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   Table of Contents - Current issue
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October-December 2017
Volume 8 | Issue 4
Page Nos. 513-682

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EDITORIAL  

Secret weapon in the battle against cavities? p. 513
SG Damle
DOI:10.4103/ccd.ccd_781_17  
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ORIGINAL ARTICLES Top

In search of a novel substitute: Clinical and radiological success of lesion sterilization and tissue repair with modified 3mix-mp antibiotic paste and conventional pulpectomy for primary molars with pulp involvement with 18 months follow-up p. 514
Divya Doneria, Seema Thakur, Parul Singhal, Deepak Chauhan, Karunakar Keshav, Anika Uppal
DOI:10.4103/ccd.ccd_47_17  
Objectives: The aim of this study was to evaluate the clinical and radiographic success of zinc oxide (ZnO)-ozonated oil, modified 3Mix antibiotic paste, and vitapex in the treatment of primary molars requiring pulpectomy. Methods: Sixty-four primary molars of forty-three healthy children aged between 4 and 8 years with primary molars requiring root canal procedure were treated with ZnO-ozonated oil, modified 3Mix-MP antibiotic paste, and vitapex. Clinical follow up was done at 1, 6,12 months and 18 months while radiographical follow-up was done at 6,12 and 18 months, respectively. Results: The results showed that the clinical success rates of ZnO-ozonated oil, modified 3Mix-MP paste and vitapex were 95.5%,89.5% and 100% respectively and radiographical success rates were 94.4%,80.95% and 100% respectively after 18 months period of observation. Conclusion: The overall success rates of ZnO-ozonated oil, vitapex and modified 3Mix antibiotic paste were comparable.
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A comparative evaluation between cheiloscopic patterns and terminal planes in primary dentition p. 522
R Vignesh, C Vishnu Rekha, Sankar Annamalai, Parisa Norouzi, Ditto Sharmin
DOI:10.4103/ccd.ccd_48_17  
Objective: To assess the correlation between different cheiloscopic patterns with the terminal planes in deciduous dentition. Materials and Methods: Three hundred children who are 3–6 years old with complete primary dentition were recruited, and the pattern of molar terminal plane was recorded in the pro forma. Lip prints of these children were recorded with lipstick-cellophane method, and the middle 10 mm of lower lip was analyzed for the lip print pattern as suggested by Sivapathasundharam et al. The pattern was classified based on Tsuchihashi and Suzuki classification. Results: Type II (branched) pattern was the most predominant cheiloscopic pattern. The predominant patterns which related to the terminal planes were as follows: Type IV (reticular) and Type V (irregular) pattern for mesial step, Type IV (reticular) pattern for distal step, and Type I (complete vertical) pattern for flush terminal plane. No significant relationship was obtained on gender comparison. Conclusion: Lip prints can provide an alternative to dermatoglyphics to predict the terminal plane in primary dentition. Further studies with larger sample size are required to provide an insight into its significant correlations.
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Analysis of salivary IgA, amylase, lactoferrin, and lysozyme before and after comprehensive dental treatment in children: A prospective study p. 526
Akhilesh Sharma, Priya Subramaniam, Shebin Moiden
DOI:10.4103/ccd.ccd_103_17  
Objective: This study aimed to evaluate the levels of salivary IgA, amylase, lactoferrin, and lysozyme before and after comprehensive dental treatment in children with early childhood caries. Design: Thirty children aged 36–60 months, with a deft score ≥5, were selected for the study. Before dental treatment, paraffin-stimulated whole saliva was collected in a sterile graduated cup for a period of 5 min. The saliva samples were quantitatively analyzed for levels of IgA, amylase, lactoferrin, and lysozyme using enzyme-linked immunosorbent assay. Comprehensive dental treatment was carried out in all the children including caries preventive procedures. A second sample of saliva was collected at 3 months following completion of dental treatment. Data obtained was subjected to statistical analysis using Student's t-test. Results: The mean levels of salivary IgA was significantly reduced from 59.60 μg/ml to 56.42 μg/ml after dental treatment (P < 0.05). There was a significant reduction in the levels of salivary amylase from 115.78 μg/ml to 113.33 μg/ml (P < 0.001). Following dental treatment, salivary lactoferrin and lysozyme levels were significantly reduced from 3.76 μg/ml and 10.62 μg/ml to 3.44 μg/ml and 10.27 μg/ml, respectively (P < 0.001). Conclusions: Levels of salivary IgA, amylase, lactoferrin, and lysozyme were reduced significantly at 3 months following comprehensive dental treatment.
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Comparative evaluation of platelet-rich fibrin with connective tissue grafts in the treatment of miller's Class I gingival recessions p. 531
Sonam Mufti, Sarvagna Mayank Dadawala, Phoram Patel, Monali Shah, Deepak Harish Dave
DOI:10.4103/ccd.ccd_325_17  
Background: One of the most common aesthetic problem encountered in the field of periodontology is gingival recession, which is, perceived by the patients as increase in length of teeth. The treatment of buccal gingival recession is a common requirement due to aesthetic concern or root sensitivity. This study was planned to evaluate the efficacy of PRF membrane compared to that of CTG in Miller's class I gingival recessions. Materials and Methods: 32 sites with Miller's Class I gingival recessions, out of which 16 sites received PRF (test) and 16 sites received CTG (control). Each patient had undergone an initial periodontal treatment, including oral hygiene instructions, plaque control, and scaling and root planing, followed by re-evaluation. All clinical recordings; recession height, recession width, clinical attachment level, height of keratinized tissue, thickness of keratinized tissue, healing index and pain perception, were performed immediately before surgery (baseline) and after 6 months interval following periodontal surgery. Results: In the test group, significant improvement was seen in terms CAL, REC-HT, REC-WD, HKT and TKT from baseline to 6 months. In the control group, only significant improvement seen was in REC-HT and TKT from baseline to 6 months. Comparison of both Healing Index and VAS score was done and it showed no significant difference between test and the control group except VAS at 1 week. Conclusion: Though CTG is a gold standard procedure, PRF can be used as an alternative procedure by keeping patient's comfort and recognition in mind.
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Impact of dental trauma on quality of life among 11–14 years schoolchildren p. 538
Ibrahim Hassan El-Kalla, Hanaa Mahmoud Shalan, Rabaa Abo Bakr
DOI:10.4103/ccd.ccd_428_17  
Background: Traumatic injuries are common dental problems in pediatric dentistry that may influence the children's quality of life. Aim: the aim of this study is to assess the impact of traumatic dental injuries (TDI) and oral health-related quality of life (OHRQoL) among Egyptian schoolchildren aged 11–14 years. Materials and Methods: A cross-sectional study was carried out involving a sample of 11700 schoolchildren from public and private schools of Mansoura city, Egypt. OHRQoL was assessed using Child Perceptions Questionnaire. Clinical examination included the presence and type of TDI, malocclusion status, and dental caries in anterior teeth (decayed, missing, and filled teeth). Results: The prevalence of TDI was 13.6%. Untreated TDI was more likely to have a negative impact on the children's daily living regarding pain, functional, emotional, and social aspect than treated injuries and control children. Pearson's correlation test indicated significant association between trauma and malocclusion and dental caries. Conclusion: Untreated dental injury has a negative impact on quality of life regarding social, functional, and emotional aspects. However, treated injured teeth appear to improve social and emotional aspects of the OHRQoL of school children, whereas functional limitations may continue because of the pulpal and periodontal effects of the injury.
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Oral health-related quality of life following third molar surgery in an African population p. 545
Adebayo Aremu Ibikunle, Wasiu Lanre Adeyemo
DOI:10.4103/ccd.ccd_435_17  
Introduction: Surgical extraction of impacted mandibular third molars is often associated with sequelae such as postoperative pain, facial edema, and limitation in mouth opening ability. These sequelae may result in changes in the patients' lifestyle and quality of life (QoL). Aim: The aim of this study was to evaluate the effect of surgical extraction of impacted mandibular third molars on patients' QoL in the immediate postoperative period (7 days). Materials and Methods: Ethical approval for this study was obtained from the Health Research and Ethics committee of the Lagos University Teaching Hospital. A total of 124 individuals with impacted mandibular third molars, who satisfied the inclusion criteria and consented to participate in this study, were included. The Oral Health Impact Profile-14 (OHIP-14) QoL questionnaire was used to assess QoL. QoL was assessed preoperatively (baseline) and on postoperative days (PODs) 1, 3, and 7. Maximal interincisal mouth opening, facial width, and pain were also reviewed at all evaluation points. Data analysis was done using the Statistical Package for Social Sciences (SPSS) for Windows (version 16.0, Chicago, IL, USA). Results: A total of 124 individuals were included in the final analysis. An age range of 18–51 years with a mean (±standard deviation) of 28.5 (7.4) years was observed. A male to female ratio of 1:1.5 was observed. The most frequently encountered type of impaction was the mesioangular impaction 51 (41.1%) and recurrent pericoronitis was the principal reason for extraction 53 (42.7%). The severity of the sequelae (pain, trismus, and facial edema) was maximal on the first POD. Patients' overall QoL deteriorated sharply on the first POD and subsequently improved. Conclusion: Surgical extraction of mandibular third molars is associated with worsening of patients' postoperative QoL in the immediate postoperative period. Prospective patients should be informed about this, and ways of reducing this untoward effect should be explored.
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Influence of intracanal irrigants on coronal fracture resistance of endodontically treated and bleached teeth: An In vitro Study p. 552
Maryam Khoroushi, Fatemeh Tavakol, Farinaz Shirban, Sanaz Ziaei
DOI:10.4103/ccd.ccd_445_17  
Background: Irrigation has a key role in the success of endodontic treatment. Intracanal irrigant solutions have adverse effects on the physical properties of dentin. Aim: The present study aimed to evaluate the effect of different irrigation protocols on coronal fracture resistance of endodontically treated teeth undergoing bleaching treatment. Design and Materials and Methods: Access cavities were prepared in 120 maxillary premolars which were divided into two groups (n = 60) – Group A: nonbleached, Group B: bleached (B). Each group was subdivided into five subgroups based on irrigation protocol (n = 12); G1: normal saline (NS), G2: 2.5% sodium hypochlorite (NaOCl), G3: 10% citric acid (CA), G4: 17% ethylene diamine tetra acetic acid, and G5: NaOCl plus CA. In Group B, the teeth were bleached using 38% hydrogen peroxide and 20% carbamide peroxide gels as in-office and at-home bleaching techniques for 3 weeks. All the teeth were restored with composite resin, thermocycled, and incubated for 24 h. The specimens underwent fracture resistance tests. Data were analyzed with ANOVA, Tukey honestly significant difference test, t-test, and Chi-squared test (α =0.05). Results: T-test showed significant differences between each two corresponding subgroups (P < 0.0001). In Group A, NS demonstrated significantly higher fracture resistance compared to others; however, minimum fracture resistance recorded in G2. In Group B, the maximum fracture resistance was recorded in G1, with the minimum being recorded in G5. Samples irrigated with NaOCl and NaOCl plus CA exhibited significantly lower fracture resistance compared to NS subgroup (P < 0.05). Conclusions: Within the limitations of this study, it can be concluded that the irrigation protocol used during endodontic treatment with/without bleaching can affect the coronal fracture resistance.
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The bond strength of nanohybrid and nanoceramic composites to feldspathic porcelain p. 558
Hatice Özdemir, Nuran Dinçkal Yanikoglu
DOI:10.4103/ccd.ccd_504_17  
Background: Porcelain fracture is the most important problem in fixed prosthetic restorations. The replacement of fractured restoraions isn't often prefer by patients and dentists. Intraoral repair of fractured porcelain is a big alternative for patient and dentist. For this reason, dentists try to improve different surface treatments to increase the bond strength between porcelain and repair materials such as composite resins. Aims: The aim of this study was to evaluate the shear bond strength (SBS) of nano-hybrid (Nh.com) and nano-ceramic composite resins (Nc.com) to this feldspathic porcelains (Vita and Ivoclar). Settings and Design: 120 ceramic disc were fabricated from feldspathic porcelain. Materials and Methods: The following surface treatment was applied on the ceramic surface: 1) Hydrofluoric acid+silane, 2) Air-abrasion+silane, 3) Air-abrasion=Control group. Nh.com and Nc.com was placed on the porcelain surface. Half of the specimens were stored in 37 ± 2oC distilled water and another half were subjected to thermocycling before SBS. The samples placed in an universal testing machine and applied shear force until seperation occured. Statistical analysis used: The data were analyzed by multi-way analysis of variance (ANOVA) and Duncan test (P<0.05). Results: The results show that Ivoclar and Vita had almost equal fracture values. Nh.com showed high bond strength than Nc.com. In the Ivoclar porcelain, hydrofluoric acid etching had highest fracture values than other surface treatments, and in the vita porcelain air-abrasion had a little difference from hydrofluoric acid etching. Conclusions: Different surface treatments show different effect on SBS between feldspathic porcelain and composite resins.
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Effect of calcium channel blockers on gingival tissues in hypertensive patients in Lagos, Nigeria: A pilot study p. 565
Kehinde Adesola Umeizudike, Adetokunbo B Olawuyi, Theophilus I Umeizudike, Akinsanya D Olusegun-Joseph, Babawale T Bello
DOI:10.4103/ccd.ccd_536_17  
Background: Long-term treatment of common chronic cardiac conditions such as hypertension with calcium channel blockers (CCBs) has long been associated with gingival hyperplasia. This oral side effect may affect esthetics and function, yet often overlooked and therefore underreported among Nigerians. Aim: This study aimed to determine the association of CCBs with gingival overgrowth (GO) in hypertensive patients. Methods: This was a hospital-based, case–control study conducted among 116 hypertensive patients (58 CCB and 58 non-CCB age-matched controls) attending the medical outpatient clinic of a tertiary health institution in Lagos, Nigeria. Data collection tools included interviewer-administered questionnaires and periodontal examination. Sociodemographic details, medical history, and periodontal indices (gingival index, plaque index, class of GO according to drug-induced GO [DIGO] Clinical Index) were recorded. Results: The mean age was 59.4 ± 12.6 years, females representing 50.9%. In the CCB group, 39 (67.2%) participants were on amlodipine and 19 (32.8%) were on nifedipine. The mean duration of CCB use was 55.6 ± 53 months. DIGO was higher in CCB (36.2%) than that in non-CCB participants (17.2%) (χ2 = 4.4, P = 0.036). The risk of GO was higher in CCB users (odds ratio [OR] 2.7, [95% confidence interval (CI)]: 1.1–6.5). Amlodipine users had higher DIGO (37.5%) than that of nifedipine users (21.1%) (OR 2.3, [95% CI]: 1.0–5.3). The predominant class of DIGO among the CCB users was Class 2 DIGO Clinical Index (90.5%). Conclusion: The study reveals that the risk of GO is nearly three times in CCB than that of non-CCB users and twice higher in amlodipine than nifedipine users in Nigeria.
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Effect of ultraviolet irradiation on the osseointegration of a titanium alloy with bone p. 571
Ashish Yadav, Ranjana Yadav, Aratee Gupta, Akash Baranwal, Atul Bhatnagar, Vakil Singh
DOI:10.4103/ccd.ccd_576_17  
Introduction: Attempt has been made to analyze the potential of titanium (Ti) alloy for osteointegration by the effect of surface photo functionalization in different aspects as follows: in Ringer's solution, in vitro cell growth, and in vivo study on rabbit. The present study was aimed to investigate the influence of ultraviolet (UV) light on surface topography, corrosion behavior, and bioactivity of indigenously manufactured samples of Ti alloy mini-implant. Materials and Methods: The study includes surface modification of Ti samples by UV treatment, corrosion testing of the specimens using Potentiostat (GAMRY System), qualitative examination of modified surface topography using scanning electron microscope, and cellular viability test on Ti alloy surface (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide ASSAY). To find the effect of UV light on implant bone integration, biochemical test was performed on the femur of rabbits. Results and Discussion: Corrosion resistance of untreated Ti alloy in Ringer's solution was found to be less, whereas corrosion rate was more. Corrosion resistance of UV-treated samples was found to increase significantly, thereby lowering the corrosion rate. Cell growth in UV-treated specimen was observed to be higher than that in untreated samples. It is important to mention that cell growth was significantly enhanced on samples which were UV treated for longer duration of time. Conclusions: There was a marked improvement in cell growth on UV-treated Ti alloy samples. Hence, it is expected that it would enhance the process of osseointegration of Ti with bone. Another important finding obtained was that the removal torque values of UV-treated implants were higher than that of untreated implants. The overall result reveals that UV treatment of implants does help us in speeding up the osseointegration process.
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A radiographic study of the association between apical periodontitis and technical quality of intraradicular posts and root canal fillings: A cross-sectional study in Qassim Region, Saudi Arabia p. 579
Ra'fat Ibrahim Farah, Abdulrahman Sulaiman Aldakhili, Ayoub Sulaiman Alnasser
DOI:10.4103/ccd.ccd_605_17  
Objectives: This study evaluates the association between the apical periodontitis (AP) and quality of intraradicular posts and the quality of root fillings assessed radiographically in Qassim region, Saudi Arabia. Materials and Methods: Digital periapical radiographs of 327 teeth with post-retained restoration were retrieved randomly from the Qassim University screening clinic's digital archives and evaluated. The quality of the intraradicular post and root filling was evaluated according to the optimum criteria. The presence of AP was assessed based on the periapical index scoring system. The relation between the post technical quality, the quality of root filling, and AP was determined. The data were analyzed using Chi-square test and logistic regression. Results: AP was found in 22% of the investigated teeth. Adequate root fillings were found in 69% of roots, and 14% of these cases were associated with AP. In roots with root filling classified as inadequate, 38% had AP with a statistically significant association between the root filling length and the presence of AP (P < 0.001). The most frequently used posts were prefabricated metallic posts (57%). Teeth restored with cast posts and prefabricated metallic posts exhibited AP with a frequency of 42.3% and 25.4%, respectively, and teeth with nonmetallic posts had significantly fewer cases of AP (12.0%) with a statistically significant association between the post type and the presence of AP (P = 0.016). Conclusion: Both the quality of the root filling and the intraradicular post type were correlated significantly with the presence of AP. The technical quality of root fillings and intraradicular posts was adequate. Nevertheless, the use of threaded posts is still a common practice in this study population.
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Isolation and typing of Streptococcus mutans and Streptococcus sobrinus from caries-active subjects p. 587
Hamzah Abdulrahman Salman, R Senthilkumar, Khalid Imran, K Panneer Selvam
DOI:10.4103/ccd.ccd_610_17  
Background: Streptococcus mutans and Streptococcus sobrinus are main etiological agents of dental caries. Aim: The aim of the study was to isolate, identify, characterize, and determine the minimum inhibitory concentration (MIC) of S. mutans and S. sobrinus from caries-active subjects. Materials and Methods: Sixty-five plaque samples were collected from caries-active subjects aged between 35 and 44 years, processed and cultured on mitis salivarius bacitracin agar. All the bacterial isolates were subjected to morphotyping and the suspected colonies were identified by 16S rDNA sequencing. The S. mutans and S. sobrinus strains were characterized by biotyping and phylogenetic analysis. The MIC of ampicillin and erythromycin was determined by microtiter plate method. Results: Of the study population, 41 isolates displayed typical colony morphologies of S. mutans and S. sobrinus. The 16S rDNA sequencing results revealed that 36 isolates were S. mutans and 5 isolates were S. sobrinus. The biotyping of these isolates demonstrated three biotypes, namely, biotype I (n = 35), biotype III (n = 1), and biotype IV (n = 2). However, 3 isolates exhibited variant biotypes. The phylogenetic analysis revealed that the clinical strains of S. mutans and S. sobrinus clustered independently along with respective reference strains. The average MIC of ampicillin and erythromycin against S. mutans and S. sobrinus was 0.047 μg/ml and 0.39 μg/ml, respectively. Conclusion: The 16S rDNA sequencing was an impeccable method for S. mutans and S. sobrinus identification when compared with morphotyping and biotyping methods. The study also suggested that nonspecific bacteria might be involved in caries formation.
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Differential diagnosis between chronic versus aggressive periodontitis and staging of aggressive periodontitis: A cross-sectional study p. 594
Srinivas Sulugodu Ramachandra, Vivek Vijay Gupta, Dhoom Singh Mehta, Kalyan C Gundavarapu, Nibali Luigi
DOI:10.4103/ccd.ccd_623_17  
Background: Differentiating between chronic periodontitis (CP) and aggressive periodontitis (AgP) is challenging. The aim of this study was to assess the variations in diagnosis between CP versus AgP and the staging of AgP based on the disease-staging index for AgP among periodontists, specialists in oral medicine, and general dental practitioners (GDPs). Materials and Methods: Fifteen cases diagnosed as either CP or AgP were included in a “case document” and sent electronically to 75 respondents. Case document included a detailed history with periodontal charting, clinical features, images, and radiographs for all the cases. Diagnosis and staging for the case (if diagnosed as AgP) were requested. A reordered case document (cases in a different sequence) was again sent to respondents after a gap of 1 month. Statistical analysis: Descriptive statistics including frequency and percentage were calculated. Pearson's Chi-square test was used to analyze the data collected. Results: For the “case document,” 10.17% of the responses were different from those of the authors for diagnosis, whereas 4.48% of the responses were different from those of the authors for the staging of AgP. The agreement in the overall responses was in the range of 0.69–0.84, which was considered good. Comparison of the responses for diagnosis showed statistically significant (P = 0.009) difference between specialists in oral medicine and GDPs. Conclusions: Variations exist among respondents regarding the diagnosis of CP versus AgP. Staging of AgP based on the listed criteria showed low variations.
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Evaluating the effect of different conditioning agents on the shear bond strength of resin-modified glass ionomers p. 604
Namith Rai, Rajaram Naik, Ravi Gupta, Shobana Shetty, Amith Singh
DOI:10.4103/ccd.ccd_631_17  
Aim of the Study: This study aims to evaluate the effects three different conditioning agents on the shear bond strength of resin-modified glass ionomers to human dentin. Materials and Methods: One hundred and twenty recently extracted, caries-free premolars and molars will be cleaned of debris and disinfected in a 0.5% solution of sodium hypochlorite and sterile water for 30 min. The occlusal surface of each tooth will be reduced using conventional model trimmer with water to produce the dentin surface. Then, three different resin-modified glass ionomer cements (GICs) were triturated and mixed according to the manufacturer's instructions, 10 specimens will be made of each group. The excess restorative material will be removed from matrix band dentin interface with a sharp number 25 bard parker blade. Samples were shear tested with Instron universal testing machine with a crosshead speed of 0.5 mm/min. A shearing bar beveled to a 1 mm thick contact surface area will be placed at the junction of dentin and plastic band matrix. The load required for the failure will be recorded in pounds and converted to megapascals. Results: Statistical analysis was done with analysis of variance and Tukey's test. Ketac primer as conditioning agent along with Fuji II LC as restorative material had the highest shear bond value whereas intact smear layer which was unmodified dentin had the least value. Conclusion: Within the limitations of the present study, it can be concluded that surface conditioning of dentin resulted significantly higher bond strength than unconditioned dentin surfaces. Clinical Significance: Resin-modified glass ionomers have several advantages compared to chemically cured GICs. The advantages include command cure, ease of handling, improved physical properties, and esthetics. Resin-modified glass ionomers have been marketed as direct restorative materials for Class V lesions as well as liners, bases, and luting agents. Several conditioning agents have been evaluated to condition dentin before the application of conventional glass ionomers and resin-modified glass ionomers. These have mainly included polyacrylic acid, citric acid, phosphoric acid, and ethylenediamine tetra-acetic acid. Of late, manufactures have recommended other conditioners to replace polyacrylic acid which includes Ketac primer as one of the conditioning agents.
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An In vitro Comparison of pushout bond strength of resilon with MetaSEAL and AH plus sealers p. 613
Priyanka Sarangi, Rashmirekha Mallick, Sukanta Kumar Satapathy, Gaurav Sharma, Fathima Kouser, Satyajit Mohapatra
DOI:10.4103/ccd.ccd_666_17  
Aim: The aim of this study is to evaluate and compare the pushout bond strengths of Resilon with two different sealers: Resilon/MetaSEAL (methacrylate based) and Resilon/AH Plus (an epoxy resin-based sealer). Materials and Methods: Forty single canal anterior teeth were decoronated at cementoenamel junction and standardized to 10 ± 1 mm length. Working length was determined followed by biomechanical preparation. Then, the specimens were randomly assigned into two groups of 20 teeth each based on the sealer used with Resilon. All canals were obturated using single-cone obturation technique. Root samples were prepared for pushout testing. The universal testing machine gave the debonding force for individual specimen. This was done for all the specimens. Statistical Analysis: This was done by using unpaired Student's t- test. Results: The roots filled with Resilon/MetaSEAL had higher bond strength (1.49 ± 0.09 MPa) compared to Resilon/AH Plus (0.90 ± 0.04 MPa) group. The difference in bond strength was statistically significant (P = 0.0000). Conclusion: Through this pushout bond strength test, it could be noted that MetaSEAL did appear to bond to the dentin and could be used as a potential endodontic sealer.
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Modified angle's classification for primary dentition p. 617
Kaushik Narendra Chandranee, Narendra Jayantilal Chandranee, Devendra Nagpal, Gagandeep Lamba, Purva Choudhari, Kavita Hotwani
DOI:10.4103/ccd.ccd_714_17  
Aim: This study aims to propose a modification of Angle's classification for primary dentition and to assess its applicability in children from Central India, Nagpur. Methods: Modification in Angle's classification has been proposed for application in primary dentition. Small roman numbers i/ii/iii are used for primary dentition notation to represent Angle's Class I/II/III molar relationships as in permanent dentition, respectively. To assess applicability of modified Angle's classification a cross-sectional preschool 2000 children population from central India; 3–6 years of age residing in Nagpur metropolitan city of Maharashtra state were selected randomly as per the inclusion and exclusion criteria. Results: Majority 93.35% children were found to have bilateral Class i followed by 2.5% bilateral Class ii and 0.2% bilateral half cusp Class iii molar relationships as per the modified Angle's classification for primary dentition. About 3.75% children had various combinations of Class ii relationships and 0.2% children were having Class iii subdivision relationship. Conclusions: Modification of Angle's classification for application in primary dentition has been proposed. A cross-sectional investigation using new classification revealed various 6.25% Class ii and 0.4% Class iii molar relationships cases in preschool children population in a metropolitan city of Nagpur. Application of the modified Angle's classification to other population groups is warranted to validate its routine application in clinical pediatric dentistry.
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Scanning electron microscopic evaluation of efficacy of 17% Ethylenediaminetetraacetic acid and chitosan for smear layer removal with ultrasonics: An In vitro study p. 621
Aradhana Babu Kamble, Sathish Abraham, Deepak Dadarao Kakde, C Shashidhar, Disha Lalit Mehta
DOI:10.4103/ccd.ccd_745_17  
Introduction: The main aim of root canal treatment is cleaning, shaping and then obturating three dimensionally to prevent reinfection. This includes chemicomechanical cleansing by instrumentation and the use of irrigating solutions. Therefore, the purpose of this study was to compare the smear layer removal from root canal dentine subjected to two root canal irrigants, 17% EDTA and 0.2% Chitosan, a new irrigant using Scanning Electron Microscope. Methodology: 40 single rooted premolars were decoronated followed by instrumentation with I Race files and intermediate irrigation with 3% sodium hypochlorite and activation with ultrasonics. Then the samples were longitudinally sectioned and place in the respective test solutions and their controls for 5 minutes. Scanning Electron Microscopic evaluation was further carried out. Results: The results of the present study indicates that the Chitosan which was proved effective in removing smear layer. Conclusion: A moderate concentration of 0.2% chitosan removes the smear layer with greater efficiency.
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CASE REPORTS Top

Indirect sinus lift done using “Autogenous Core Lift” Technique in combination with alloplastic phosphosilicate putty in atrophic maxillary posterior region: A clinical report with 1-Year follow-up p. 627
Umesh Y Pai, Shobha Rodrigues, Puneeth Hegde, Nikita Khurana
DOI:10.4103/ccd.ccd_80_17  
Pneumatization of the sinus is a common occurrence after extraction of maxillary posterior teeth. Implant procedures require a clinically acceptable level of bone to be present for implants to be placed in function. Residual bone with >4 mm of height can be managed using the indirect sinus lift procedure, whereas bone height <4 mm requires a direct sinus lift using lateral window approach. This clinical case report describes the use of autogenous core used to lift the membrane in conjunction with calcium phosphosilicate putty using minimal armamentarium, thereby avoiding the associated morbidity and complications associated with a direct sinus lift procedure.
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18p deletion syndrome: Case report with clinical consideration and management p. 632
Megha Goyal, Mayuri Jain, Sachin Singhal, Kirty Nandimath
DOI:10.4103/ccd.ccd_129_17  
18p deletion syndrome is characterized by the deletion of short arm of chromosome 18. Presentation of this syndrome is quite variable with dysmorphic features, growth deficiencies, and mental retardation with poor verbal performance. Few patients even fail to thrive when malformations involving the heart and brain are severe. In the present article, we report an isolated case of 18p deletion in a 23-year-old female who for the first time reported to the hospital for dental problems. The patient was short statured with mental retardation and craniofacial, skeletal, dental, and endocrinal abnormalities. Such presentation warrants prompt diagnosis for effective management. Furthermore, genetic counseling for such patients and their families should be considered as a part of treatment itself.
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Toothpaste use protocol with dental bleaching for a conservative treatment: Case reports p. 637
Waldemir F. Vieira-Junior, Thayla H. N. Gouveia, Bruna G Silva, Vanessa C. P. S. Bueno, Flávio H. B. Aguiar, Débora A. N. L. Lima
DOI:10.4103/ccd.ccd_192_17  
In-office bleaching is a treatment based on products that contain hydrogen peroxide (HP) while demonstrating whitening effectiveness. HP could promote alterations to surface morphologies and properties of dental tissues. The objective was describe a toothpaste protocol associated to bleaching therapy to promote a safer approach. Patient 1 (male) and Patient 2 (female) were attended, and toothbrushing (twice a day) with a dentifrice containing bioactive glass (BG) (NovaMin™) and fluoride was indicated before and during the treatment. Three bleaching sessions were made in cases, at intervals of 7 days. The gels used were 35% HP (Patient 1) and 35% HP supplied with calcium (Patient 2). The effectiveness of bleaching treatment was observed in both cases (Vita scale), with an esthetic self-acceptance. Sensitivity associated with the procedure was not reported. The indication of BG-based toothpaste is relevant in relation to enamel properties and did not affect the whitening effectiveness of dental bleaching.
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Tetanus: A report of two cases and review of literature – A continuing threat to the elderly in Japan p. 642
Tsutomu Sugiura, Kazuhiko Yamamoto, Masatoshi Sato, Tadaaki Kirita
DOI:10.4103/ccd.ccd_259_17  
Tetanus has become rare in industrialized countries, largely due to the effectiveness of immunization. However, the elderly are susceptible to tetanus because many have not received primary immunization; the incidence of tetanus in Japan is still 120 cases/year. The initial symptoms of tetanus, such as trismus and dysphagia, are observed in the orofacial region. However, because of the disease's rarity, the clinician may be unfamiliar with the clinical presentation and may not suspect tetanus. We report two cases of elderly patients with generalized tetanus. Both patients presented trismus and/or dysphagia and consulted three different departments before the diagnosis of tetanus. Japanese clinicians will encounter tetanus more frequently than practitioners in other countries. Dental surgeons should be familiar with the clinical appearance of tetanus and should consider this disease in a nonimmunized patient presenting as an atypical case of trismus and dysphagia.
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The So-called Garrè's osteomyelitis of jaws and the pivotal utility of computed tomography scan p. 645
Marco Túllio Brazao-Silva, Tiago Novaes Pinheiro
DOI:10.4103/ccd.ccd_304_17  
The present paper draw the attention of clinicians to investigate multiple slices of the computed tomography (CT) scan looking for a safe diagnosis of the so-called Garrè's osteomyelitis (GO) of jaws, a not uncommon disease characterized by astonishing bone growth. We report a case involving the left mandible of a 12-year-old girl presenting with a bony enlargement at left mandible. Initial examination revealed carious process of tooth 36 with radiographic apical rarefaction. However, we need to take care with this diagnosis because other aggressive diseases may cause bone enlargement mimicking GO. We observed here that careful examination of CT slices must be elucidative. In the present case, we observed the formation of a hypodense channel between periapical disease and the bone growth, through CT, thus supporting the pathophysiologic conditions for GO and allowing a safer decision to make the intervention restricted to tooth.
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Surgical management of large radicular cyst associated with mandibular deciduous molar using platelet-rich fibrin augmentation: A rare case report p. 647
Vijaya S Dhote, Nilima R Thosar, Sudhindra M Baliga, Priyanti Dharnadhikari, Poonam Bhatiya, Punit Fulzele
DOI:10.4103/ccd.ccd_370_17  
Radicular cysts arising from deciduous teeth are rare and usually cause a large bony defect. Autologous platelet-rich fibrin (PRF) is an easily available healing biomaterial in oral surgical defect with the new perspective of accelerated healing of a large bony defect. The present case is of unusually large radicular associated with neglected carious mandibular deciduous second molar in 10-year-old girl and its surgical management with PRF augmentation as a healing biomaterial in the bony defect. One-year follow-up showed uneventful healing and eruption of succedaneous tooth. Healing was relatively faster and facilitated by PRF placement. Furthermore, the importance of anticipatory guidance about the treatment of diseased primary teeth and their preservation gets highlighted.
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Fragile X Syndrome: A rare case report with unusual oral features p. 650
Prayas Ray, Arpanna Singh, Jayanta Kumar Dash, Prasanna Kumar Sahoo, Jitendra Kumar Dash
DOI:10.4103/ccd.ccd_550_17  
Fragile X syndrome (FXS) is a rare variant of special health-care need demonstrating delayed developmental milestones and associated with intellectual and emotional disabilities ranging from learning problem to mental retardation. The syndrome is usually not diagnosed until 8–9 years of age since the clinical manifestations of the syndrome are greatly attenuated in childhood. The physical characteristics such as facial features, hyperactivity, attention deficit, autistic behavior, and macroorchidism are quite evident in younger age group. The most typical orofacial characteristics associated with children suffering from FXS are mandibular prominence, ogival, and cleft palate. Till date, very few dental literatures have been reported regarding the association of FXS with orodental anomalies. Here, we report a rare case of 14-year-old boy suffering from FXS with typical orofacial characteristics, multiple supernumerary teeth, and dental caries.
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Glandular odontogenic cyst: Case series p. 653
Gokhan Gurler, Humam Al-Ghamian, Nihan Aksakalli, Cagri Delilbasi
DOI:10.4103/ccd.ccd_554_17  
Glandular odontogenic cyst (GOC) is an uncommon and aggressive jaw cyst with a high recurrence rate. It may grow into a large size. Diagnosis of the cyst is challenging since it may be confused with some other jaw cysts and malignancies. Treatment methods vary from conservative surgery to radical bone resection. In this case series, we briefly present five cases of GOC diagnosed and treated at our clinic. Thorough histopathological diagnosis and long-term follow-up are necessary in patients with GOC.
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Orthodontic camouflage: A treatment option – A clinical case report p. 658
William Ubilla Mazzini, Fátima Mazzini Torres
DOI:10.4103/ccd.ccd_555_17  
Orthodontic camouflage provides an alternative treatment for angle III malocclusion since patients with limited economic resources cannot opt for orthognathic surgery, it being clear that correction will be achieved at the dental level and not at the bone complex. Objective: To determine an alternative treatment for patients who do not have the possibility of having orthognathic surgery. Clinical case: A 13-year-old female patient, dolico facial biotype with slightly concave profile, with Class III Skeletal by mandibular prognathism, anterior crossbite, anterior diastema, and large mandibular body, molar class, and canine III. Alexander technique brackets were placed; premolar extraction was not planned. Once the case was completed, the correction of the anterior crossbite was achieved, thanks to the use of the spaces that existed at the beginning of the treatment and also that a correct distalization of canines and retraction of the lower anterior segment were performed.
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Mucormycosis in a diabetic patient: A case report with an insight into its pathophysiology p. 662
Syeda Neelam Afroze, Rajani Korlepara, Guttikonda Venkateswara Rao, Jayakiran Madala
DOI:10.4103/ccd.ccd_558_17  
Mucormycosis is one of the most rapidly progressing and fulminant forms of fungal infection which usually begins in the nose and paranasal sinuses following inhalation of fungal spores. It is caused by organisms of the subphylum Mucormycotina, including genera as Absidia, Mucor, Rhizomucor, and Rhizopus. The incidence of mucormycosis is approximately 1.7 cases per 1,000,000 inhabitants per year. Mucormycosis affecting the maxilla is rare because of rich blood vessel supply of maxillofacial areas although more virulent fungi such as Mucor can overcome this difficulty. The common form of this infection is seen in the rhinomaxillary region and in patients with immunocompromised state such as diabetes. Hence, early diagnosis of this potentially life-threatening disease and prompt treatment is of prime importance in reducing the mortality rate.
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Localized gingival overgrowths: A report of six cases p. 667
Sohini Banerjee, TK Pal
DOI:10.4103/ccd.ccd_624_17  
Localized gingival overgrowths are commonly encountered in our day-to-day clinical practice and often present a diagnostic dilemma to the clinicians. These lesions vary depending on the location, site, extent, histology, and/or etiopathology. Although most of the localized gingival enlargements represent the reactive lesion to plaque accumulation, the differential diagnosis ranges from peripheral fibroma to pyogenic granuloma to peripheral fibroma with ossification and/or calcification, peripheral giant cell granuloma, etc., Even the peripheral ameloblastoma may present clinically as a mere localized gingival enlargement. Therefore, proper histopathological diagnosis along with biopsy is necessary to effectively manage these lesions and to reduce their propensity for recurrence.
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Treatment of a Class II malocclusion with deep overbite in an adult patient using intermaxillary elastics and spee curve controlling with reverse and accentuated archwires p. 672
Fabrício Pinelli Valarelli, Ronaldo Carniel, Paula Patrícia Cotrin-Silva, Mayara Paim Patel, Rodrigo Hermont Cançado, Karina Maria Salvatore Freitas, Marcos Roberto de Freitas
DOI:10.4103/ccd.ccd_625_17  
This paper aimed to describe the orthodontic treatment of an adult patient with the following characteristics: asymmetric Class II malocclusion, left subdivision, mandibular midline shifted to the left, mild mandibular anterior crowding, excessive overbite, 4-mm overjet, and a brachycephalic facial pattern. A 31-year-old male patient, treated with fixed preadjusted appliance with Roth prescription, with leveling and alignment NiTi archwire sequence. To correct the asymmetric Class II malocclusion, midline shift as well the overjet and overbite, intermaxillary elastics and accentuated and reversed stainless steel archwires were used, respectively. The posttreatment results showed a Class I molar relationship, as well the overjet and overbite correction. These results could be achieved due to a correct treatment plan and so to the patient cooperation.
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Taking a glance at anterior crossbite in children: Case series p. 679
Derya Ceyhan, Canan Akdik
DOI:10.4103/ccd.ccd_633_17  
Anterior crossbite is a malocclusion that takes place for various reasons, leads to major problems and may be fixed using various methods. This study aimed to provide an update regarding the methods used for anterior crossbite treatment presenting treatments of the removable active acrylic appliance with bite plane. Clinical examination of aged 9–15, seven healthy children who visited our clinic due to crowding and esthetic displeasure in anterior teeth indicated that one or more permanent maxillar incisor teeth were positioned behind of permanent mandibular incisor teeth. After clinical-radiographical examinations, removable active acrylic appliances with bite plane were decided to apply. Patients with adapted-activated appliances were called to follow-ups once a week. Treatments continued 4–6 weeks in mixed dentition, 7–8 weeks in permanent dentition. In choosing the method, advantages-disadvantages, indications-contraindications of methods should be discussed. Correct indication and suitable motivation are important for the success of anterior crossbite treatment.
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