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   Table of Contents - Current issue
October-December 2019
Volume 10 | Issue 4
Page Nos. 583-685

Online since Wednesday, May 27, 2020

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Putting an end to ENDS (electronic nicotine delivery systems) p. 583
Girish Malleshappa Sogi
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An Indian dentist becomes the president of the American Dental Association Highly accessed article p. 585
Girish Malleshappa Sogi
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mOral health in India: Current scenario and future perspectives p. 586
OP Kharbanda, Harsh Priya, Upendra Singh Bhadauria, Charu Khurana, Diptajit Das
Oral diseases affect half of the world's population and found to be the most common and preventable noncommunicable diseases worldwide. The World Health Organization Oral Health Programme work plan 2018–2020 is to prevent the burden of oral diseases using digital technology. With 5 billion mobile phone subscribers in the world, covering over 85% of the world's population, the utilization of technology-based interventions for oral health promotion is no different. In India, numerous medical applications such as eRaktkosh and mDiabetes have been developed for the improvement of general health, whereas few initiatives such as mCessation and National Quitline services for oral health have been undertaken. Digitalization and oral health forms a crucial component in the future of oral health, which should be utilized in ensuring oral health for all.
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Comparative evaluation of three abutment–implant interfaces on stress distribution in and around different implant systems: A finite element analysis p. 590
Vishwas Kharsan, Vaibhav Bandgar, Aftab Mirza, Kiran Jagtiani, Neha Dhariwal, Rahul Kore
Aim: This study was conducted to compare and evaluate the effect of three abutment–implant connections on stress distribution around three different implants under similar material properties and loading condition using finite element analysis (FEA). Materials and Methods: Three different types of implant–abutment connections were selected. The features of these connections are Sample A: Tri-channel internal connection (Nobel Biocare); Sample B: Internal conical-hex Morse Taper (ADIN); and Sample C: Internal octa-Morse taper method (Osstem). The following softwares – ANSYS Version: 14.5 for FEA; Meshing software: Hypermesh 11; and CATIA: to produce computerized models of implants and for mandibular modeling were used. The implants were scanned with a high-quality scanner. All the above data were used to produce computerized models by CATIA software. Within the implant system, finite element method modeling was performed by implementing bonded conditions on the abutment–implant interfaces implementing four different load conditions. The computerized model was transferred to ANSYS software. A statistical analysis was done to compare the groups. Results: The samples were evaluated using three-dimensional FEA analysis. It was found that stress at 100 N, 100 N with 15° tilt, 300 N, and 300 N with 15° tilt was found to be highest in Sample A followed by Sample C and Sample B, and the difference was statistically insignificant. Conclusion: Within the limitations of the present study, the tri-channel internal connection showed maximum stresses and least by the internal conical-hex Morse Taper and internal octa-morse taper connection.
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Oral health status of middle-aged (45–55 Years) rural women: A cross-sectional study from North India p. 595
Avijit Avasthi, Koratagere LingappaVeeresha, Danish Bilal
Aim: This study aimed to assess the oral hygiene practices and oral health status of middle aged (45–55 years) women residing in rural areas of Ambala district (Haryana). Materials and Methods: In this cross-sectional study, 79 villages were selected using simple random sampling technique through an online randomizer. The study participants (780) were selected through convenience sampling and oral health status was (dental caries, periodontal status, prosthetic needs, and dental fluorosis) recorded on a self-structured format based on World Health Organization Criteria (WHO, 1997). Group comparisons were done by using Chi-square test for categorical data. Results: In the present study, 69.2% of the study participants used toothbrush and toothpaste for cleaning teeth. Women in the age group of 45–50 years had lower mean Decayed, Missing and Filled Teeth (7.80 ± 5.21) when compared with the age group of 51–55 years (9.77 ± 6.16). Ninety-eight percentage of the women were in need of dental prosthesis. Among the study participants, 56.5% had 4–5 mm loss of attachment (LOA) and 23.2% had 6–8 mm of LOA. Difference between the need for multiunit dental prosthesis among the age groups (45–50 years) and (51–55 years) was statistically significant (P < 0.05). Conclusion: Thus middle-aged women residing in rural area have high oral care need; however, there is quite a gap between the need for dental care and the amount of dental care utilized.
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Shear bond strength and bonding properties of orthodontic and nano adhesives: A comparative In-Vitro study p. 600
Rabia Bilal, Bilal Arjumand
Introduction: Nano restorative composites have been successfully used in restorative dentistry and have high strength and wear resistance. Conventional orthodontic adhesives also possess optimal strength to withstand occlusal forces. This study was done to compare the shear bond strength (SBS) of orthodontic bracket after bonding with nanorestorative composite and orthodontic adhesives. Materials and Methods: This in-vitro experimental study used sixty extracted teeth (divided into two groups). In Group A (n = 30), the brackets were bonded with Filtek Z350 (3M/Unitek, Monrovia, California, USA), a nano ceramic restorative composite, and in Group B (n = 30), the brackets were bonded with Transbond XT (3M/Unitek, Monrovia, California, USA), a conventional orthodontic adhesive. The SBS of the orthodontic brackets was measured using a universal testing machine. The modified 0–5-scale adhesive remnant index (ARI) was used to assess the amount of adhesive on enamel and bracket surfaces. The surface topography was observed to evaluate enamel damage. Results: The mean (standard deviation [SD]) SBS of 11.07 (1.96) Mega Pascal (MPa) was observed with Filtek Z350, whereas the group bonded with Transbond XT showed the mean (SD) SBS of 12.18 (1.69) MPa. The results showed that Transbond light curing adhesive produced higher SBS than Filtek, but the difference was statistically insignificant (P = 0.088). The comparison of ARI score between the two groups also showed statistically insignificant difference (χ2 = 4.764, df = 5, P = 0.445), and most of the teeth in both groups exhibited score 3 (63%), showing the least damaging mode of bond failure to the enamel bracket interface. Conclusion: There was no significant difference in the mean SBS of Filtek Z and Transbond XT adhesives. Both materials showed optimum bond strength to withstand occlusal forces.
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Comparative evaluation of the remineralizing potential of commercially available agents on artificially demineralized human enamel: An In vitro study p. 605
Chintan Joshi, Uma Gohil, Vaishali Parekh, Surabhi Joshi
Background: Caries is highly prevalent multifactorial disease, but its progression can be prevented in the initial stage of demineralization through remineralization (RML). Various materials have been proposed for the same, successful outcome can prove to be a boon in the prevention of caries. Aim: The aim of the study is to assess the RML potential of four commercially available agents so as to restore the enamel closest to its previous microhardness levels. Materials and Methods: Sixty permanent intact premolars were randomly divided into six groups: Four test groups – (1) bioactive glass (BAG) Novamin (SHY-NM), (2) nano-hydroxyapatite (nHAp) (Acclaim), (3) functionalized tricalcium phosphate (f-TCP) (Clinpro Tooth Crème), and (4) grape seed extract (GSE); one positive control – (5) fluoride (1000 ppm) containing dentifrice (Colgate Calci-Lock); and one negative control – (6) distilled water. The samples were initially evaluated for baseline surface microhardness (SMH); later on, these samples were placed in the demineralizing solution for 48 h in an incubator at 37°C, and postdemineralization again SMH was measured. Thereafter, the samples were subjected to the pH cycling for consecutive 21 days, and SMH was recorded. The SMH was evaluated using a Vickers microhardness tester. Statistical analysis was done using a post hoc Tukey test for each group based on the stage of treatment and one-way ANOVA for comparison among different groups. Results: BAG Novamin showed SMH recovery at 96.75% followed by f-TCP at 95.83%, nHAp at 90.88%, and GSE at 48.71%. Statistically significant differences were observed between the first three groups and the rest of the groups after RML stage. Conclusion: BAG Novamin, f-TCP, and nHAp showed considerable RML followed to a lesser extent by GSE.
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Barriers of restorative care among dental patients in Jeddah: A cross-sectional analytical survey p. 614
Amit Vanka, Othman Wali, Shanthi Vanka, Mohammed Baabod, Sajda Khan Gajdhar, J P L N Sastry
Introduction: The epidemiological data in the Kingdom of Saudi Arabia indicate that there has been increased prevalence of dental caries and increased treatment needs, with negligible rates of restorative care among the population. The restorative treatments done among the population are very limited. There are no published reports that systematically document the barriers of restorative care among the residents of Jeddah. Aim: This present paper is a humble attempt toward the study of barriers of restorative care and systematic documentation of the dental patients in a private dental school in Jeddah. Materials and Methods: The methodology adopted by the study is the preparation of a questionnaire after validation and analyzing the responses from the sample of the universe of dental patients in Jeddah. The questionnaire broadly included (1) fear of consulting a dentist, (2) dental anxiety/fear to receive dental care, (3)cost of dental treatment, (4) fee for restoration, (5) pain, and (6) experience of a dentist (fear that a student may treat them). The completed questionnaire of 22 questions was proofread by a group of general dentists to check for clarity and meaning of the statements. After the changes, the questionnaire was distributed to 275 patients. The analysis of the data in the study was done by the SPSS version 23. Chi-square was calculated for the analyses of all the independent variables. Results: 41.4% of people have fear to visit a dentist. Hence, this is one of the barriers of restoration. Nearly 50% have responded that restorative treatment is painful. In addition, the experience of the dentist has an impact on the respondents getting treatments in the dental clinic. 76% of the respondents have a fear when a student who has lesser experience will be treating them in the dental clinic. Conclusion: Dentists have to distinguish between perceived barriers and the real barriers to choosing restorative treatments.
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Volumetric analysis of root canal filling in deciduous teeth after using different canal-drying methods: An In-vitro study p. 622
CS Sri Darshini, Preetha Peethambar, Sapna Konde, Manisha Agarwal
Background: Drying the root canals in pulp therapy is often ignored, but is essential for a successful clinical outcome. The conventional method used for drying root canals is by the use of paper points, but recently, various other methods have also been employed for this purpose. Aim: The purpose of this study was to volumetrically analyze root canal fillings in deciduous teeth, after using different canal-drying methods namely 95% ethanol, CANAL CLEAN (Cerkamed Medical Company), and Endo-Aspirator (Cerkamed Medical Company), and compare with the conventional paper point drying method. Methodology: Access cavities were prepared on eighty extracted primary canines, and irrigation was done with 1% sodium hypochlorite and normal saline while enlarging the canals. The specimens were then scanned using a cone-beam computed tomography (CBCT), and preobturation volume (X) of each tooth was measured. The teeth were then randomly divided into two groups – Group 1 – Zinc oxide eugenol (ZOE) group and Group 2 – Metapex group. Each group was further divided randomly into four subgroups based on the drying agent used – Subgroup A – Control group, Subgroup B – 95% ethanol group, Subgroup C – CANAL CLEAN group, and Subgroup D – Endo-Aspirator group. After obturation, a second CBCT was taken to measure the postobturation volume (Y). The percentage of obturated volume was calculated by the following formula: (postobturation volume/preobturation volume) ×100 ([Y/X] ×100). Statistical Analysis: The obtained data were tabulated and subjected to statistical analysis using one-way ANOVA test and unpaired t-test. Results: A significantly high postobturation volume was seen after using 95% ethanol followed by CANAL CLEAN, Endo-Aspirator, and paper points. On comparing the obturation volumes within Metapex and ZOE groups, Metapex group had significantly high obturation volumes irrespective of the drying method used. Conclusion: 95% ethanol is the best intracanal drying agent as it provides optimum pupal obturation.
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Complement receptor 1 (CR1)/ CD35+ expression analysis of salivary neutrophils on Streptococcus mutans phagocytosis p. 627
Muhammad Luthfi, Retno Indrawati, Aqsa Sjuhada Oki, Muhaimin Rifa'i
Background: Severe early childhood caries (S-ECC) is a form of dental caries which is very destructive in early childhood since involving several teeth, include the maxillary anterior teeth. Streptococcus mutans (S. mutans) play an etiological integral role of ECC so that S. mutans are considered as the predictor of dental caries. The neutrophil is a key component of the rst line of defense against microbial invasion. The essential function of neutrophil is to kill pathogenic microbes through a phagocytosis process which is mediated by Complement Receptor 1 (CR1)/ (CD35+). Aims and Objectives: To analyze the phagocytosis process of the salivary neutrophil which is mediated by innate immunity component, i.e., Complement Receptor 1/CR1 (CD35) on S-ECC. Materials and Methods: his study was an observational analysis with cross-sectional approach using t-test analysis. This study employed the isolation steps of neutrophils saliva of caries-free children and the S-ECC and then conducted phagocytosis of salivary neutrophils test on S. mutans mediated by CD35 using ow cytometry. Results: Phagocytosis of salivary neutrophils on S. mutans mediated by CD35 on caries-free (2.35 ± 0.56) is higher than that on the S-ECC (1.54 ± 0.35). Conclusions: It is concluded that there is a decrease of phagocytic on S. mutans mediated by Complement Receptor 1/CR1 (CD35+) on S-ECC.
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Comparison of push-out bond strength of three different obturating systems to intraradicular dentin: An In vitro study p. 631
Mohammed Khwaja Moinuddin, L Karthik Prasad, Nimeshika Ramachandruni, Shekar Kamishetty, Ravi Chandra Cherkupalli
Background: To increase the push-out bond strength of endodontic materials, newer obturation materials and obturation techniques are being introduced. Aim: The present study aimed to evaluate the push-out bond strength of three different obturating materials using a universal testing machine (UTM). Materials and Methods: A total of thirty freshly extracted maxillary anterior teeth were collected and randomly divided into three groups of ten each. Biomechanical preparation was done in all the teeth, and they were then divided into three experimental groups according to the obturation material and technique used, as follows: Group I: gutta-percha (GP) with AH Plus root canal sealer (lateral condensation); Group II: thermoplasticized GP technique – noncarrier based (CALAMUS®) with AH Plus sealer (backfill); and Group III: C-points (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected to push-out test using the UTM, where the punch moved in an apical to coronal direction at a crosshead speed of 0.5 mm/min, which resulted in the displacement of the filling material. The depth of dye penetration was examined under a stereomicroscope at ×30 magnification. Results: All the analyses were performed using SPSS software version 16. P < 0.05 was considered statistically significant. Comparisons of mean values were done using ANOVA with post hoc Games–Howell test and ANOVA with post hoc Tukey's test. Group III demonstrated the highest mean push-out bond strength and Group I exhibited the least bond strength. A statistically significant difference was found between Group III and Group I with regard to the push-out bond strength assessment. Conclusion: Push-out bond strength differs among different obturation materials and obturation techniques.
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Interrelation of cardiovascular diseases with anaerobic bacteria of subgingival biofilm p. 637
Elena Nikolaevna Nikolaeva, Viktor Nikolaevich Tsarev, Tatyana Viktorovna Tsareva, Evgenii Valeryevich Ippolitov, Sergey Darchoevich Arutyunov
Aims: The aim of this study is to study the colonization of subgingival biofilm (SGB) with periodontopathogenic bacteria species and endothelium-dependent vasodilation in patients with coronary heart disease and concomitant periodontitis. Subjects and Methods: Forty-five patients with cardiovascular diseases (CVDs) were examined – 28 women (62%) and 17 men (38%) aged 53–76 years, including 15 patients with acute myocardial infarction (AMI), 15 patients with exertional angina (pectoris), and 15 patients with chronic periodontitis (CP) without CVD. Dental and cardiological health conditions were determined, a biochemical blood test was conducted, endothelium-dependent vasodilation in the brachial artery was measured, and DNA of periodontopathogenic bacteria in SGB was detected. Results: A reliable interrelation between the colonization of SGB with periodontopathogenic bacteria and development of AMI was established. In AMI patients, the frequency of Porphyromonas gingivalis, Tannerella forsythia, and Aggregatibacter actinomycetemcomitans detection was significantly higher than in the group of participants without cardiovascular disease. The presence of P. gingivalis and A. actinomycetemcomitans in patients with CP directly correlated with severity of periodontal tissue destruction. Endothelium-dependent vasodilation in the brachial artery moderately correlated with patient's cardiological condition (r = 0.3284), biochemical markers of atherosclerosis development (r = 0.6465), and frequency of P. intermedia detection in periodontal pockets (r = 0.3828). Conclusions: Periodontal status in patients with AMI is characterized by unsatisfactory and poor hygiene, increased indices of bleeding on probing, and periodontal pocket depth in comparison to groups of patients with angina pectoris and CP without cardiovascular pathology.
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Efficacy of platelet-rich fibrin in interdental papilla reconstruction as compared to connective tissue using microsurgical approach p. 643
Dhanavendra Singh, Rajesh Jhingran, Vivek Kumar Bains, Rohit Madan, Ruchi Srivastava
Aim: This study aims to evaluate autologous platelet-rich fibrin (PRF) and autogenous connective tissue graft (CTG) in interdental papilla (IDP) reconstruction with buccal and palatal split-thickness flap (STF) using microsurgical technique. Materials and Methods: Forty Class I or Class II open gingival or cervical embrasure in maxillary anterior region in 14 patients were surgical treated for the reconstruction of IDP. For experimental Group I (STF with PRF, n = 20), surgical site was flushed with PRF fluid. PRF was then placed under the buccal flap and in the IDP region and squeezed. For experimental Group II (STF with CTG, n = 20) after the preparation of recipient site, CTG procured from palate was trimmed to the desired size and shape and placed at the site. Clinical parameters and patient satisfaction response recorded were plaque index, gingival index, probing pocket depth, clinical attachment level, height of IPD, and papilla index score (PIS). Results: STF surgery in combination with PRF or CTG, are an effective procedure to increase IDP-height with mean values of 3.10 mm (87.3%) and 3.45 mm (95.8%) for Group I (STF + PRF) and Group II (STF + CTG), respectively. In terms of complete fill (CF) achieved at 3 months, in the present study, the result showed that 90% CF was obtained in Group I (STF + PRF) and 95% in Group II (STF + CTG). The patient response and acceptance for surgical treatment modality in terms of patient postsurgical discomfort score and patient esthetic score was higher for Group II (STF + CTG) than Group I (STF + PRF). Conclusion: Based on single-centered 3 months' follow-up, it may be concluded that STF surgery in combination with PRF or CTG is an effective procedure to increase IDP-height; however, a long-term multicentric randomized clinical trial may be necessary to evaluate the clinical outcome for autologous PRF in comparison to CTG with STF.
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Evaluation of histological and pH changes in platelet-rich fibrin and platelet-rich fibrin matrix: A In vitro study p. 652
Shruthi Nagaraja, Sylvia Mathew, Rajanikanth B Rajaram, C Pushpalatha, Anil Abraham, Shashank Chandanala
Background: The autologous platelet concentrates (PCs), such as platelet-rich fibrin (PRF) and platelet-rich fibrin matrix (PRFM), are processed through different centrifugation protocols, which can affect their biological properties and in turn influence treatment outcome. The pH value can influence the process of wound healing directly or indirectly. Hence, a study was conducted to evaluate fibrin network pattern, initial pH of obtained matrix, and its changes during degradation matrix and to determine platelet and leukocyte count in PRF and PRFM. Materials and Methods: Blood from the volunteers was collected in blood vacutainers for processing PRF and PRFM. It was centrifuged as per the standard protocol. Serum from PRF and PRFM was subjected for analysis of platelet and leucocyte concentration using Hemo-Analyzer. The pH of PRF and PRFM were evaluated over 5 days using a pH meter. PRF and PRFM were subjected to histological and scanning electron microscopic analysis. Results: There was no significant variation in the platelet and leukocyte count between PRF and PRFM. A steady rise in the level of pH with respect to PRFM was observed, whereas there was a decrease in the pH levels in PRF. Fibrin network was denser in PRF compared to PRFM. Conclusion: The PCs undergo variation in pH upon degradation. Formation of fibrin matrix is influenced by the method of preparation. Fibrin pattern is crucial to facilitate adhesion of cells and transport of nutrients to enable proliferation and differentiation of mesenchymal cells and better wound healing.
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Effect of incorporation of nanoclay on the properties of heat cure denture base material: An In vitro study p. 658
Angel Mary Joseph, Suja Joseph, Nicholas Mathew, Ashwin Thomas Koshy, Namratha L Jayalakshmi, V Mathew
Purpose: The aim of the study was to evaluate the effect of incorporation of organically modified nanoclay in 1%, 3%, and 5% by weight on the flexural strength, surface hardness, and linear polymerization shrinkage of heat cure denture base material. Materials and Methods: One hundred and twenty specimens of heat-polymerized acrylic resin were fabricated. The specimens were divided into four groups (n = 10) coded I to IV. Group I was the control group (unmodified acrylic resin specimens). The specimens of the remaining three groups were reinforced with nanoclay (organically modified montmorillonite) nanoparticles to achieve loadings of 1%, 3%, and 5% by weight. The resulting nanocomposites were subjected to mechanical testing and were characterized using X-ray diffraction, scanning electron microscope, and transmission electron microscope. Results: The statistical analysis showed that there was no significant increase in flexural strength within and between the groups. The most significant increase in surface hardness was observed between Group I (control) and Group II (1% nanoclay). Linear polymerization shrinkage of the specimens showed a significant decrease in the control and all the experimental groups. Conclusion: Addition of 1 wt% nanoclay to polymethyl methacrylate heat cure denture base material could enhance the surface hardness and reduce the linear polymerization shrinkage of the resin. However, there was no significant increase in flexural strength of the resulting nanocomposite.
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Nonsyndromic familial congenital lower lip pits p. 664
Chaitali Hambire, Umesh Hambire
Congenital pits on lower lips unassociated with any syndrome are a rare developmental malformation. Vermilion border of the lower lip is the most common site of occurrence. Mostly, these lip pits are inherited as an autosomal dominant trait with variable penetrance. The females are more affected than males. This is a case report of a 7-year-old female child with nonsyndromic congenital lower lip pits, where two of her other family members were also affected.
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Re-invigoration of pink esthetics by a novel minimally invasive technique: A report of two cases p. 668
Himani Sharma, Divya Dureja, Ritika Arora
The importance of pink esthetics as well as increased patient comfort has been gaining its pace in dentistry. Moreover, when it comes to the treatment of gingival recession, the ideologies of the periodontists have changed over time, i.e., from “extension to prevention;” it has now become “conserve to preserve.” Utilizing this same principle, pinhole technique was introduced comprising sutureless surgery with minimal surgical intervention, thus providing maximum comfort to the patient while undergoing treatment and postoperatively. This article presents a case report of two cases who were treated with a minimally invasive pinhole surgical technique, with complete root coverage and minimal complications.
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Various treatment modalities in aggressive periodontitis p. 672
Priya Dayashankar Chaurasia, Deepika Pawar Chandrashekara Rao, Eeshita Bhowmik
This is a case report of an 18-year-old female diagnosed with localized aggressive periodontitis. Following basic scaling and root planing, flap surgery was performed in all the four quadrants using various regenerative materials. A follow-up of 2½ years shows improvement in clinical and radiographic parameters, with no recurrence of the disease process.
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Sclerosing polycystic adenosis of hard palate: A rare entity in salivary glands p. 676
Priyanka Guduguntla, Rajani Korlepara, Venkateswara Rao Guttikonda
Sclerosing polycystic adenosis (SPA) is a rare neoplasm of salivary glands, with a striking resemblance to the benign fibrocystic disease of the breast. The most common site of occurrence is the parotid gland. However, submandibular gland, minor salivary glands, and buccal mucosa may also be affected. It shows a slight female predilection and occurs over a wide age range. The exact nature of the disease is unknown but is postulated to be a neoplasm recently. The treatment is effective by localized surgical excision, and recurrence is rare. To the best of our knowledge, there is only one case report of SPA involving palate. Here, we describe an additional case report of SPA occurring in the palatal region of a 49-year-old male patient.
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Oral submucous fibrosis in a 5 year old child p. 679
Harshavardhan Talla, PV Ravindranath Reddy, Mahesh Mudavath, Tejaswi Bathina
Oral submucous fibrosis (OSMF) is one of the potentially malignant disorders (PMDs), predominantly observed in adults with a habit of chewing areca nut. A rapid increase in the use of commercially available nicotine products, especially among the children and adolescents, is a reason for consequential concern. Nicotine products remain to be the chief etiological factor, which increases the susceptibility of the oral mucosa to different kinds of PMDs irrespective of the age groups. Here is a case report of oral submucous fibrosis in a 5-year-old child, highlighting a strong association of areca nuts in the causation of OSMF.
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Vestibular incision subperiosteal tunnel access with titanium-prepared platelet-rich fibrin – A golden approach for treating multiple recession defects in esthetic zone p. 682
Manvi Chandra Agarwal, Priyansha Rathore, Shiva Shankar Gummaluri, Prerna Agarwal, Sanju Kumari
Gingival recession is defined as apical migration of marginal gingival tissue causing the exposure of root surface. Abnormal brushing techniques, trauma, anatomical presence of tooth, caries, and improper oral hygiene measures are some of the problems leading to gingival recession. Several treatment modalities such as coronary advanced flaps and free gingival grafts have been used for the treatment of gingival recession defects and showed good results. However, while treating multiple gingival recessions, some new treatment modalities were introduced in literature. Vestibular incision subperiosteal tunnel access (VISTA) as a minimally invasive technique for root coverage was introduced with various advantages such as no secondary surgical site needed for harvestment of donor tissue and it provides excellent esthetic results with decreased patient morbidity. The present case report emphasizes on the treatment of multiple gingival recessions in the maxillary anterior teeth region using VISTA with titanium-prepared platelet-rich fibrin.
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