYSTEMATIC REVIEWS Top

Adhesion in dentin prepared with Er,Cr:YSGG laser: Systematic review Highly accessed article p. 129
Ana Catarina Silva, Paulo Melo, João Cardoso Ferreira, Teresa Oliveira, Norbert Gutknecht
DOI:10.4103/ccd.ccd_302_18  
Background: In dentistry, cavities prepared with Erbium lasers present more advantages, compared to traditional methods, but there is still a lack of investigation about the adhesion in dentin surfaces prepared with Erbium lasers, especially with Erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser. Aim: The purpose of this systematic review was to find out which might be “The most adequate adhesive and laser parameters for adhesion in dentin prepared with Er,Cr:YSGG laser.” Methods: An electronic search was performed in the PubMed database. The search was limited to studies between 2009 and 2016. Results: Ten articles were selected to the systematic review according to TRANSPARENT REPORTING of Systematic Reviews and Meta-ANALYSES checklist. Conclusions: The adhesive that showed the best bond strength results in dentin prepared with Er,Cr:YSGG laser was the self-adhesive Clearfil™ SE (Kuraray), with preconditioning with 40% phosphoric acid. The settings 2 W, 75% water, 60% air, 140 μs pulse duration, and 20 Hz showed the best adhesion outcome.
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Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: A Systematic review of in vitro studies p. 135
Margi Parikh, Karkala Venkappa Kishan, Nidhi P Solanki, Maitry Parikh, Krushn Savaliya, Vinukonda Hima Bindu, T Das Devika
DOI:10.4103/ccd.ccd_335_18  
Introduction: The aim of this systematic review was to systematically evaluate and summarize the outcomes of in vitro studies comparing Endoactivator irrigation and Endovac irrigation techniques for removing calcium hydroxide (Ca[OH]2) medicament from the root canals. Materials and Methods: The research question was developed according to the population, intervention, comparison, and outcome strategy. A computerized literature search was conducted in Medline, PubMed, Google Scholar, and Embase. A hand search of the reference lists of identified articles was performed to separate relevant articles. Two reviewers critically assessed the studies that fulfilled the inclusion criteria and processed. Evaluation of the risk of bias of the studies was performed independently by the two reviewers. Results: After study selection, 61 were assessed for eligibility. Of these, 13 met the inclusion criteria and were included in the systematic review. Since significant heterogeneity was found in the methodologies, it was not possible to conduct a meta-analysis. Conclusions: On the basis of available evidence, we determined that Endoactivator irrigation technique showed better performance in removing Ca(OH)2intracanal medicaments from middle third and coronal third area of the root canals and Endovac irrigation technique showed better performance from the apical third area of the root canals. Due to the limitations, small sample sizes, and low number of included studies, further research is needed to confirm our results.
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CASE REPORTS Top

Management of dentoalveolar trauma in a 3-year-old child with Glanzmann's Thrombasthenia, a rare bleeding disorder: Case report and review p. 143
Rakesh N Bahadure, Vijaya Dhote, Kulsum Iqbal Sayed, Sandeep Bailwad, Poornima Kodate
DOI:10.4103/ccd.ccd_137_18  
Glanzmann's thrombasthenia (GT) is a rare inherited bleeding disorder characterized by disturbed ability of the blood platelets to gather around the site of a broken blood vessel and fail to form a plug to stop bleeding due to deficiency of a glycoprotein IIb/IIIa in the process of blood clotting and results in moderate-to-severe bleeding on slightest injury to blood vessels. It is typically diagnosed in infancy or early childhood due to mucocutaneous bleeding tendencies. Treatment goals in GT are aimed at control of bleeding. Dentoalveolar trauma in patient with bleeding disorder poses a challenge in pediatric dentistry. The present article reports the successful management of subluxation dental injury in a 3-year-old child with “Glanzmann's thrombasthenia associated with sickle cell anemia.” A narrative review of GT is given highlighting the importance of preventive dentistry and anticipatory guidance to reduce potential complications in such patients.
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Hybrid ameloblastoma of anterior maxilla: A rare and puzzling pathologic entity – Case report with systematic review p. 147
Shalu Rai, Deepankar Misra, Mukul Prabhat, Ankit Jain, Prerna Jain
DOI:10.4103/ccd.ccd_341_18  
Hybrid ameloblastoma has a variable clinical, radiological, and histopathological presentation. They contain two or more different histologic types and their biologic comportment is still arguable. We herein present a case of a hybrid variant of desmoplastic ameloblastoma which is the first of its kind to have ever been reported due to its unusual location in the maxillary anterior region, along with systematic review of clinicopathologic features of reported cases immunohistochemical markers may act as an adjunct in the accurate diagnosis of these lesions.
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Langerhans cell histiocytosis in an adult with oral cavity involvement: Posing a diagnostic challenge p. 154
Richa Nangalia, Rudra Prasad Chatterjee, Sanchita Kundu, Mousumi Pal
DOI:10.4103/ccd.ccd_432_18  
Langerhans cell histiocytosis (LCH) is a rare hematological disorder characterized by local or generalized, uncontrolled proliferation and infiltration of Langerhans type of histiocytic cells. It represents a spectrum of clinicopathologic disorders, ranging from a highly aggressive and frequently fatal multisystem disease to an easily cured solitary lesion of bone. Involvement of children and the younger age group is more common than the adults. Oral cavity involvement occurs early in LCH, but the initial symptoms are generally nonspecific, often causing misdiagnosis. This report describes a rare case of chronic localized LCH in an adult patient, with involvement of oral cavity. A 34-year-old male patient presented with multiple nodulo-papular, ulcerated lesions in gingiva involving both the jaws (primarily mandible) and the left buccal mucosa, in addition to regional teeth mobility. The most striking feature was that even after extraction of mobile teeth, the lesions persisted. After recording proper history, performing clinical and radiological evaluation, an incisional biopsy was performed followed by histopathology and immunohistochemistry to reach a confirmatory diagnosis of LCH, thereby implementing early and appropriate initiation of treatment.
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Miniscrew implants for intrusion of supraerupted molar: A noninvasive approach for space regaining p. 158
Adrita Purkayastha, Rinkee Mohanty, Sourav Panda, Utkalika Das
DOI:10.4103/ccd.ccd_444_18  
Inadequate interocclusal space often leads to difficulty in prosthetic rehabilitation. Dental implant-indicated sites are governed by various factors which include bone availability, adequate mesiodistal width, and most importantly, adequate interocclusal space for proper prosthetic design on the dental implant. The use of miniscrew implant with coil spring for regaining interocclusal space would be an advantageous procedure for biomechanical intrusion of supraerupted teeth, rather than treating the same with invasive clinical crown reduction/intentional endodontic treatment. This case report describes the use of miniscrew implant with coiled spring on a supraerupted maxillary molar for interocclusal space regaining, to facilitate proper prosthetic rehabilitation in the dental implant site.
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Multiple complex odontomas of the mandible: A rare case report and literature review p. 161
João Botelho, Vanessa Machado, João Carvalho Gomes, Gonçalo Borrecho, Paulo Maia, José João Mendes, Francisco Salvado
DOI:10.4103/ccd.ccd_463_18  
A 53-year-old female appeared with pain in the right mandible ramus, for the past 9 months, after tooth extraction. Clinical and radiological examination using conventional and advanced computerized tomography diagnostic imaging led to a provisional diagnosis of multiple complex odontomas. Complete conservative excision of the lesion was performed. The clinical diagnosis was confirmed histopathologically. Postoperative period was uneventful with no evidence of recurrence. According to an extensive literature review, this report describes the oldest patient ever diagnosed with multiple odontomas in the literature.
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Solitary bone cyst of posterior maxilla: A rare presentation p. 166
Sneha P Patil, Sonia J Sodhi, Sunil S Mishra, Syeda Shadab Farha
DOI:10.4103/ccd.ccd_470_18  
Solitary bone cyst (SBC) is an uncommon, nonneoplastic osseous lesion that mainly affects metaphysis of long bones and rarely presents in jaws. Due to the lack of true epithelial lining, it is considered as a pseudocyst. It is generally asymptomatic and often discovered incidentally during routine radiographic examination as well-defined unilocular or multilocular radiolucent lesion in the posterior mandible mainly in the first two decades of life. Here, we report a very rare case of a 15-year-old female patient having a lesion in the posterior maxilla with clinical, radiological, and histopathological presentations of SBC.
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Segmental osteotomy, implants, and restorative procedures for the treatment of an extruded maxillary alveolar segment p. 170
Sanket Gavhane, Godwin Clovis Da Costa, Paul Chalakkal, Neil De Souza
DOI:10.4103/ccd.ccd_487_18  
This case report highlights a case of full-mouth rehabilitation in a 38-year-old female. Extrusion of the right posterior maxillary alveolar segment had resulted due to the presence of an opposing edentulous mandibular span, which had led to complete absence of restorative space in the lower arch. Maxillary posterior segmental osteotomy was carried out to obtain adequate space for placing an implant-supported prosthesis in the opposing edentulous mandibular span. The procedures before the surgery consisted of articulation of the diagnostic casts on to a semi-adjustable Hanau™ Wide-Vue articulator and a mock surgery on the upper cast to assess the amount of segmental osteotomy necessary to accommodate an implant-supported prosthesis in the lower edentulous region. Other procedures included implant placements, root canal treatment, post and core build-up, and full-crown placement on various teeth.
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Oral manifestations of Nance–Horan syndrome: A report of a rare case p. 174
Neil De Souza, Paul Chalakkal, Sergio Martires, Renita Soares
DOI:10.4103/ccd.ccd_490_18  
Nance–Horan syndrome (NHS) or X-linked cataract dental syndrome is an extremely rare condition affecting multiple systems. It is characterized by ophthalmological, dental, and facial anomalies. Individuals display facial dysmorphism, mandibular prognathism, congenital cataract, and strabismus. Common dental findings include notching of incisors, supernumerary teeth, and mulberry molars. This article aims to provide an update on NHS while reporting previously unreported findings such as talon's cusp and taurodontism.
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Recurrence of plexiform ameloblastoma as acanthomatous ameloblastoma: A rare case report p. 178
Sanat Kumar Bhuyan, Ruchi Bhuyan, Tapan Kumar Sahoo, Pinali Das
DOI:10.4103/ccd.ccd_505_18  
Ameloblastoma is an uncommon locally invasive benign odontogenic tumor arising from the odontogenic epithelium. It is a slow-growing tumor with locally aggressive nature, and posterior mandible is the most common location. The recurrence rate is high even after en bloc resection. Acanthomatous ameloblastoma is one of the rare variants of ameloblastoma and is usually seen in older age group. Here, we present a case of acanthomatous ameloblastoma in a 46-year-old female who previously diagnosed and treated for a case of plexiform ameloblastoma 17 years back. This is the first case to be reported among ameloblastoma with different histopathological variants at recurrence.
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