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   Table of Contents - Current issue
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April-June 2017
Volume 8 | Issue 2
Page Nos. 191-339

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EDITORIAL  

Smart sugar? The sugar conspiracy Highly accessed article p. 191
SG Damle
DOI:10.4103/ccd.ccd_568_17  
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GUEST EDITORIAL Top

Digital imaging in dentistry: A review Highly accessed article p. 193
Sadaksharam Jayachandran
DOI:10.4103/ccd.ccd_535_17  
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ORIGINAL ARTICLES Top

Comparative evaluation of effectiveness of three desensitizing tooth pastes for relief in the dentinal hypersensitivity p. 195
Disha Bansal, Mrinalini Mahajan
DOI:10.4103/ccd.ccd_135_17  
Context: Dentinal hypersensitivity is a sharp pain occurring on exposure of the exposed dentin to various stimuli such as hot, cold, air, tactile, and chemical. Aim: This study aimed to compare the effectiveness of three desensitizing pastes in the treatment of dentinal hypersensitivity. Materials and Methods: A total of 45 individuals (with two teeth per patient) were considered for this study and randomly divided into three groups, Group 1: treated with 5% NovaMin-containing toothpaste, Group 2: treated with 8% arginine-containing toothpaste, and Group 3: herbal desensitizing toothpaste. Using tactile stimulus and air stimulus, the sensitivity scores were recorded on visual analog scale (VAS), immediately after paste application, then at 2 weeks, and then at the end of 4 weeks and compared. Results: There was a significant change in the VAS scores in Group 1 when compared to Group 2 and Group 3. Group 1 showed better reduction in the hypersensitivity in long term. Statistical Analysis: One-way ANOVA test, post hoc Tukey test, and post hoc Bonferroni test were used for statistical analysis. Conclusion: Desensitizing pastes can be an effective and economical option in the treatment of the dentinal hypersensitivity.
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Evaluation of oral pentoxifylline in the management of oral submucous fibrosis – An ultrasonographic study p. 200
Jayachandran Sadaksharam, Sureshkumar Mahalingam
DOI:10.4103/ccd.ccd_1192_16  
Aim and Objective: To evaluate the therapeutic efficacy of oral pentoxifylline in the treatment of oral submucous fibrosis (OSMF) patients by assessing the clinical symptoms such as burning sensation, mouth opening, and submucosal layer thickness and echogenicity using ultrasonography, both pre- and post-operatively. Materials and Methods: Thirty study subjects were included in the study and divided into two groups in single-blind randomized manner, oral pentoxifylline and dexamethasone group. Burning sensation, mouth opening, ultrasonographic submucosal thickness, and echogenicity were recorded both pre- and post-operatively. Any adverse effects reported by the patients were also noted. The data collected were statistically analyzed, and response to pentoxifylline and intralesional dexamethasone with hyaluronidase was observed using ultrasonography. Results: A highly significant reduction (P < 0.001) in burning sensation, improvement in mouth opening, and changes in submucosal thickness were noticed in both groups, and significant improvement (P < 0.05) in echogenicity in both the groups was noticed. However, pentoxifylline group showed marginally better improvement than dexamethasone group. Conclusion: Pentoxifylline can bring about significant improvement in OSMF, which can be used as better alternative where intralesional steroid was contraindicated or not well tolerated.
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Comparative evaluation of the efficacy of platelet-rich fibrin and calcium phosphosilicate putty alone and in combination in the treatment of intrabony defects: A randomized clinical and radiographic study p. 205
Isha Agrawal, Sarath Chandran, Priyadarshini Nadig
DOI:10.4103/ccd.ccd_1147_16  
Background: Combination of platelet-rich fibrin (PRF) and bone substitutes for the treatment of intrabony pockets is based on sound biologic rationale. The present study aimed to explore the clinical and radiographic effectiveness of autologous PRF and calcium phosphosilicate (CPS) putty alone and in combination in treatment of intrabony defects. Materials and Methods: A total of 45 intrabony defects were selected and randomly divided into three groups. In Group I, mucoperiosteal flap elevation followed by placement of PRF was done. In Group II, mucoperiosteal flap elevation followed by placement of CPS putty was done. In Group III, mucoperiosteal flap elevation followed by placement of PRF and CPS putty was done. Clinical parameters such as gingival index (GI), pocket depth (PD), clinical attachment level (CAL), gingival marginal position and radiographic parameters such as bone fill, changes in crestal bone level, and defect depth resolution were recorded at baseline and after 6 months postoperatively. Results: Statistically significant changes in GI, PD reduction, CAL gain, defect fill, and defect depth resolution from baseline to 6 months were seen in all the three groups (P < 0.05). On intergroup comparison, no statistically significant changes were seen in all clinical parameters. However, the difference in defect fill and defect depth resolution between the Groups I and III and Group II and III was significant. Conclusion: Within limitations of study, combination of PRF and CPS putty showed a significant improvement in PD reduction, CAL gain, and bone fill.
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Comparative alveolar ridge preservation using allogenous tooth graft versus free-dried bone allograft: A randomized, controlled, prospective, clinical pilot study p. 211
Chaitanya Pradeep Joshi, Cynthia Bernardo D'Lima, Urmila Chandrashekhar Samat, Prerna Ashok Karde, Agraja Ganpat Patil, Nitin Hemchandra Dani
DOI:10.4103/ccd.ccd_147_17  
Background: For the first time in India, allografts from human extracted teeth were prepared. A randomized, prospective, clinicoradiographical, histological study was conducted to evaluate their efficacy in comparison with freeze-dried bone allograft (FDBA) in alveolar ridge preservation. Materials and Methods: Graft preparation: with written consent, teeth were collected from three donors (full mouth extraction cases). Once donors' serums were tested negative for HIV, HBV, HCV, and Venereal disease research laboratory (VDRL), mineralized whole tooth allograft (WTA) and dentin allograft (DA) were prepared using the standard protocol of Tissue Bank at Tata Memorial Hospital, Mumbai, India. Study Design: In this randomized controlled trial, 15 patients undergoing extraction of at least four teeth were selected. In each patient after atraumatic extractions, one socket was grafted with WTA, second with DA, third with FDBA, and fourth was left ungrafted (control site). All the sites were covered with chorion membrane. To estimate three-dimensional alveolar crest changes, cone beam computed tomography scans were taken immediately after grafting and 4 months postoperatively. Bone biopsies using 3 mm trephine bur were obtained from four patients at the time of implant placement and evaluated histologically. Results: Clinically uneventful healing was observed at all sites. Compared to other sites, WTA and DA consistently showed superior results demonstrating least reduction in alveolar crest height and width which was statistically significant (P < 0.05). Between WTA and DA sites, there was no statistically significant difference. Histological analysis also confirmed more new bone formation at WTA and DA sites. Conclusions: Rather than disposing extracted human teeth as a biomedical waste (common practice), they can be collected from suitable systemically healthy donors. With the help of tissue bank, they can be processed into an allograft, serving as an excellent alternative to conventional allografts.
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An appraisal of the prevalence and attributes of traumatic dental injuries in the permanent anterior teeth among 7–14-Year-Old school children of North East Delhi p. 218
Kopal Garg, Namita Kalra, Rishi Tyagi, Amit Khatri, Gaurav Panwar
DOI:10.4103/ccd.ccd_133_17  
Aims: The aim of this study was to assess the prevalence, associated risk factors, characteristics, and pattern of traumatic dental injuries (TDIs) in the permanent anterior teeth among school children of North East Delhi area. Settings and Design: A cross-sectional study was done in 3000 school-going children aged 7–14 years. Materials and Methods: A detailed case history and clinical examination were performed on the entire sample population. TDIs were recorded according to Andreasen's epidemiological classification of TDIs including World Health Organization codes. Statistical Analysis Used: For finding the independent association of the significant variables with outcome, multivariable logistic regression analysis was used. Results: A prevalence of 10.7% was observed in the sample being studied. Dental trauma was significantly (P < 0.05) associated with male gender, and high statistical significance (P < 0.001) was noted with age, participation in sports, lip seal, and overjet. Fall of the child while playing by himself/herself was the most common cause; afternoon and schools were the most common time and place of occurrence of TDIs, respectively. Single tooth enamel fractures in the left maxillary central incisors were most commonly seen. Adhesive restorations were the most frequent form of treatment required. Conclusions: Organizing studies addressing the prevention and treatment needs of TDIs and educational programs aimed toward parents and school teachers are of paramount importance. Furthermore, recognizing the tremendous treatment negligence is extremely critical to adequately analyze indifference of the people toward dental trauma and its consequences.
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Smokeless tobacco: Profiling sachets and pattern of use among low socioeconomic population of Puducherry p. 225
Kuldeep Singh Shekhawat, Arunima Chauhan, S Sakthidevi, Prasoon Goyal, Saptadeepa Bhattacharjee
DOI:10.4103/ccd.ccd_154_17  
Background: Tobacco consumption is highest among labor classes and low socioeconomic status (SES), with inclination toward smokeless tobacco (SLT). Aim: The aim of the study was to determine the prevalence and pattern of SLT consumption with secondary objective to profile various sachets of SLT most commonly sold in the study setting. Setting and Design: A cross-sectional questionnaire study conducted in rural Puducherry. Materials and Methods: A self-interviewed structured questionnaire was administered to 150 participants from two villages. Data on education, occupation, and income were collected with details in the form of tobacco consumed, duration of habit, daily consumption, and brand of SLT among other things. Profiling of sachets was done with manufacturing date, date of expiry, presence and absence of warning signs, and name of the manufacturer as parameter. Statistical Analysis: Descriptive analysis was done for frequency distribution and Chi-square test for proportions. Results: The overall prevalence of SLT was 44% with women consuming more than males. 41–50-year-old were highest users of SLT. More than 50% of the participants were unaware of the “pictorial warnings” and 65% did not know about the presence of “contents” on sachets. Pan masala with tobacco was the most preferred form. Only 5 of the 23 commercial brands of sachets had both “pictorial and readable warnings” printed. Conclusion: The prevalence of STC was high when compared to the general population. Steps need to be taken to address the adverse effects printed on sachets for low SES populations. The printed warnings need to be inspected regularly. Dual tobacco use is a new addition to the existing list of challenges.
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Efficacy of milk as a desensitizing agent for the treatment of sensitivity following scaling and root planing p. 231
Jyosthna G Madhurkar, Pragathi R Bhat, Anirudh B Acharya, Srinath L Thakur, Vijay A Trasad
DOI:10.4103/ccd.ccd_73_17  
Background: Dentine hypersensitivity (DH) is the most common problem encountered by most of the dentists in their day-to-day clinical practice. It is characterized by a sharp pain or discomfort arising as a response to thermal, chemical, or osmotic stimuli and is caused due to exposure of dentine after the enamel or cementum at the root surface has been lost by the treatment, underlying dental and gingival diseases or physiologic wear and tear of the teeth. This further complicates preventive oral hygiene procedures by the patients, which jeopardize periodontal treatment or may as well aid in periodontal treatment failure. Aim and Objective: To evaluate the efficacy of commercially available milk as a desensitizing agent for the treatment of sensitivity following scaling and root planing. Materials and Methods: Patients were selected randomly for scaling and then assessed for sensitivity. Those patients having DH were divided into two groups, wherein the Group A (test) patients were advised to rinse with commercially available milk at room temperature and those in Group B (control) with a commercially available mouthwash (Sentosil-SF). A four-point verbal rating scale was designed to record the numerical value of DH and were recalled for follow-up on 4th, 7th, and 10th day posttreatment. Results: The study demonstrated that there was a considerable reduction in hypersensitivity in both the groups on the 7th and 10th day. In the milk group, eight patients showed a complete reduction in hypersensitivity on 7th day and 13 patients on 10th day, while in the mouthwash group, five patients showed the same on 7th day and ten patients on the 10th day, thus suggesting that more individuals in the milk group were benefited. However, there was no statistically significant difference between the groups in every visit. Conclusion: Although there is a vast literature available which suggests the efficacy of commercially available mouthwash in reducing hypersensitivity, this study is the first of its kind which evaluates the efficacy of commercially available milk in reducing sensitivity which is induced postscaling. Considering that milk rinse is cheap and easily available at home, it can be used as a desensitizing agent, and rinsing with milk for few days is effective and stable in quick reduction of hypersensitivity induced by scaling.
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Profile changes and stability following distraction osteogenesis with rigid external distraction in adult cleft lip and palate deformities p. 236
Jaeson M Painatt, Ravi Veeraraghavan, Ushass Puthalath, Sherry Peter, Latha P Rao, Maria Kuriakose
DOI:10.4103/ccd.ccd_1164_16  
Objectives: The objective of this study is to analyze the hard and soft-tissue profile changes as well as the upper airway changes after distraction osteogenesis (DO) using rigid external distraction device in adult cleft lip and palate (CLP) patients. The study also evaluates the stability of the surgical result. Materials and Methods: Three lateral cephalometric radiographs were taken: Predistraction (T1), postdistraction (T2), and 1 year after distractor removal (T3). The treatment changes (T1 vs. T2) and the stability (T2 vs. T3) were analyzed. The overall treatment changes after 1 year were also evaluated (T1 vs. T3). The lateral cephalograms were digitally analyzed with the help of software named Dolphin. Statistical Analysis Used: Wilcoxon Signed-Ranks test was used, and the probability value (P value) of 0.05 was considered as statistically significant level. Results: Eleven adult patients with CLP were retrospectively analyzed. After distraction, there was a significant mean maxillary advancement of 14 mm (P < 0.01) from a T1 value of 73.54 ± 10.38 to a T2 value of 88.2 ± 10.49. The lower facial height and the incisor exposure were significantly increased. The nasolabial angle had a significant improvement of 24.5° (P < 0.01) from a T1 value of 56.6 ± 21.03 to a T2 value of 81.18 ± 14.4.The upper airway was significantly improved by 3.7 mm (P < 0.01) with a T1 value of 13.5 ± 3.8 to a T2 value of 17.2 ± 3.66. After 1-year follow-up, there was a significant maxillary relapse of 3.20 mm (P < 0.05) from a T2 value of 8.29 ± 6.84 to a T3 value of 5.09 ± 5.59. However, the soft-tissue profile and upper airway remained stable. Conclusion: The clinician should have an understanding of the related hard and soft tissues as well as airway changes which may assist him when planning for maxillary advancement for CLP patients with DO. There were significant improvements immediately after distraction, but during the 1-year follow-up, some relapse was seen. This stressed on the need for overcorrection of about 35%–40% for adult CLP patients.
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Effect of desensitization using bioactive glass, hydroxyapatite, and diode laser on the shear bond strength of resin composites measured at different time intervals: An In vitro Study p. 244
Timsi Gupta, Shruthi Nagaraja, Sylvia Mathew, Indiresha H Narayana, KS Madhu, K Dinesh
DOI:10.4103/ccd.ccd_155_17  
Background: Dentin desensitizers may change the properties of smear layer and have adverse effects on the bonding performance of adhesive systems. Aim: The aim of this study was to compare the effect of bioactive glass (BG), hydroxyapatite, and diode laser desensitization on shear bond strength of resin composites to dentin at different time intervals. Materials and Methods: Seventy-two caries-free maxillary premolars were selected. Buccal surfaces were flattened to expose dentin. Teeth were divided into four groups (Groups 1, 2, 3, and 4) according to treatment modality (control with no pretreatment, Sensodyne Repair and Protect, Teethmate Desensitizer, diode laser). Bonding was performed using self-etch adhesive followed by composite buildup. Universal testing machine was used to determine shear bond strengths immediately after bonding, after 3 months, and 5 months storage in artificial saliva. Results: Pretreatment with BG and hydroxyapatite desensitizers increased, whereas diode laser decreased mean shear bond strength of composite to dentin as compared to control group. No statistical significant difference in shear bond strength values was seen in groups after storage. Conclusion: Desensitizing toothpastes incorporating remineralizing agents not only occluded open dentinal tubules but also increased shear bond strength of composite to dentin.
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Long-term retrospective study of implants placed after sinus floor augmentation with fresh-frozen homologous block p. 248
Livingstom Rubens Sousa Rocha, Antonio Carlos Aloise, Rafael de Mello Oliveira, Marcelo Lucchesi Teixeira, André Antonio Pelegrine, Luís Guilherme Scavone Macedo
DOI:10.4103/ccd.ccd_63_17  
Aim: The aim of this study was to analyze and follow-up implants placed in the posterior maxillary regions previously grafted with homologous bone. Materials and Methods: Forty-one grafts with homologous bone blocks were performed in maxillary sinuses, and 121 implants were placed in premolar and molar regions approximately 6 months after the grafts. Patients were followed up for periods varying from 12 to 124 months after rehabilitation. Results: The results showed two implant failures, for a 98.3% success rate during the follow-up period. Discussion: The implants placed had an average torque of 40 N-cm, regardless of the, design, diameter, and length of the implants used. Conclusion: After following up on the implants placed in this study, we concluded that those placed in regions of the maxillary sinuses previously grafted with homologous bone blocks had high long-term success rates and met the functional masticatory requirements.
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Correlation of ABO blood group phenotype and rhesus factor with periodontal disease: An observational study p. 253
Anju Gautam, Neelam Mittal, TB Singh, Ruchi Srivastava, Pushpendra Kumar Verma
DOI:10.4103/ccd.ccd_307_17  
Background: The knowledge of the ABO blood group phenotype of the patients and their correlation with the periodontal disease maybe important in the development of early treatment strategies, and it would be helpful to target non-responding areas to periodontal therapy of the susceptible individuals. Aims: The present study was conducted to determine whether there was any correlation between periodontal diseases and ABO blood groups and Rh factor. Material and Method: This study was carried out on 537 subjects attending Faculty of Dental Sciences OPD in BHU. Subjects were divided into three groups: group I (healthy subjects), group II (subjects with gingivitis), and group III (subjects with periodontitis) based on periodontal examination (Gingival index, Bleeding Index, Probing pocket depth and clinical attachment level). ABO Blood grouping were done and correlated with the periodontal status of study subjects. Statistical Analysis: Data was analyzed using the statistical software namely Statistical Package for the Social Sciences (SPSS, Version 16, IBM Analytics) and Systat 8.0. Results: In this study, there was a greater prevalence of gingivitis in blood group O and periodontitis in blood group B. The blood group AB showed the least prevalence of periodontal diseases. Similarly gingivitis and peridontitis were significantly higher among Rhesus positive groups when compared with Rhesus negative groups. Conclusion: Considering the results of this study, it can be concluded that ABO blood groups and Rh factor could be a risk factor for the development of periodontal disease.
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Evaluation of salivary cortisol changes and psychological profiles in patients with recurrent aphthous stomatitis p. 259
Fatemeh Rezaei, Maziar Aminian, Asad Vaisi Raygani
DOI:10.4103/ccd.ccd_165_17  
Background and Objective: Some studies suggest that psychological condition and stress can play role in the development of recurrent aphthous stomatitis (RAS). The purpose of this study was to evaluate salivary cortisol changes and psychological conditions in patients with RAS. Materials and Methods: Twenty-seven patients (13 males and 14 females, mean age of 32.8 (±10.2) years) with minor RAS and 27 age- and sex-matched controls without RAS participated in this study. The concentration of cortisol (nanomole/L) was measured in samples of unstimulated saliva from patients and controls two times; once during the presence of active lesions and once again when the lesions had healed by immunologic assay. The Hospital Anxiety and Depression Scale was employed to determine psychological condition. Visual analog scale for pain severity was recorded for patients with active lesions episode. Data were analyzed by the SPSS software (version 18.0) using paired and unpaired t-tests and Pearson correlation coefficient. Results: Salivary cortisol level was lower in patients during active lesions (12.4 ± 5.1) and healing (10.5 ± 3.9) episodes compared to the controls (13.1 ± 3.6) (P = 0.583, P = 0.015; respectively). There was no significant difference in salivary cortisol between active lesions and healing episodes (P = 0.943). Anxiety and depression represented no significant differences between active lesions and healing episodes (P > 0.05). Anxiety and depression levels in patients were significantly higher than in controls (P < 0.05). Pain severity in active lesions was not significantly correlated to salivary cortisol level, and anxiety or depression scores (P > 0.05). Conclusion: The findings showed that occurrence of RAS was associated with anxiety and depression but not with alterations of salivary cortisol level.
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Effect of water storage on the flexural strength of heat-cured denture base resin reinforced with stick (s) glass fibers p. 264
Ankit Galav, Suryakant C Deogade, Sneha Mantri, K Sumathi, Sneha Galav
DOI:10.4103/ccd.ccd_157_17  
Background: Flexural strength (FS) of denture base resins (DBRs) had been improved by reinforcing it with different glass fibers. However, a limited data are available on the effect of glass fiber reinforcement with conventional heat-cured resin after prolonged water storage. Aims and Objectives: This study aimed to evaluate the reinforcing effect of novel S-glass and nylon fibers on the FS of acrylic DBRs. It also aimed to evaluate the effect of glass fiber reinforcement on the FS of acrylic DBRs after a prolonged storage in water. Materials and Methods: One hundred and sixty identical specimens were fabricated in specially designed molds according to the manufacturer's instructions. The three experimental groups were prepared consisting of conventional (unreinforced) acrylic resin, novel S-glass fiber-reinforced and nylon fiber-reinforced acrylic resin. The specimens were fabricated in a standardized fashion for each experimental group. Each group was further subdivided into two groups on the basis of storage conditions (dry and wet). FS was tested using a three-point universal testing machine at a crosshead speed of 5 mm/min. Glass fiber-reinforced group was further tested after prolonged storage in distilled water. Entered data were statistically analyzed with one-way ANOVA and least significant difference post hoc test. Results: In this study, statistically significant differences were noted in the FS of all the groups. S-glass fiber-reinforced group had highest FS compared to the other two groups (P < 0.001). Nylon fiber-reinforced group had lowest FS. All the groups stored in distilled water revealed a decrease in strength compared to those stored in dry atmosphere. Among wet specimens, those stored for 3 weeks had a significantly higher FS than those stored at one and 2 weeks (P < 0.01). Conclusion: Within the limitations of this investigation, the FS of heat-cured acrylic DBR was improved after reinforcement with glass fibers. It can be recommended to strengthen distal extension partial and complete denture bases. Nylon fibers may not be desirable for strengthening acrylic denture bases.
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Cervical and incisal marginal discrepancy in ceramic laminate veneering materials: A SEM analysis p. 272
Hemalatha Ranganathan, Dhanraj M Ganapathy, Ashish R Jain
DOI:10.4103/ccd.ccd_156_17  
Context: Marginal discrepancy influenced by the choice of processing material used for the ceramic laminate veneers needs to be explored further for better clinical application. Aims: This study aimed to evaluate the amount of cervical and incisal marginal discrepancy associated with different ceramic laminate veneering materials. Settings and Design: This was an experimental, single-blinded, in vitro trial. Subjects and Methods: Ten central incisors were prepared for laminate veneers with 2 mm uniform reduction and heavy chamfer finish line. Ceramic laminate veneers fabricated over the prepared teeth using four different processing materials were categorized into four groups as Group I - aluminous porcelain veneers, Group II - lithium disilicate ceramic veneers, Group III - lithium disilicate-leucite-based veneers, Group IV - zirconia-based ceramic veneers. The cervical and incisal marginal discrepancy was measured using a scanning electron microscope. Statistical Analysis Used: ANOVA and post hoc Tukey honest significant difference (HSD) tests were used for statistical analysis. Results: The cervical and incisal marginal discrepancy for four groups was Group I - 114.6 ± 4.3 μm, 132.5 ± 6.5 μm, Group II - 86.1 ± 6.3 μm, 105.4 ± 5.3 μm, Group III - 71.4 ± 4.4 μm, 91.3 ± 4.7 μm, and Group IV - 123.1 ± 4.1 μm, 142.0 ± 5.4 μm. ANOVA and post hoc Tukey HSD tests observed a statistically significant difference between the four test specimens with regard to cervical marginal discrepancy. The cervical and incisal marginal discrepancy scored F = 243.408, P < 0.001 and F = 180.844, P < 0.001, respectively. Conclusion: This study concluded veneers fabricated using leucite reinforced lithium disilicate exhibited the least marginal discrepancy followed by lithium disilicate ceramic, aluminous porcelain, and zirconia-based ceramics. The marginal discrepancy was more in the incisal region than in the cervical region in all the groups.
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Effect of nonsurgical periodontal therapy on serum highly sensitive capsule reactive protein and homocysteine levels in chronic periodontitis: A pilot study p. 279
Siddharth Mallapragada, Jyoti Kasana, Pallavi Agrawal
DOI:10.4103/ccd.ccd_140_17  
Introduction: The aim of the present study was to assess the effect of nonsurgical periodontal therapy on circulating serum high-sensitivity capsule reactive protein (hs-CRP) and homocysteine (Hcy) levels in patients with chronic periodontitis. Materials and Methods: The study involved fifty participants. The test group included 25 systemically healthy controls (mean age 38.44 ± 3.27 years) with severe chronic periodontitis and the control group (n = 25) included age- and sex-matched systemically and periodontally healthy controls. Clinical parameters were recorded, intraoral periapical radiographs were taken, hematological tests and assessment of serum hs-CRP levels and Hcy levels were performed at baseline and 3 months after completion of nonsurgical periodontal therapy. Results: Mean serum hs-CRP and Hcy concentration in patients with chronic periodontitis were 3.37 ± 0.54 mg/L and 21.47 ± 7.93 μmol/L, respectively, and was significantly higher than the controls (1.68 ± 0.71 mg/L and 13.93 ± 8.30 μmol/L, respectively) (P < 0.05). Posttreatment, the mean serum hs-CRP and Hcy concentration reduced significantly in both test and control groups (P < 0.05). Conclusion: Chronic periodontitis leads to an increase in circulating levels of hs-CRP and Hcy in plasma and nonsurgical periodontal therapy decreases periodontal inflammation, which in turn reduces systemic inflammation and consequently decreases serum levels of hs-CRP and Hcy.
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Total serum protein estimation and its correlation with clinical and histopathological grading using Masson's Trichrome stain in patients of oral submucous fibrosis p. 286
Ankita Sannad, Sandhya Tamgadge, Avinash Tamgadge, KS Yadav, Ajay Giri, Mukesh Wankhede
DOI:10.4103/ccd.ccd_95_17  
Objectives: Oral submucous fibrosis (OSMF) caused by dense deposition of collagen fibers which is a protein. There is a plethora of research to evaluate degree of collagen deposition using various simple histochemical techniques, but its correlation with total serum protein (TSP) level has not been explored so far. Materials and Methods: This case–control study comprised total forty samples with thirty cases of OSMF and ten cases were selected as control group, divided into four groups as per Lai et al. classification. Histological grading was also done according to the Rooban et al.'s classification. Blood sample was collected to evaluate TSP estimation. Findings were tabulated, and comparisons were made between clinical, histological, and TSP estimation. Discrete statistical data were analyzed by Chi-square test, ANOVA, and t-test with a statistical analysis package (SPSS version software 6.0). Results: No significant correlation was obtained between clinical staging and histopathological grading. Definite correlation was obtained in TSP and globulin levels of OSMF patients and their grades of fibrosis histopathologically. Conclusion: In the present study, it was observed that biochemical investigations involving assessment of TSP can be used as a diagnostic tool in OSMF, along with histopathological examination.
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Patient-centered microsurgical management of gingival recession using coronally advanced flap with either platelet-rich fibrin or connective tissue graft: A comparative analysis p. 293
Archana Kumar, Vivek Kumar Bains, Rajesh Jhingran, Ruchi Srivastava, Rohit Madan, Iram Rizvi
DOI:10.4103/ccd.ccd_70_17  
Purpose: To evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in gingival recession defects in conjunction with coronally advanced flap (CAF) using a microsurgical technique. Materials and Methods: Forty-five Class I and II recession defects were randomly equally (n = 15) divided into three groups: Group I sites treated with CAF with PRF, Group II sites treated with CAF with CTG, and Group III sites treated with CAF alone using microsurgical approach. Parameters recorded were vertical gingival recession (VGR) and horizontal gingival recession (HGR), % complete root coverage (CRC), patient comfort score (PCS), patient esthetic score (PES), and hypersensitivity score (HS) at 10 days, 3 months, and 6 months. Results: CAF surgery alone and in combination with PRF or CTG are effective procedures to cover denuded roots with mean VGR values of 1.26 ± 0.70 mm (74.4%), 1.26 ± 0.59 mm (58%), and 1.06 ± 0.79 mm (53.3%) for Groups I, II, and III, respectively. In terms of CRC achieved at 6 months, results showed that 100% CRC was obtained in 60% sites of Group I, 20% sites of Group II, and 27% sites of Group III. Patient response and acceptance for surgical treatment modality in terms of PCS and PES were highest for Group I (PRF and CAF) followed by Group III and Group II, and there was decrease in HS for Group I (PRF and CAF) while no significant changes in HS were observed for Group II and Group III. At the end of 6 months follow-up, there was a significant increase in gingival thickness measurements using transgingival probing in Group II, whereas nonsignificant changes were observed in Group I and Group III. Conclusions: A long-term multicenter randomized controlled clinical study may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG and CAF alone.
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Family-related factors associated with caries prevalence in the primary dentition of 5–6-year-old children in urban and rural areas of Jabalpur City p. 305
Amrita Pal, Shilpi Gupta, Ashish Rao, Sommyta Kathal, Soumyadip Roy, Swarnam Pandey
DOI:10.4103/ccd.ccd_1135_16  
Aim: The purpose of this study was to examine the prevalence of dental caries in primary dentition of 5–6-year-old children in urban and rural areas of Jabalpur city. Materials and Methods: The present cross-sectional study was conducted in the rural and urban areas of Jabalpur city, India. A power analysis was carried out to select a representative sample of 5–6-year-old children (n = 408), 204 from government schools and 204 from private schools. Parents were interviewed using a self-structured questionnaire to collect data with regard to variables under evaluation. Statistical Analysis: Collected data were subjected to descriptive analysis using the SPSS 12.0 version. Risk factor association with dental caries was investigated using a stepwise logistic regression analysis with P < 0.05 considered significant. Results: This shows significantly higher decayed missing filled teeth among rural children than urban children. It was seen that 46.5% of children whose mothers were illiterate were affected with dental caries. In urban area, 91.5% of children whereas 77% of children in rural area have parental control on sugar consumption. Conclusion: It is important to focus on parents' education level when planning preventive programs for young children. Assessing family-related risk factors is essential when instituting preventive/treatment programs for young children.
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Comparison of three different sealer placement techniques: An In vitro confocal laser microscopic study p. 310
Avoy Kumar Dash, Shanin Farista, Abhilasha Dash, Ajinkya Bendre, Sana Farista
DOI:10.4103/ccd.ccd_1109_16  
Introduction: Three-dimensional obturation of the root canal system is the final objective of root canal therapy. Greater penetration of sealer in root dentine lesser will be the voids at the dentine–sealer interface. Hence, analysis of the dentin/sealer interface allows the determination of a filling technique which could obturate the root canals with least gaps and voids. Therefore, the aim of this study is to compare the depth and percentage of sealer penetration into root dentin using three different root canal sealer placement techniques under confocal laser scanning microscope. Materials and Methods: Thirty single-rooted teeth were selected and prepared. Adseal sealer (Meta Biomed, South Korea) was mixed with Rhodamine B dye and applied using lentulo spiral (Dentsply Maillefer, USA) as Group 1, bidirectional spiral (EZ-Fill– EDS, USA) as Group 2, and ultrasonic endodontic tip (Sonofile– Dentsply Tulsa, USA) as Group 3. Canals were then obturated with gutta-percha. The roots were sectioned at the 3 and 6-mm levels from the apical foramen and examined under confocal laser microscope. Results: Maximum mean depth and percentage of sealer penetration were observed for Group 1 and minimum for Group 3. Furthermore, statistical significant differences among Group 1 and Group 3 were found at 6-mm level and among Group 2 and Group 3 were found at 3-mm level (P < 0.05). Conclusion: The depth and percentage of sealer penetration of sealer are influenced by the type of placement technique and by the root canal level, with penetration decreasing apically. Lentulo spiral has shown better penetration of sealer than the bidirectional file and ultrasonics.
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In vivo evaluation of 4% articaine and 2% lignocaine intraligamentary injection administered with single tooth anesthesia-wand p. 315
Madhan Chenchugopal, Jayanthi Mungara, Nilaya Reddy Venumbaka, Arun Elangovan, Poornima Vijayakumar, Sakthivel Rajendran
DOI:10.4103/ccd.ccd_882_16  
Background: The available literature confirms the effectiveness of intraligamentary injections equal to nerve blocks and articaine equal to lignocaine with better depth of penetration for single tooth pulpectomy procedures with less postoperative soft tissue trauma. An advancement in the field of local anesthesia delivery is the Single Tooth Anesthesia-Wand (STA-Wand) which is relatively pain-free and offers comfort to the child. Aims: This study aims to evaluate and compare the anesthetic effectiveness and postoperative complications of 4% articaine and 2% lignocaine intraligamentary injection administered as single tooth anesthesia using a computer-controlled local anesthetic delivery system, the STA-Wand. Settings and Design: Using a randomized, split-mouth, cross-over study design, twenty children aged 4–10 years who required bilateral mandibular pulpectomies were administered intraligamentary injections with 4% articaine and 2% lidocaine in two appointments using STA-Wand. Pain, anxiety, and cooperation levels were scored by an operator and an observer at four phases of treatment using Wong-Baker Faces Pain Rating Scale and Two-6 point Co-operation Anxiety Rating Scale. Results were tabulated and analyzed. Statistical Analysis: Mann–Whitney U-test, paired t-test, and Student's t-test. Results: Both the local anesthetic agents were equally effective with no significant difference (P > 0.05) throughout rest of the treatment procedure compared to injection phase in minimizing pain, anxiety, and gaining the cooperation levels of children whereas during injection phase, 4% articaine showed superior effectiveness in minimizing pain compared to 2% lignocaine (P = 0.054). Conclusion: Both the local anesthetic agents delivered using STA-Wand is clinically acceptable, effective, and safe for usage in children.
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Clinical and Radiographic comparative evaluation of buccal and palatal corticotomy with buccal corticotomy in periodontally accelerated osteogenic orthodontics with surgical bur p. 321
Pavankumar Addanki, Jagadish Reddy Gooty, Rajababu Palaparthy
DOI:10.4103/ccd.ccd_846_16  
Background: Periodontally accelerated osteogenic orthodontics is a clinical procedure that combines selective corticotomy, particulate grafting, and application of orthodontics. It reduces treatment time, increases stability of teeth, and prevents relapse of orthodontic tooth moment. The present study was aimed to explore the clinical and radiographic comparison of bone density changes, retraction time differences in buccal and palatal corticotomy with buccal corticotomy which was done by surgical bur. Materials and Methods: A split-mouth was designed in 16 patients and divided into right (buccal and palatal corticotomy) (Group I), left (buccal corticotomy) (Group II) sides. In both groups, decortication was done with surgical bur. Clinical parameters such as gingival bleeding index and probing pocket depth were recorded at baseline, 1 month, 3 months, and 6 months. Bone density changes were measured by computed tomography at baseline and after 6 months after surgery and also used for evaluating differences in bone density changes between two groups. Retraction time differences were also measured in both groups. Results: In both groups, there was significant difference between bone density changes at baseline and 6 months after surgery. However, the difference between two groups was not significant. The difference in clinical parameters between two groups was not significant. The difference in retraction time differences was not significant. Conclusion: Within limits of the study, it may be concluded that there was difference between bone density changes before and 6 months after surgery. Difference in total treatment time found to be no significant between two groups.
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CASE REPORTS Top

Hemifacial hyperplasia p. 327
Loutfi Salti, Michael Rasse, Khaled Al-Ouf
DOI:10.4103/ccd.ccd_113_17  
Hemifacial hyperplasia is a rare developmental anomaly characterized by marked unilateral facial tissues. It involves orofacial soft tissues, bones of the face, and teeth. The cause remains ambiguous although several predisposing factors have been reported. A case report of a 32-year-old girl with unilateral hemifacial enlargement, pain in temporomandibular joint, and limited mouth opening associated is presented to highlight the clinical and imaging findings and to discuss the differential diagnosis.
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A 2D panoramic surgical stent imaging: Complete arch mandibular implant fixed prosthesis along with bar supported maxillary over denture p. 332
Mukesh Kumar Singhal, Rumneet Kaur Billing, Nitin Srivastava, Zainab Khan
DOI:10.4103/ccd.ccd_472_17  
Successful rehabilitation of a patient should restore function, esthetic, and speech by prosthesis. Treatment modalities vary from patient to patient. Semi-precision attachments and implants offer several advantages over the traditional approach. The aim and objective of this report was to assess a case of a 55-year-old female patient who had lost all her teeth, except maxillary canines #13 and #23 and with severe bone loss in the mandible. Tooth-supported bar attachment was planned for maxilla, and a total of five dental implants were placed in the mandible using a flapless approach aided by radiographic gutta-percha surgical stents over panoramic two-dimensional imaging. Customized, radiographic stents help for the placement of implant in the view of paralleling and flapless surgery, completely. An immediate loading protocol is adopted as from day of the surgery to 6 weeks along with implant supported full arch fixed dentures after 4 months. The outcome of the treatment was impressive, and the patient gave a positive response with superb esthetics and functions.
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Ramsay hunt syndrome: A diagnostic challenge for general dental practitioners p. 337
Gautham Singh, V Subhalakshmi, S Balasubramanian, Madhvika Patidar, Kranti Kiran Reddy Ealla
DOI:10.4103/ccd.ccd_1099_16  
Ramsay hunt syndrome is not just a syndrome but it's rather an infectious disease caused by reactivation of latent varicella-zoster virus in geniculate ganglion. This was first explained by J. Ramsay Hunt as a triad of complications like otalgia, mucosal and cutaneous rashes with or without trigeminal facial palsy. The facial palsy can occur with characteristic vesicles along the path of nerve. We present a case of Ramsay Hunt syndrome in a 48-year-old male. The unilateral pattern of facial involvement and presence of vesicles assisted us for early diagnosis, distinguishing the syndrome with diseases mimicking other severe neurological illnesses and prompt treatment.
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