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   Table of Contents - Current issue
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October-December 2018
Volume 9 | Issue 4
Page Nos. 511-677

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Harnessing healing inside the body? Highly accessed article p. 511
SG Damle
DOI:10.4103/ccd.ccd_850_18  
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REVIEW ARTICLE Top

Evaluation of treatment outcomes of en masse retraction with temporary skeletal anchorage devices in comparison with two-step retraction with conventional anchorage in patients with dentoalveolar protrusion: A systematic review and meta-analysis Highly accessed article p. 513
Hanin Nizar Khlef, Mohammad Younis Hajeer, Mowaffak A Ajaj, Omar Heshmeh
DOI:10.4103/ccd.ccd_661_18  
Objective: The main objective is to evaluate the effectiveness of en masse retraction with temporary skeletal anchorage devices (TSADs) versus two-step retraction with conventional anchorage (CA) in terms of the skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment. Materials and Methods: An electronic search of PubMed and nine other major databases for prospective, randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was carried out between January 1990 and April 2018. The bibliography in each identified article was checked out. In addition, manual searching was performed in the same time frame in five major orthodontic journals. Adult patients undergoing fixed orthodontic treatment with extraction of maxillary premolars followed by an en masse retraction in the experimental group and two-step retraction of upper anterior teeth in the control group. Methodological index for nonrandomized studies for CCTs and Cochrane's risk of bias tool for RCTs were applied. Results: Four articles (two RCTs and two CCTs) were included in this review and all articles were appropriate for the quantitative synthesis. There was no significant difference between the en masse retraction and two-step retraction groups in terms of SNA, SNB, ANB, and MP-SN angles. Using TSADs gave significantly better results in terms of posterior anchorage and incisors inclination, and greater anterior teeth retraction in comparison with CA (standardized mean difference [SMD] = –3.03 mm, P < 0.001; SMD = 0.74°, P = 0.003; SMD = –0.46 mm, P = 0.03, respectively). En masse/TSAD combination caused a significantly greater increase in nasolabial angle, higher decrease in facial convexity angle, and greater lower lip retraction in comparison with two-step/CA combination (weighted mean difference = 4.73°, P = 0.007; P = 0.0435; SMD = –0.95 mm, P = 0.01, respectively). Conclusion: There is weak-to-moderate evidence that using either en masse/TSAD combination or two-step/CA combination would lead to similar skeletal improvement. There is a very weak-to-moderate evidence that using TSADs with en masse retraction would cause better posterior anchorage and incisors inclination, and greater anterior teeth retraction than using CA with two-step retraction. There is weak-to-moderate evidence that using en masse/TSAD combination would lead to a better improvement in the facial profile. According to the quality of evidence, we confirm the need for more well-conducted RCTs in the en masse retraction field.
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ORIGINAL ARTICLES Top

Unveiling the link between prostatitis and periodontitis p. 524
Ramanarayana Boyapati, Chakrapani Swarna, Narasimhaswamy Devulapalli, Sahitya Sanivarapu, Kishore Kumar Katuri, Lakshmikanth Kolaparthy
DOI:10.4103/ccd.ccd_746_18  
Background: One of the important tumor markers having critically important applications in every aspect of treating men with prostatic illness is prostate-specific antigen (PSA), formed by prostate acini's epithelial cells. Where prostate is affected by inflammation or malignancy, the PSA levels rise to/and above 4 ng/ml. This study analyzes the interlink between different severity of periodontitis and prostatitis by assessment of PSA antigen levels and periodontal clinical parameters. Materials and Methods: In this study, 100 chronic prostatitis patients diagnosed to also have periodontal diseases were divided into four batches on the basis of the nature of prostatitis and levels of periodontal clinical attachment. The grouping was as: group 1A – clinical attachment level (CAL) <3 mm and mild prostatitis, Group 2A – CAL ≥3 mm and mild prostatitis, and Group 1B – CAL <3 mm and moderate-to-severe prostatitis, Group 2B – CAL ≥3 mm and moderate-to-severe prostatitis. Readings of CAL, probing pocket depth, bleeding on probing, plaque index, and gingival index (PI and GI) were recorded, followed by calculation and assessment of PSA values and correlation of periodontal parameters, respectively. Results: An important and affirmative correlation (r = 0.5549, P < 0.05) was seen between PSA and CAL scores at significance level of 5%, and also between PSA and probing depths (PD) scores at 5% (r = 0.5315, P < 0.05), indicating that PSA and CAL scores, as also PSA and PD scores are mutually dependent. The similar positive correlation was seen between PSA with PI (r = 0.3231, P < 0.05) and GI (r = 0.3567, P < 0.05) scores, respectively, at 5% level of significance, which shows PSA is also mutually dependent on PI and GI scores. Conclusion: Patients with of grades, moderate-to-severe prostatitis as well as periodontitis were found having higher PSA levels. The clinical readings of periodontal parameters were significantly higher in patients with moderate-to-severe prostatitis which shows a pathological link between the above two.
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Bilateral cleft lip repair – advantages of pfeifer's technique p. 530
Yaratha Sivanagendra Reddy, Rayadurgam Venkata Kishore Kumar, Devireddy Sathya Kumar, Gali Rajasekhar, Vaka Ramesh Babu, Kanubaddy Sridhar Reddy, Kuruganti Prasanna Purna
DOI:10.4103/ccd.ccd_729_18  
Context: Primary repair of bilateral cleft lip depends on the sound knowledge of anatomy, identification of landmarks, clinical variation of presentation, surgical expertise of the operator, etc., Herewith, we present the results of 129 cases performed during our study. Aim: To evaluate the advantages of Pfeifer's technique in bilateral cleft lip repair. Design: This was a retrospective analysis of the results of repair. Patients and Methods: The study was carried out on 129 patients using Pfeifer's technique. Pfeifer described a technique which involves changing the lip skin incision to a wavy line, thus making it less conspicuous, using the concept of “morphological order.” The basis of this technique is, a skin incision between two points can be lengthened if both points are joined in a curved or wavelike manner rather than in a straight line. Results: Lip parameters improved by 70% as viewed in frontal profile in terms of white roll match, vermilion match, and Cupid's bow. Nasal parameters improved by 80% as viewed in basal view in terms of alar symmetry, nasal dome and alar base. Conclusions: We found four advantages by strict adherence to the steps in the technique as given in the available literature. This technique is easy to learn and teach with satisfactory results.
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Concentrated bone marrow aspirate-coated hydroxyapatite for reconstruction of small-to-moderate-sized mandibular defects caused by the removal of benign pathologies p. 535
Raja Sekhar Gali, Ravindran Chinnaswamy, Sathya Kumar Devireddy, Mahaboob Vali Shaik, Rayadurgam Venkata Kishore Kumar, Sridhar Reddy Kanubaddy, Ramesh Babu Vaka, YS Harish, Rama Mohan Pathapati
DOI:10.4103/ccd.ccd_745_18  
Purpose: The aim of this study was to evaluate the bone regeneration potential of concentrated bone marrow aspirate (BMA)-coated hydroxyapatite (HA) for reconstruction of mandibular defects caused by the removal of benign pathologies. Patients and Methods: This prospective clinical study included ten patients with histopathologically proven benign pathologies of the mandible measuring <5 cm anteroposteriorly, who were treated with enucleation or marginal resection, followed by autologous concentrated BMA-coated synthetic biphasic HA (HA and beta-tricalcium phosphate) graft placement. Clinical and radiological evaluations of grafted sites of the mandible were done at 1 week, 1, 3, and 6 months postoperatively using Irwin's radiologic staging and grayscale histogram. Results: All patients (10/10, 100%) had proper incorporation of the graft with the normal adjacent bone. Grayscale histogram revealed the initial stages of graft resorption, followed by formation of new bone-grafted sites. No complications such as infection and total graft loss were encountered except for one patient who had partial wound dehiscence that responded well to local wound care and resuturing. Conclusion: Concentrated BMA-coated synthetic HA effectively promotes bone regeneration in small-to-moderate-sized defects of the mandible.
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Do children of working mothers experience more dental caries? Highly accessed article p. 541
RM Baiju, Elbe Peter, Vivek Narayan, Jolly Mary Varughese, NO Varghese
DOI:10.4103/ccd.ccd_682_18  
Background: Pain and discomfort due to untreated dental caries lead to eating and sleep disruptions, behavioral changes, and poor quality of life. Among adolescents, severe dental caries may lead to activity restriction, school absenteeism, and poor academic performance. Dietary factors, parent's socioeconomic status, and family income have been associated with dental caries experience. The employment status of the mother is a measure of socioeconomic status of the family. Aims: This study aims to estimate the prevalence of dental caries and to find out its sociodemographic, oral health behavioral, and clinical determinants among older adolescent (15–18 years) students in Kerala. Settings and Design: This was a cross-sectional study conducted at higher secondary schools. Methods: Oral examination and sociodemographic and oral health behavioral data collection were done among 1065 older adolescent students in the age group 15–18 across five districts of Kerala by a multistage cluster sampling design. Decayed, missing, and filled teeth (DMFT) and Significant Caries (SiC) index were taken. Statistical Analysis Used: SPSS version 16 software was employed. Multiple regression analysis was done to estimate adjusted odds ratios (OR) of predictors of dental caries experience. Results: The overall dental caries experience for the group was 59.8% (95% confidence interval [CI]: 56.9–62.7). About 40% of students had no caries experience, 43% had DMFT score 1–3, and only 16.8% had DMFT score 4 and more. Mean DMFT was 1.67 (95% CI: 1.56–1.79). Diet preference, timing of sugar intake, and sugar form were not significantly associated with caries. Mean SiC index was 3.90 (95% CI, 3.75–4.05). In the unadjusted analysis, age, gender, place of residence, mother's employment status, school type, frequency of sugar intake, oral hygiene status, and timing of last dental visit were significant. In the adjusted analysis, however, age, male gender, government schools, timing of last dental visit, and employed mothers were significant predictors for higher dental caries experience. Conclusions: Mother's employment was the strongest predictor (OR 2.82, 95% CI: 2.15–3.69) for dental caries experience among adolescents when adjusted to other variables in the final multivariate model.
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Distribution of dendritic cells and langerhans cells in peri-implant mucosa p. 548
Jagadish Reddy Gooty, Deepthi Kannam, Vikram Reddy Guntakala, Rajababu Palaparthi
DOI:10.4103/ccd.ccd_688_18  
Background: Peri-implant diseases leading to the failure of dental implants is concern in the field of dentistry. Difference in immune response around peri-implant tissues with healthy tissue might be responsible for the hidden cause of peri-implant diseases. Hence, in the current study, the dispersion of the dendritic cell (DC) subpopulations and Langerhans cells (LCs) was evaluated in healthy peri-implant mucosa (HPIM) and healthy mucosa (HM) to know the imbalance in immune homeostasis. Subjects and Methods: A total of 15 nonsmoker participants were selected for the study. First sample of the HM was obtained before the implant placement (Group I) and second sample of peri-implant mucosa was obtained at the time of placement of the gingival former (Group II). Immunochemistry was used to quantify DCs and LCs in the samples. Statistical Analysis Used: To analyze the distribution of cells in the epithelium and lamina propria, Wilcoxon matched pairs test was used. Results: Mean numbers of CD1a (LCs) in the epithelium and lamina propria of Group I and Group II were 25.2 ± 6.41 and 27.47 ± 10.26 and 19.27 ± 7.27 and 12.46 ± 3.04, respectively. Mean numbers of factor XIIIa (DCs) in the epithelium and lamina propria in Group I and Group II were 30.37 ± 5.42 and 86.93 ± 13.99 and 50.47 ± 7.27 and 124.33 ± 10.27, respectively. Statistically significant differences in the number of cells in the epithelium and lamina propria of Group I and Group II were noted (P = 0.001 and P = 0.001). Conclusions: CD1a-positive LCs were more in the epithelium rather than lamina propria in Group II. Higher numbers of factor XIIIa-positive DCs were observed in the lamina propria than epithelium in Group I and II.
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Influence of toothpaste pH on its capacity to prevent enamel demineralization p. 554
Lidia Gavic, Kristina Gorseta, Ali Borzabadi-Farahani, Antonija Tadin, Domagoj Glavina
DOI:10.4103/ccd.ccd_667_18  
Aim: This study evaluated in vitro the remineralization capacity of commercial toothpastes with different fluoride (F) concentrations and their effectiveness when they are acidified. Materials and Methods: One hundred and twelve caries-free teeth were used to prepare enamel specimens, and the specimens were divided into 16 groups (n = 7). Baseline surface Vickers microhardness was measured for all the specimens and all the tested groups were subjected to the pH-cycling regime involved five demineralization challenges each day for 10 days, and surface Vickers microhardness was then measured. Once daily, specimens were exposed for 30 min after last demineralization challenge of the day to the slurry of each toothpaste containing 1450 ppm F, 1000 ppm F, 450 ppm F, and 0 ppm F. The slurry was in original pH or acidulated on 6.5, 6.0, or 5.5 pH. The difference among tested group was assessed by analysis of variance and Newman–Keuls test (P < 0.05). Results: The highest increase in microhardness was detected after treatment with toothpaste containing 1450 ppm fluoride (percentage of increase in microhardness was 6.20%), and the biggest loss was detected after treatment with toothpaste containing no fluoride (percentage of decrease was 6.82%), but there was no significant difference between tested groups. Conclusions: The highest increase in microhardness was detected after treatment with toothpaste containing more fluorides (1450 ppm F) regardless of the acidity.
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Comparing the effectiveness of probiotic, green tea, and chlorhexidine- and fluoride-containing dentifrices on oral microbial flora: A double-blind, randomized clinical trial p. 560
Jayashri Prabakar, Joseph John, I Meignana Arumugham, R Pradeep Kumar, D Sri Sakthi
DOI:10.4103/ccd.ccd_659_18  
Introduction: Oral cavity harbors wide variety of microorganisms; these are considered crucial for the dental caries initiation and progression. Plaque-induced caries is a local disease; therefore, dentifrices are the most ideal vehicle for the daily delivery of antibacterial agents. In recent years, alternatives to fluorides such as green tea, probiotic, and chlorhexidine (CHX) toothpastes have been proposed to possess antiplaque and anticariogenic properties. Aim: To compare the effectiveness of probiotic, green tea, and CHX- and fluoride-containing dentifrices on oral microbial flora. Materials and Methods: A double-blinded, parallel group, randomized controlled clinical trial was conducted among healthy adults. Fifty-two individuals were randomly allocated to four groups (n = 13): Group I – green tea dentifrice, Group II – fluoridated dentifrice, Group III – CHX dentifrice, and Group IV – probiotic dentifrice. Plaque and saliva samples were evaluated for Streptococcus mutans and Lactobacillus at baseline and 15th and 30th days of follow-up. Paired t-test and one-way ANOVA were used to compare the mean differences of plaque and salivary S. mutans counts at two and three time periods. Wilcoxon signed-rank and Kruskal–Wallis tests were used to compare the mean Lactobacillus count in plaque and saliva samples at two and three time periods, respectively. Results: The mean S. mutans and Lactobacillus counts in plaque and saliva samples were significantly reduced by all the treatment groups at the 30th day of follow-up. However, Group III showed the highest reduction and was found to be statistically significant (P < 0.05). Conclusion: All the four groups exhibited antimicrobial activity by bringing about a significant reduction in the mean S. mutans and Lactobacillus colony counts at the 30th day of follow-up. Among all the preventive modalities, Group III (CHX dentifrice) showed better results compared to other groups.
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Erbium-doped, yttrium-aluminum-garnet laser debonding of porcelain laminate veneers: An ex vivo study p. 570
Yong Zhang, Jean-Paul Rocca, Carlo Fornaini, Yinghua Zhen, Zengyi Zhao, Elisabetta Merigo
DOI:10.4103/ccd.ccd_632_18  
Background: The use of ceramic laminate veneer has considerably and successfully grown to improve anterior tooth esthetics in recent years. The removal of ceramic laminate veneers with laser is reported only in a scanty number of publications and for this reason the importance and the aim of this ex vivo study consist to verify the ability of Er: YAG laser for laminate veneers debonding with the preserving of the tooth structures (scanning electron microscopy [SEM] observations). Aim: The purpose of this study consists to verify if erbium-doped, yttrium-aluminum-garnet (Er:YAG) laser, at low fluences, is able to debond porcelain veneers, successfully used to improve anterior tooth esthetics, without damaging the tooth structures. Settings and Design: A total of 12 freshly extracted teeth were used, and samples were decontaminated, stored, and bonded to obtain veneers adhesion. One week after, Er:YAG laser with a non-contact sapphire tip with air-water spray was used for veneer debonding at 100 mJ of energy and 30 Hz of frequency (Fluence 19.94 J/cm2). Results: Results demonstrated that veneer debonding is possible with an Er:YAG laser and the total number of pulses seems not related to its efficiency. SEM observation confirms that residual tooth structure is not altered when using these low fluences. Conclusions: Low fluences with Er:YAG laser are able to debond veneers while preserving the tooth structures and SEM observation confirmed that residual tooth structure is not altered with low fluences.
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Transforming growth factor-β1 and runt-related transcription factor 2 as markers of osteogenesis in stem cells from human exfoliated deciduous teeth enriched bone Grafting p. 574
Chiquita Prahasanti, Noer Ulfah, Ivan Indra Kusuma, Nur Hayati, Diah Savitri Ernawati, Agung Krismariono, Taufan Bramantoro
DOI:10.4103/ccd.ccd_609_18  
Background: Stem cells from human exfoliated deciduous teeth (SHED) are one source of adult stem cells which can proliferate and differentiate into many types of tissues than any other stem cells. SHED represent potential stem cells for therapeutic therapy and tissue engineering. Aims: The aim of this study was to compare the expression of transforming growth factor-β1 (TGF-β1) and runt-related transcription factor 2 (RUNX2) in hydroxyapatite (HA) scaffold with SHED. Subjects and Methods: Eight experimental animals were divided into two groups. The first group was transplanted with HA and the second with HA and SHED. The expression of TGF-β1 and RUNX2 was seen 21 days later by means of immunohistochemical analysis. Statistical Analysis Used: Data were analyzed using an independent t-test with a significance level of 5%. Results: The analysis results of an independent t-test showed a significant difference between the two groups. The second group given HA with SHED showed a significantly higher expression of TGF-β1 and RUNX2 than that of the first group. Conclusions: Expression of TGF-β1 and RUNX2 occurs after the application of HA with SHED, while TGF-β1 and RUNX2 expression in the HA with SHED group was significantly higher than in the group without SHED.
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Relationship between dermatoglyphics, cheiloscopy, rugoscopy, and dental caries: A cross-sectional study in Bengaluru, Karnataka p. 577
Manisha Agarwal, Ajna Alex, Sapna Konde
DOI:10.4103/ccd.ccd_611_18  
Introduction: Early detection of susceptibility to dental caries by studying its genetic basis by effectively utilizing noninvasive, less expensive, and effective tools is gaining popularity. Cariogenesis is affected by a combination of environmental and behavioral factors. Aim: The aim of this study was to compare the reliability of dermatoglyphic, cheiloscopic, and rugoscopic patterns for assessing the risk of dental caries in children. Materials and Methods: The study included 100 children aged 3–7 years who were divided into two groups based on their decayed, missing and filled teeth (DMFT/deft) index. Fingerprints, lip prints, and rugae patterns were recorded and analyzed. Results: The most common fingerprints patterns in the children with higher deft scores were loop pattern (52%), followed by whorls (32%) and arches (16%). The branched pattern of lip prints was found to be the most prevalent in all children irrespective of their caries status. Among palatal rugae shapes, wavy was found to be the most prevalent (54%) one in our study population, irrespective of the deft scores. Considering the palatal rugae unifications, it was found that converging type was significantly (P = 0.032) more prevalent in children with less deft scores (32%) compared to those with high deft caries (14%). Conclusion: Palatal rugae unifications have proved to be a good marker of dental caries. Among the various genes that may be playing a role in caries formation, BCOR and BCORL1 genes may also be playing a role in the development of palate and the rugae patterns and also in the development of enamel, which is known to be the most vulnerable dental tissue to dental caries.
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The effect of combination spirulina–chitosan on angiogenesis, osteoclast, and osteoblast cells in socket models of hyperglycemic Rattus norvegicus p. 582
Nike Hendrijantini, Rostiny Rostiny, Mefina Kuntjoro, Kent Sidharta, Dea Syarafina Putri Wiyono, Alocitta Anindyanari, Sherman Salim
DOI:10.4103/ccd.ccd_617_18  
Background: Prolongation of the inflammatory process in hyperglycemic interferes with bone formation, inhibits the healing process, and triggers bone resorption. A combination of spirulina and chitosan in the tooth socket of Rattus norvegicus is expected to promote the bone remodeling process. This study aimed to evaluate the effect of spirulina and chitosan on angiogenesis, osteoclast, and osteoblast cell in tooth socket models of type 1 diabetes. Materials and Methods: A laboratory-based experiment involving 36 R. norvegicus, divided into three groups (nondiabetes mellitus (DM), uncontrolled DM, and controlled DM) and further divided into six subgroups. The controlled groups (K1, K2, and K3) were induced with 3% carboxymethyl cellulose Na, while the treated groups were induced with 12% spirulina and 20% chitosan. On the 14th day, the mandibles of the rats were removed. The capillary lumen, osteoblasts, and osteoclast cells were counted by hypothalamic–pituitary–adrenal examination and the results analyzed by means of Shapiro–Wilk, Levene's, one-way ANOVA, and post hoc Tukey's honestly significant difference test. Results: There was a significant increment in the number of capillary lumen, osteoblast cells, and a decrease in osteoclasts in all three treated groups (P1, P2, and P3). Conclusions: A combination of spirulina and chitosan can effectively promote the healing process in postextraction sockets of type 1 DM R. norvegicus.
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A comparative evaluation of microleakage among newer composite materials: An in vitro Study p. 587
Sruthi Keerthi Sudhapalli, Swathi Sudhapalli, Rahul Anand Razdan, Virendra Singh, Abhilasha Bhasin
DOI:10.4103/ccd.ccd_621_18  
Background: Good adhesive bonding of restorative materials to cavity walls minimizing microleakage is an important criterion for the performance and longevity of a restoration in the oral cavity. The present study is aimed to compare the microleakage among newer composite materials. Materials and Methods: Forty-five extracted healthy premolars were collected; standard Class II cavities were prepared. They were randomly divided into three groups of 15 teeth each. The groups were made based on the different composite restorative materials used for restoration. Group A consisted of conventional microfilled composite resin restorations, and Group B was posterior nanocomposite resin. Group C was restored using ORMOCER – Admira. After completion of restorations, all teeth were subjected to thermocycling at 5° C, 37° C, and 55° C for 250 cycles. Later, all samples were immersed into 50% silver nitrate dye group wise for for 4 hours (h), and teeth were sectioned buccolingually. Sectioned teeth were observed under a stereomicroscope for the evaluation of microleakage. ANOVA and unpaired t-tests were used for statistical analysis. The significance level was at set P < 0.001. Results: The results of this study showed that Group C (ORMOCER – Admira) presented with the least microleakage followed by Group B (Tetric N-Ceram) followed by Group A (Tetric Ceram). Conclusions: Overall ORMOCER – Admira performed better than the other two composite materials with the least microleakage.
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Osteogenic differentiation of human amniotic mesenchymal stem cells in chitosan-carbonate apatite scaffold (in vivo study) p. 592
Michael Josef Kridanto Kamadjaja, Sherman Salim, Fedik Abdul Rantam, Ni Putu Mira Sumarta
DOI:10.4103/ccd.ccd_627_18  
Background: Studies of bone tissue engineering as a viable alternative to autogenous bone graft show promising results, although its mechanism and effectiveness remain only partially understood. Purpose: to explain the osteogenic differentiation of scaffold chitosan (Ch)–carbonate apatite (CA) in seeding with human amniotic mesenchymal stem cells (hAMSCs) on the regeneration of calvarial bone defects in rats. Materials and Methods: Shitosan-Carbonate Apatite (Ch-CA) scaffold was created by means of a freeze-drying method. Twenty Wistar rats were randomly divided into two groups: control and treatment. Defects were created in the calvarial bone of each treatment group with a scaffold subsequently implanted. After 8 weeks, the rats were terminated for histology and immunohistochemistry examination. Results: Expressions of vascular endothelial growth factor, bone morphogenetic protein2, Runt-related transcription factor 2 (RUNX2), and angiogenesis occurred earlier in the tissue-engineered group than that in the control group. An 8-week analysis also showed that the expression of RUNX2, alkaline phosphatase, osteocalcin, and collagen type 1 was at more elevated levels in the treatment group than that in the control group. Conclusion: These results showed that the combination of hAMSCs and Ch-CA scaffold may become one of the candidates for bone tissue engineering.
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Nicotine, the predictor of success or failure of dental implants: A retrospective study p. 597
Ajai Gupta, Suprabha Rathee, Thotapalli Suman, Mahesh Ahire, Srishti Madhav, Mahinder Singh Chauhan
DOI:10.4103/ccd.ccd_597_18  
Background: Dental implant therapy is a treatment of choice in missing teeth. However, certain conditions such as smoking, hypertension, and diabetes have negative influence on success of dental implants. Nicotine is found to cause osteoclastic changes. The present study was conducted to assess the relationship between nicotine and implant failure. Materials and Methods: The present retrospective study included 2570 patients of both genders. They were divided into two groups. Group I consisted of 1250 patients with a history of smoking and Group II were nonsmokers and comprised 1320 patients. The presence of pain, mobility, and inflammation was considered positive signs for implant failure. Results: The results showed that in Group I, males had 6.13% and females had 5% dental implant failure. Overall failure rate in Group I was 5.56%. In Group II, males had 2.98% and females had 0.9% failure. Overall failure rate in Group II was 2.35%. The difference between both groups was statistically significant (P < 0.05). In Group I, maximum (56), and in Group II, 18 patients had habit of >10 years of smoking. Maximum patients had habit of consumption of >20 cigarettes/day (Group I) and Group II had only 10 patients with this frequency. Maximum dental implant failures were observed in maxillary arch (70) than in mandibular arch (32). The difference was statistically significant (P < 0.05). Conclusion: Smoking influences the survival rate of dental implants. Thus, patient should be educated to discontinue the habit before implant placement.
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Comparative evaluation of shear bond strength of newer resin cement (RelyX ultimate and RelyX U200) to lithium disilicate and zirconia ceramics as influenced by thermocycling p. 601
Rinki Kansal, Sapna Rani, Manoj Kumar, Shalabh Kumar, Gaurav Issar
DOI:10.4103/ccd.ccd_601_18  
Background/Purpose: The purpose of this study was to compare the shear bond strength of high strength ceramics to cut dentine as influenced by different resin cement types after thermocycling. Materials and Methods: Shear bond strength testing was carried out for 56 sound, freshly extracted first permanent molars. Specimens were divided at random into 2 groups (n = 28) Lithium disilicate and Zirconia. Lithium disilicate and Zirconia specimens were further subdivided depending upon luting with Rely X ultimate cement bonded with single bond universal adhesive and Rely X U200 cement. Half of the specimens of each material luted with cements were subjected to thermocycling. Shear bond strength was evaluated using Universal testing machine at a crosshead speed of 5 mm/min. Results were compared and evaluated using t-test at a significance level of 0.05. The nature of bond failure was observed under a stereomicroscope for each sample. Results: The mean difference of Lithium disilicate test specimens bonded with Rely X ultimate cement bonded with single bond universal adhesive with and without thermocycling was found to be 42.95+/-17.41MPa and 120.62+/-56.46 MPa respectively. The mean difference of Zirconia test specimens with Rely X ultimate cement bonded with single bond universal adhesive, with and without thermocycling, was found to be 8.74+/-2.90 MPa and 164.28+/-43.78 MPa respectively. The mean difference of Lithium disilicate test specimens bonded with Rely X U200 with and without thermocycling was found to be 2.36+/-0.63 MPa and 36.79.62+/-17.21MPa respectively. The mean difference of Zirconia test specimens bonded with Rely X U200 with and without thermocycling was found to be 5.96+/-3.11MPa and 122.46+/-23.01MPa respectively. Conclusion: Zirconia was found to have better shear bond strength than Lithium discilicate. The use of single bond universal adhesive improves bonding to newer higher strength ceramics such as Zirconia. Cohesive failure was predominant at cement dentine interface.
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Microbial analysis and determination of antibiotic susceptibility of dental laboratory equipments and laboratory attire p. 607
Manoj Shetty, Nikhila Thulasidas, Nivya John, Chethan Hegde
DOI:10.4103/ccd.ccd_569_18  
Context: This study was done to determine the level and type of microbial contamination present on the surface of various dental laboratory equipment and laboratory attire and to determine the antibiotic susceptibility pattern of these isolated pathogens. Subjects and Methods: The samples were divided into following groups: six groups of dental laboratory equipment (articulators, facebow, fox plane, polishing buff, micromotor handpiece, and surveyors) and dental attire of laboratory technicians and students. A total of 33 swabs were collected from each dental laboratory equipment, namely, articulators, facebow, fox plane, polishing buff, micromotor handpiece, and surveyors. The dental laboratory attire of students and dental technicians were analyzed separately. The swabs were collected from the laboratory attire at the end of the week, and they were washed once a week and at the beginning of the week. The groups are Group 1 – dental laboratory attire (students), Group 2 – dental laboratory attire (technicians), Group 3 – polishing buff, Group 4 – facebow, Group 5 – surveyor, Group 6 – fox plane, Group 7 – articulator, and Group 8 – micromotor handpiece. The moistened swabs were inoculated into the broth and subcultured on to the MacConkey Agar plates, and then incubated aerobically at 37°C for 24 h. The organisms were identified based on colony morphology, Gram staining, and standard biochemical tests. The antibiotic susceptibility patterns of the isolated organisms were done according to the CLSI guidelines. The collected data were statistically analyzed. Statistical Analysis Used: The data collected were entered into a Microsoft Excel Spreadsheet and analyzed using IBM SPSS Statistics, Version 22 (Armonk, NY, IBM Corp.). The frequency and mean standard deviation of the samples were analyzed using Fisher's exact value test. Percentage of resistance among the isolates to different antimicrobials was also determined. Results: The microorganisms isolated were Staphylococcus aureus, Escherichia coli, coagulase-negative Staphylococcus, Pseudomonas, Klebsiella, nonfermenting Gram-negative bacteria, and Bacillus species. The mean microbial levels in dental laboratory attire were more (5 log10colony-forming units [CFU]) compared with dental equipment (3 log10CFU–4 log10CFU). Furthermore, most of the isolated organisms showed increased antimicrobial resistance. Conclusion: Majority of the isolated organisms were not a part of the normal oral microflora and are capable of causing various diseases. The increased resistance to the antimicrobials showed by the isolated organisms proves that there are increased chances of multiresistant organisms to occur in the future.
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Comparative evaluation of treatment of localized gingival recessions with coronally advanced flap using microsurgical and conventional techniques p. 613
Chandni Patel, Rupal Mehta, Surabhi Joshi, Tanvi Hirani, Chintan Joshi
DOI:10.4103/ccd.ccd_571_18  
Background: Coverage of gingival recession is a very precision-oriented procedure. Employment of operating microscope has proved to be a boon in various surgical procedures and therefore can have positive benefits on the outcome of a procedure. Aim: The aim of this study is to find out whether the use of an operating microscope in the surgical treatment of Millers Class I and Class II gingival recession defects could improve the outcome in terms of root coverage and final tissue appearance compared to those done by the conventional technique. Materials and Methods: This clinical study was carried out on ten patients with the presence of bilateral isolated gingival recession classified as Miller's Class I or Class II recession defect. The split-mouth design was used where coronally advanced flap with the placement of platelet-rich fibrin was done in defects in test (microsurgical) and control (conventional) groups. Various clinical parameters were recorded at baseline and then postoperatively at 3-months and 6-month intervals. Results: The visual analog scale scores showed a statistically significant difference between scores while all other parameters had no statistically significant difference in intergroup comparison after 3 and 6 months. Conclusion: While microscope permitted less traumatic and minimally invasive procedure, both groups showed convincing improvement in clinical parameters.
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Assessment of oral health status and treatment needs among individuals with thyroid dysfunction in Nashik city (Maharashtra): A cross-sectional study p. 619
Minal Madhukar Kshirsagar, Arun Suresh Dodamani, Gundbakhta Nagappa Karibasappa, Prashanth Yachrappa Vishwakarma, Jagdishchandra Bheemasain Vathar, Kapil Ramesh Sonawane
DOI:10.4103/ccd.ccd_574_18  
Objectives: The objective of the study is to assess the prevalence of dental caries and periodontal health status among individuals suffering from thyroid dysfunction in Nashik. To compare the prevalence of thyroid dysfunction between males and females. Materials and Methods: The present study is cross-sectional in nature. The study group comprised of randomly selected 100 individuals diagnosed as suffering from thyroid dysfunction and fulfilling eligibility criteria, visiting endocrinology center in Nashik city. Type III clinical examination was used for the assessment of oral health status. Control group was selected from the neighborhood in general population who had matched with the eligibility criteria of the study group. Oral hygiene status was assessed by using the WHO pro forma, 2013. Collected data were compiled into MS-Excel and subjected to statistical analysis using appropriate statistical tests. Results: Severity of dental caries status and periodontal destruction was found more in study group as (P < 0.05). The prevalence of thyroid dysfunction, severity of dental caries status and periodontal destruction was seen more in females as compared to males. Conclusion: Thyroid dysfunction has an impact on general and oral health as well. It is necessary to identify it early so as to prevent further progression of disease and destruction of oral tissues. It is also necessary to modify treatment plan if the patient is diagnosed with thyroid dysfunction to prevent further complications.
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Evaluation of smile characteristics in three different sagittal malocclusions before and after nonextraction orthodontic treatment p. 625
Parisa Salehi, Shabnam Ajami, Neda Babanouri, Sanaz Abbasi
DOI:10.4103/ccd.ccd_554_18  
Introduction: To investigate the smile esthetics variables in three malocclusion classifications of angle to find out if the final smile esthetics was correlated with the initial types of malocclusion. Materials and Methods: This cross-sectional study was performed on 90 adult patients (18–28 years old) with three classes of malocclusion (n = 30 for each class), who were just treated by an orthodontist based on standard edgewise (0.018 inch). A standardized smile mesh analysis was used to evaluate seven smile characteristics. Results: Orthodontic treatment improved all the smile characteristics in the three groups. All groups showed an increase in smile width, smile index, and vertical indices; while, the transverse indices decreased. Significant increase was observed in four smile measurements in patients with Class II malocclusion. Comparing the smile characteristic changes among the three groups revealed that the changes induced by orthodontic treatment were significantly higher in patients with Class II malocclusion. Conclusion: The smile esthetics in all the three types of malocclusion benefited from the orthodontic treatment; however, the changes were more significant in Class II malocclusions. None of the three malocclusion types showed significant difference between the pre- and post-treatment smile characteristics.
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Stress Distribution on Root Dentin Analogous to Natural Teeth with Various Retentive Channels Design on the Face of the Root with Minimal or No Coronal Tooth Structure: A Finite Element Analysis p. 630
Shoeb Yakub Shaikh, Shahnawaz Mulani, Safia Shoeb Shaikh
DOI:10.4103/ccd.ccd_536_18  
Aim: the aim of this study was to evaluate post-core design on Stress distribution in maxillary central incisor with various designs retentive channels placed on the face of the root with no remaining coronal tooth structure. Materials and Methods: 3 dimensional finite element model of a maxillary central incisor was developed and seven other study modes were developed. Tooth was scanned using CBCT unit, with reverse engineering software. 3D wire mesh, with ten node tetrahedral element, developed was transferred to ANASYS software. Composite was used for post-core-crown as post endodontic restoration. Mechanical properties were assigned to each component for FEA. All the materials were assumed to be isotropic, linearly elastic, homogenous and tightly bonded. A load of 100N were applied from vertical, horizontal and lateral oblique from incisal and palatal surface respectively. Results: Analysis revealed that stresses were concentrated at the point of load application on crown(vertical(V) 14.35MPa, horizontal(H) 27.04 MPa and lateral oblique(L)13.75MPa) and depending on the post core design the stresses were homogenous evenly distributed over the root dentin, core and least over the post. There was variation in stress distribution under vertical horizontal and lateral oblique load. Conclusion: Teeth with no remaining coronal structure and by placing retentive channels on the face of the root will enable homogenous stress distribution, promote mechanical retention and stability to the post core crown post endodontic restoration.
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Comparative clinical and microbial evaluation of two endodontic file systems and irrigating solutions in pediatric patients p. 637
Gurpreet Kour, Updesh Masih, Abhishek Dhindsa, Sushma Gojanur, Suneel Kumar Gupta, Biant Singh
DOI:10.4103/ccd.ccd_543_18  
Aims: The purpose of the study was to determine the best combination for chemomechanical preparation in primary teeth using two endo file systems (hand and rotary) along with two different irrigants. Materials and Methods: Sixty primary molars indicated for pulpectomy, underwent chemomechanical preparation using endo files (H hand files and rotary Protaper files) and root canal irrigating solutions (Smearclear and QMiX). Samples from root canals were collected before and after the chemomechanical preparation of the canal and were cultured for microbial analysis of Enterococcus faecalis. Results: Endodontic irrigating solutions showed significant differences of effectiveness on the growth inhibition of bacterial strain. The present study confirmed that the in vivo antimicrobial efficacy of QMiX solution was statistically significant when compared to the Smearclear solution. Conclusion: Based on the antimicrobial efficacy observed in the present study, it may be concluded that QMiX has a great potential than Smearclear as an intracanal irrigation solution in primary teeth and rotary preparation may be considered as more efficient and time-saving mechanical preparatory technique in primary molars.
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Pulpal temperature rise: Evaluation after light activation of newer pulp-capping materials and resin composite p. 644
Jash Lakhani, Vineet Agrawal, Rajesh Mahant, Sonali Kapoor, Dipak Vaghamshi, Arpit Shah
DOI:10.4103/ccd.ccd_504_18  
Background: To evaluate temperature changes in pulp chamber during light activation of newer pulp- capping materials and composite resin using light-emitting diode. Materials and Methods: A standardized Class I cavity was prepared in 80 extracted, intact, noncarious mandibular first molars, keeping remaining dentin thickness of 0.5 mm. The teeth were divided into four groups of 20 teeth each. Following this, apical third of the mesial root of each tooth was cut and a K type thermocouple attached to digital thermometer was inserted into pulp chamber from the sectioned mesial root. Whole assembly with teeth was suspended in water bath with constant temperature at 37°C. The previously divided teeth in four groups, were lined with Calcimol LC (Group A), Activa (Group B), TheraCal LC (Group C), and Ionoseal (Group D), followed by 3 increments of Filtek Z350 × T universal restorative. The temperature rise following light activation of pulp-capping material, bonding agent, and composite was noted. Results: The temperature rise in the pulp chamber after light activation of Activa was highest among all pulp-capping materials, followed by teeth lined with Calcimol LC, Ionoseal, and least in teeth with TheraCal LC. Conclusions: Temperature rise in the pulp chamber after light activation of newer pulp-capping materials and composite was below critical threshold for irreversible pulpal damage. Among all the pulp-capping materials, TheraCal LC showed lowest temperature rise in pulp chamber.
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CASE REPORTS Top

Fixed functional space maintainer incorporating a tenon-mortise connector p. 649
Neil De Souza, Godwin Clovis Da Costa, Paul Chalakkal, Kennedy Mascarenhas
DOI:10.4103/ccd.ccd_722_18  
This case report highlights the incorporation of a tenon-mortise type of nonrigid connector between two adjacent pontics in a fixed functional space maintainer, to allow limited passive eruption and alignment of young permanent teeth. A 13-year-old male patient had lost his lower second premolar and first molar on the right side, secondary to the surgical removal of an odontogenic keratocyst a year ago. A space maintainer had to be placed until implants, or a fixed partial denture could be placed, after the completion of his growth. The appliance consisted of band type retainers with rests on the first premolar and the second molar, rigidly connected to their adjacent pontics (second premolar and first molar), with a tenon-mortise type of connector between the pontics. The casting was composed of nickel-chromium, out of which the pontics were layered with ceramic.
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Osteoid osteoma of the mandibular condyle: A diagnostic dilemma p. 652
Shameeka Thopte, Namrata Harchandani, Shams Ul Nisa, Rahul Rochani
DOI:10.4103/ccd.ccd_639_18  
Osteoma is benign osteogenic lesions characterized by proliferation of either cancellous or compact bone and can be central, peripheral, or extraskeletal. The most common site is in the skull. When affecting the facial bones, they are frequently found in the mandible, the most common locations being the posterior lingual surface and the mandible angle area. Here, we are presenting a rare case of osteoid osteoma of the mandibular condyle causing facial deformity in a 21-year-old male patient. On investigation, orthopantomogram revealed a solitary ill-defined homogeneous mixed radiopaque-radiolucency with a thin sclerotic border on the left mandibular condyle, cone-beam computed tomography showed a solitary irregular bony multilobulated overgrowth and the fusion imaging of positron emission tomography–computed tomography showed lobulated protuberance along medial margin of the left mandibular condyle with methylene diphosphonate bone scan showed well defined focal increased tracer uptake. The left side condylectomy was performed followed by shaving of inferior border with modified condyle formation by sliding osteotomy. Secondary surgery for correction of occlusion was done, and the patient was advised for orthodontic correction. The present case showed no recurrence after 18 months of follow-up.
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Highly proliferative ameloblastic fibroma: A rare entity p. 656
Appasab Sanadi, Sagar J Shah, Someshwar Golgire, Shraddha Shetti
DOI:10.4103/ccd.ccd_637_18  
Ameloblastic fibroma (AF) is a rare odontogenic neoplasm which is commonly seen in the second decade of life. It is seen most frequently in the mandibular posterior region. AF shows clinical and radiographic resemblance with other commonly occurring odontogenic cyst and tumors. Histopathologically, it shows great resemblance with primitive dental papilla. Immunohistochemistry helps in understanding the nature and proliferative potential of tumor and helps in proper treatment planning. Large lesions and recurrent lesions are treated with segmental resection which can often lead to morbidity, especially in young patients if not managed properly. Herein, we present a case of a large AF in the posterior mandible region in a 21-year-old female patient with significant expansion and erosion of cortical plates and lower border of the mandible with a high Ki67 proliferative index (20%) which was surgically treated by segmental resection and immediate reconstruction by autogenous iliac graft.
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Favorable outcome of a maxillary supplemental premolar p. 659
Sujatha Bandi, Mahesh Nunna, Bhavya Palavalli, Sivakumar Nuvvula
DOI:10.4103/ccd.ccd_638_18  
Hyperdontia/additional teeth are the commonly used synonyms for supernumerary tooth/teeth (ST). They occur due to the disturbances during the initiation stage of tooth development. They can be noticed in any region of oral cavity and may be single, double, or multiple; unilateral or bilateral; erupted or unerupted. This report presents a case of impacted single ST in the maxillary premolar region in a 14-year-old boy. Usually, ST are extracted, but there are some conditions where ST could be used beneficially. The present case is an example where ST played a beneficial role.
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Retrieval of extruded mineral trioxide aggregate using a novel suction device p. 663
Meenu Dhiman, Jigyasa Duhan, Ruchi Juneja, Sanjay Tewari, Pankaj Sangwan
DOI:10.4103/ccd.ccd_578_18  
Treatment of necrotic immature permanent teeth is an exigently demanding situation for an endodontist. Regenerative endodontic procedures are being employed for such teeth in a hope to restore a functional pulp tissue and continue root development. However, currently advocated techniques may not be effective in retaining mineral trioxide aggregate (MTA) in its coronal position. The present paper describes two immature teeth with pulpal necrosis and apical periodontitis that were treated through revascularization. In both the cases, apical extrusion of the coronal MTA plug occurred. A suction tip was customized to completely retrieve the extruded material. Both cases proved out to be a clinical and radiographic success over extended follow-up periods.
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Periodontal microsurgical-assisted pouch and tunnel approach in combination with subepithelial connective tissue graft for the management of class IIB and IIC multiple adjacent gingival recessions in mandibular anterior segment p. 667
Sanjeev Kumar Salaria, Amit Khunger, Vikender S Yadav, Garima Sharma
DOI:10.4103/ccd.ccd_556_18  
Gingival recession (GR) is an early and common clinical expression found in a majority of the population which increases with age. Different factors contribute to its etiology. It is a matter of concern for the patient which may be due to altered function and esthetics etc. Multiple conventional plastic surgical procedures are recommended for the management of GR depending on isolated or multiple GR. The present report described the plausible etiology of multiple adjacent GRs and classified it according to a new well-elaborated recession classification system proposed by Kumar and Masamatti, due to the limitation and applicability of most commonly used Miller's GR classification in the present clinical situation and its successful management through periodontal microsurgical-assisted pouch and tunnel approach in conjunction with subepithelial connective tissue grafting without any complication 6 months postoperatively.
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Management of furcal perforation with advanced furcation defect by a minimally invasive tunnel technique p. 670
Aditi Chopra, Karthik Sivaraman
DOI:10.4103/ccd.ccd_516_18  
A perforation in the furcation area is a potential risk factor for extension of pulpal inflammation into the periodontium and formation of advanced furcation defect with severe loss of clinical attachment and interradicular bone. Furthermore, the management of such furcal perforation is difficult due to poor accessibility, visibility, and regenerative potential. The development of such advanced furcation defects further compromises the prognosis of the treatment as they preclude effective plaque control and maintenance by the patient. Therefore, the management of advanced furcation defects remains an enigmatic and challenging task for the clinician. This case report describes a minimally invasive approach for the treatment of a furcal perforation by a conservative tunnel preparation. The present case report aims to highlight the importance of surgical tunnel preparation as an alternative to conventional flap procedure to repair furcal perforation with advanced furcation defects.
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Prosthetic rehabilitation of cranial deformity in hyperostotic convexity meningioma p. 674
Yamini Nandini, Swapna Bettanapalya Venkatesh
DOI:10.4103/ccd.ccd_537_18  
Cranial defects lead to unesthetic appearance and are a constant source of apprehension to the patient. Meningioma with calvarial extension requires the excision of the involved bone for complete excision. Such total excision would leave behind a bony defect which would need reconstruction. Presurgical fabrication of acrylic flap helps in reconstruction of such cranial defect following complete excision in single stage, thereby decreasing the cost and morbidity of surgery. Further, it facilitates the reproduction of the contours, and the tissue bed is not exposed to the heat of polymerization or to the free monomer. The authors report a case of hyperostotic convexity meningioma in a middle-aged female where heat-cured acrylic resin alloplastic implant was prefabricated and used successfully.
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