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   Table of Contents - Current issue
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October-December 2020
Volume 11 | Issue 4
Page Nos. 299-407

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GUEST EDITORIAL  

Our role in the changing face of research p. 299
AR Prabhakar
DOI:10.4103/ccd.ccd_937_20  
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REVIEW ARTICLES Top

Biomimetic properties of engineered periodontal ligament/cementum in dental implants p. 301
Anil Mathew, Anna Serene Babu, Arun Keepanasseril
DOI:10.4103/ccd.ccd_196_20  
The conventional concept of osseointegrated dental implants based on direct connection to alveolar bone lacks a structured periodontal ligament (PDL) as in natural tooth. This limits the physiologic and functional efficiency of the implant in cushioning occlusal overload, orthodontic tooth movement, and proprioception. Development of bio-mimetic implants that can satisfy the bio-functional requirements of the natural tooth will be an innovative approach and preliminary researches in this area has been reported. This review includes in vivo studies which reported structural features and functional efficiency of an artificial PDL or cementum developed around dental implants. The electronic search identified 12 animal studies and one human trial which utilized retained or adjacent natural tooth roots, exogenous scaffold materials, dental progenitor cells derived from PDL of extracted tooth root as PDL substitutes. The result of the review is dominated by bio-hybrid implants that used dental follicles separated on the particular embryonic day and cell sheets from immortalized human cells. A summary of the currently available research on artificial PDL/cementum around dental implants highlights the potential need of autologous cell-derived tissues to bioengineer a fully functional implant design
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Efficacy of herbal interventions in oral lichen planus: A systematic review p. 311
Ashita R Kalaskar, Rahul R Bhowate, Ritesh R Kalaskar, Sheelpriya R Walde, Rachana D Ramteke, Priyanka P Banode
DOI:10.4103/ccd.ccd_320_20  
Introduction: Oral lichen planus (OLP) is a chronic autoimmune condition requiring prompt treatment to alleviate the signs and symptoms. There is weak evidence emphasizing the efficacy of any one therapy. Steroids, of all the therapies, have proved to be effective and hence considered as the standard care for OLP. However, the complications associated with it further worsen the patient's condition. Alternative safe approaches such as herbal interventions (HIs) have been tried in OLP. Their efficacies could only be evaluated from properly designed research protocols such as randomized controlled trials (RCTs). The present systematic review aims to assess the efficacy of HIs compared to steroids in RCTs involving OLP. Materials and Methods: An extensive search for HIs in OLP was conducted in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and gray literature. Eight studies fulfilled the eligibility criteria. Results: In all the studies, clinical severity was significantly reduced in within-group comparisons, whereas between-group comparisons showed nonsignificant results, except for total glucosides of paeony capsules. Conclusion: Efficacy of herbal therapy in OLP should be weighed against the high bias in the studies.
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ORIGINAL ARTICLES Top

Is there a need to increase palatal root torque of upper incisors in lingual appliance? A finite element analysis p. 320
SP Lekshmi, Elbe Peter, G Suja Ani
DOI:10.4103/ccd.ccd_197_19  
Objectives: To understand the effect of the biomechanical differences by assessing pre and post retraction torque, amount of retraction and arch width changes in both techniques. Methodology: A three-dimensional geometric model of maxilla with all upper teeth except first premolar was generated based on computed tomography radiograph of a dry skull using the computer program Hypermesh. 13.0. Virtual models of 0.022 ” Roth labial brackets and 0.018 ” ORMCO 7th generation lingual brackets; and for labial brackets 0.019 × 0.025” SS archwire and for lingual brackets 0.016 × 0.024” SS archwire were constructed. Sliding mechanics was used during en-masse retraction by applying a 300 g distal force on both sides of the dentition from canine to the second premolar brackets in the labial and lingual simulation. The finite element program ANSYS 12.1 was used to calculate the torque and displacement. Results: The results stipulated that in transverse direction there was lingual tipping of anteriors, mild buccal flaring in second premolars and first molars and lingual tipping in second molar in lingual appliance. In the sagittal plane, the greater distal movement of posteriors and an up-righting tendency of molars were observed in lingual appliance. Extrusion of anterior teeth were observed in both appliances. Regarding the premolars and first molars, labial movements and relative intrusion were observed in lingual appliance compared to labial appliance. Conclusion: In lingual treatment, it is crucial to increase the lingual root torque. The amount of retraction and arch widening were more in lingual appliance compared to labial technique.
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Antibacterial efficacy of muringa seed extract and potato peel extract Against Enterococcus faecalis Highly accessed article p. 327
MC Noushad, K Ashraf, MP Suneetha
DOI:10.4103/ccd.ccd_223_19  
Background: Elimination of infection and prevention of reinfection should be the main goal in the treatment of apical periodontitis. The most challenging part of endodontics is the complete disinfection of root canal system. Herbal alternatives have emerged as the more biofriendly approach in root canal irrigation and disinfection. Aim and Objective: The aim of this study was to evaluate the antimicrobial efficacy of natural extracts like muringa seed and potato peel extract against Enterococcus faecalis. Materials and Methods: The antimicrobial activity was determined using agar diffusion test. The solutions were divided into three groups: Group I- Muringa seed extract, Group II- potato peel extract, and Group III-5.25% sodium hypochlorite. The zones of inhibition of growth were recorded. The strain used for this study was Enterococcus faecalis ATCC 29212. Results and Conclusion: Muringa seed extract (Group I) demonstrated the best result among the tested solutions. Although there was no significant difference between potato peel extract (Group II) and 5.25% sodium hypochlorite (Group III). Within the limitations of this study, herbal extracts tested has shown significant antimicrobial action against Enterococcus faecalis.
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Validity of diagnostic criteria for temporomandibular joint disorder in the diagnosis of disc displacement disorders of temporomandibular joint p. 332
Shikha N Goyal, Freny R Karjodkar, Kaustubh Sansare
DOI:10.4103/ccd.ccd_237_18  
Objective: The objective of this study is to assess the validity Diagnostic Criteria for Temporomandibular joint Disorder (DC/TMD) in the diagnosis of disc displacement (DD) disorders of temporomandibular joint (TMJ). Study Design: It was a prospective study in which total of 55 patients accounting to 110 TMJ; with clinical diagnosis of DD disorder as per DC/TMD criteria and all above age of 18 years were included. All the patients with clinical diagnosis of DD disorder were advised MRI. All the MRI scans were read by single radiologist. Clinician and Radiologist were blinded to each others findings. MRI diagnosis and clinical diagnosis were compared and results were formulated. Results: The use of the Kappa statistic test indicated a good diagnostic agreement (k = 0.68) between the clinician and the radiologist. The DC/TMD criterion was found to have good validity and reliability in the diagnosis of DD disorders with sensitivity of 91.57% and specificity of 77.78%. The positive predictive value and negative predicted value calculated were 92.68% and 78%, respectively. The positive and negative likelihood ratio found was 4.12 and 0.11, respectively. Conclusion: DC/TMD is a simple, reliable, valid, cost-effective tool in the diagnosis of DD disorders.
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Influence of implant dimensions in the resorbed and bone augmented mandible: A finite element study p. 336
Doriana Agop Forna, Norina Consuela Forna, SÓnziana Anca Butnaru Moldoveanu
DOI:10.4103/ccd.ccd_366_19  
Aims: The scope of this study was to analyze the influence of clinically feasible implant diameter and length on the stress transmitted to the peri-implant bone in the case of a resorbed and bone augmented mandible through finite element analysis. Settings and Design: The study was carried out in silico. Subjects and Methods: Resorbed and bone-augmented 3D models were derived from in vivo cone-beam computed tomography scans of the same patient. Corresponding implant systems were modeled with the diameter ranging from 3.3 to 6 mm and length ranging from 5 to 13 mm, and masticatory loads were applied on the abutment surface. Statistical Analysis Used: None. Results: In the bone augmented ridge, maximum stress values in the peri-implant region drastically decreased only when using implants of a diameter of 5 mm and 6 mm. Implants up to 4 mm in diameter led to comparable stress values with the ones obtained in the resorbed ridge, when using the larger implants. The increase of length reduced stress in the resorbed mandible, whereas in the bone augmented model, it led to small variations only in implants up to 4 mm in diameter. Conclusions: It was concluded that bone augmentation provides the optimal framework for clinicians to use larger implants, which, in turn, reduces stress in the peri-implant region. Diameter and length play an equally important role in decreasing stress. Implant dimensions should be carefully considered with ridge geometry.
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Comparative evaluation of serum tumor necrosis factor α in health and chronic periodontitis: A case–control study p. 342
Prince Jain, Aditi Ved, Rajat Dubey, Neha Singh, Anuj Singh Parihar, Rochira Maytreyee
DOI:10.4103/ccd.ccd_97_18  
Background: Tumor necrosis factor-alpha (TNF-α), a ” major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF-α in serum and its relationship to periodontal disease. Aim: Our study aimed to compare the serum TNF-α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF-α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF-α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF-α in serum as a biochemical ” marker” of periodontal disease. Materials and Methods: Forty individuals participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis. The serum samples were assayed for TNF-α levels by enzyme-linked immunosorbent assay method. Results: The mean serum TNF-α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF-α was from (0.867 to 2.977). Serum TNF-α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association between periodontal disease and increased levels of TNF-α in serum. It can be concluded that there is a prospect of using the estimation of TNF-α in serum as a ” marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF-α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease ” activity” and ” inactivity” could suggest the possibility of using TNF-α in serum as an ” Indicator” of periodontal disease.
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Effects of habit-breaking appliances on tongue movements during deglutition in children with tongue thrust swallowing using ultrasonography – A pilot study p. 350
Mihir Nayak, Sandya Devi S Patil, Madhu Kakanur, Snehalika A More, S Ravi Kumar, Rachna Thakur
DOI:10.4103/ccd.ccd_415_19  
Objective: The aim of this study is to evaluate and compare the duration and range of tongue movements in tongue thrust swallow patterns with and without habit-breaking appliances using computer-aided M-mode ultrasound images. Also to record the corresponding position of the tongue associated with normal and tongue thrust swallowing pattern using B-mode ultrasound images. Methodology: Ten patients with mature swallow pattern, ten subjects with anterior tongue thrust (ATT) and ten patients with lateral tongue thrust (LTT) swallowing habit were analyzed for the duration and range of tongue movement using two-dimensional ultrasound M-mode images before and after insertion of three habit-breaking appliances (anterior tongue crib [ATC], double oral screen [DOS] and DeLuke oral trainer [DOT]). Further, B-mode images were examined for the tongue positions in different swallow patterns with and without appliances. Results: Duration and range of tongue movement for the entire swallowing phase did not show a statistically significant difference for mature, ATT and LTT. Statistical significant difference existed in the duration between ATC and DOS with DOT for ATT patient (P = 0.05). Furthermore, a significant difference existed in the range of tongue movement between DOS and DOT in LTT patients (P = 0.05). Conclusion: Remarkable changes in the tongue position were observed postinsertion of DOT in both anterior and LTT swallow patterns where the tongue tip and anterior tongue dorsum shifted upward toward the anterior palate resembling that of a mature swallow pattern.
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Evaluation of the bioactivity of surface modified polyetheretherketone (PEEK) as an implant material: An In Vitro study p. 356
Asish Martin, NS Azhagarasan, Mahadevan Ravichandran, Hariharan Ramakrishnan, S Jaya Krishnakumar, Vallabh Mahadevan
DOI:10.4103/ccd.ccd_258_19  
Purpose: The purpose of this study was to evaluate the bioactivity of polyetheretherketone (PEEK) used as an implant material after surface modification by electron beam deposition of titanium. Materials and Methods: Twenty-two samples of PEEK were obtained from a single manufacturer, water jet sectioned, and divided randomly into two groups of eleven each (Group I and Group II). Eleven PEEK samples from Group II were coated with Grade II commercially pure titanium by electron beam deposition technique. One representative sample from each group was evaluated for surface roughness, topography and composition using three dimensional surface profilometer, scanning electron microscope coupled with energy dispersive X-ray (SEM-EDX) analysis. Simulated body fluid (SBF) was prepared and calcium (Ca) content in it was quantitatively analyzed by inductively coupled plasma mass spectrometry (ICP-MS) technique. Ten samples from each group were then immersed in SBF for a period of 21 days and amount of calcium depletion was analyzed to determine the bioactivity of two groups. Surface characteristics and elemental composition of immersed samples were analyzed by SEM-EDX and correlated with results of ICP-MS tests. The data obtained were then subjected to statistical analysis using independent t-test. Results: Group II samples showed a significant increase in surface roughness compared to Group I (P < 0.02). There were significant differences in Ca depletion of Group I and Group II samples when compared to preimmersion Ca content (P < 0.001). When compared between two Groups, Group II samples showed higher Ca depletion (P < 0.001). Conclusion: Within the limitations of this study, it was concluded that PEEK dental implants which were surface modified by electron beam deposition of titanium had enhanced bioactivity when compared to unmodified PEEK. Hence, they can serve as a valuable alternative to conventional dental implant materials.
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Assessment of the need for routine distolingual local anesthetic infiltration in addition to traditional inferior alveolar, lingual and long buccal nerve blocks in mandibular third molar extractions p. 367
SN Chandan, Sujeeth Kumar Shetty, Sahith Kumar Shetty, Vageesh Bhat
DOI:10.4103/ccd.ccd_404_19  
Background and Objectives: Persistent pain during the removal of mandibular third molars is often due to accessory nerve supply causing inadequate local anesthesia. This study aims to assess the requirement of routine distolingual infiltration anesthesia in addition to traditional inferior alveolar, lingual, and long buccal nerve block in mandibular third molar extractions. Methodology: Sixty patients requiring mandibular third molar extraction were randomly divided into two equal groups; Group A (Classic inferior alveolar, lingual, and buccal nerve block) and Group B (with an additional 0.2 ml distolingual infiltration). During various steps of the procedure, any complaint of pain was recorded and graded on a subjective Visual Analog Scale (VAS). Results: There was no significant difference between the two groups in regard to age (P = 0.666) and sex (P = 0.432). And also, no difference was found in angulation (P = 0.757), class (P = 0.417) and position (P = 1.000) of third molars. Mean VAS scores in Group B (0.153) were significantly lower (P = 0.004) than that of Group A (0.600). VAS scores during procedural steps were significantly lower in Group B during mucoperiosteal elevation (P = 0.050), bone guttering (P = 0.037), and tooth splitting (P = 0.052). Conclusion: Routine distolingual infiltration anesthesia, in addition to classic inferior alveolar, lingual, and long buccal nerve block, is recommended for the extraction of mandibular third molars.
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Inflammatory and immunogenic response of the tissue after application of freeze-dried hydroxyapatite gypsum puger scaffold compared to freeze-dried hydroxyapatite bovine scaffold p. 371
Amiyatun Naini, Mohamad Rubianto, Fourier Dzar Eljabbar Latief, Achmad Gunadi, Dewi Kristiana, Nike Hendrijantini, I Ketut Sudiana
DOI:10.4103/ccd.ccd_443_19  
Background: Inflammation is a mechanism or reaction of the natural immune system to defend from external hazards. All foreign objects that enter the body will trigger an immune response in the form of antibodies. In Indonesia, the prevalence of diseases that involve the inflammatory process in the body is high. Freeze-dried hydroxyapatite gypsum puger (HAGP) scaffold is a gypsum powder which is currently under development as a bone replacement material. Freeze-dried hydroxyapatite bovine (HAB) scaffold is a bone substitute material available on the market. Objective: To analyze the inflammatory and immunogenic responses in the tissue after application of freeze-dried HAGP scaffold compared to freeze-dried HAB scaffold through mediators of tumor necrosis factor alpha (TNF-α) and immunoglobulin G (IgG) in rats. Materials and Methods: This study used Wistar rats. HAGP group and HAB group were applied subcutaneously, settled for 7 and 14 days, then the levels of TNF-α and IgG were measured using enzyme-linked immunosorbent assay. Statistical analysis was done using nonparametric test with the Kruskal–Wallis test. Results: TNF-α levels at day 7 in the HAGP group were nearly equal to the control group, while those in the HAB group were higher. Statistically, the significance was P = 0.184 (P > 0.05). At the 14th day, the level of IgG on the HAGP and HAB groups the level was higher than the control group, statistically it was found P = 0.127. Conclusion: freeze-dried HAGP scaffold compared to freeze-dried HAB scaffold did not cause inflammatory and immunogenic response on rats through mediators of TNF-α and IgG.
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CASE REPORTS Top

Treatment of class III malocclusion with activation-deactivation rapid palatal expansion and reverse headgear in a growing patient (alternate-rapid maxillary expansion and contraction) p. 376
Hemant Garg, Jagjit Kaur, Shivika Arya, Shahindah Shah
DOI:10.4103/ccd.ccd_10_20  
Treatment of Class III malocclusion is a challenge for orthodontists. The best time to intercept this malocclusion is as early as in the deciduous dentition. Orthopedic management of Class III individuals with retruded maxilla is by protraction facemask along with rapid maxillary expansion (RME). It results in forward and downward maxillary growth and backward mandibular rotation. Alternate RME and contraction (Alt-RAMEC) produces faster and more efficient results than maxillary protraction alone. The present case report describes the clinical application of Alt-RAMEC protocol for the treatment of a Class III malocclusion.
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Twinkle R 3D appliance - An innovative functional skeletal class II corrector p. 382
Rohan Rai, Jacob Joseph, K Mithun, V Harshitha, Suhani Shetty
DOI:10.4103/ccd.ccd_18_20  
Functional appliances are widely used for regulating and directing growth in which commonly used are Frankel regulator and twinblock. Frankel regulator expands the orofacial arena for allowing growth by passive expansion, whereas twin block aids sagittal correction in retrusive mandible. Heres, an attempt to bring about both the changes in a single appliance where sagittal correction as well as keeping away constricted musculature is desired. In this appliance, passive and active expansion has been used simultaneously for better results. In the hindsight of the results, we could get in this case using Twinkle R 3D appliance, we hope that this appliance will be helpful in many more similar cases and act as adundum in clinician's armamentarium.
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An interdisciplinary management of severe facial asymmetry due to hemifacial microsomia p. 387
Mary Sanjana, Sivakami Manikandan, Uma Maheshwari, Ratna Parameswaran, Devaki Vijayalakshmi
DOI:10.4103/ccd.ccd_37_20  
This case report outlines the importance of an interdisciplinary approach and a patient centric outcome for the treatment of facial asymmetry resulting from hemifacial microsomia. Different treatment modalities are available to treat asymmetries. However, the best treatment outcome can be achieved only when the treatment plan is individualized for every patient. This report portrays an adult patient with hemifacial microsomia, who had facial asymmetry from the level of supraorbital region with a Class II skeletal base. Orthodontic treatment, along with surgical management, was required to transform the patient into a symmetrical profile, which is esthetically pleasing. A sound knowledge of the various technologies and resources that are available to us and making the best use of it to bring out a drastic change in the patient's life. Combined effort of the orthodontists and oral surgeons are required to manage patient's with hemifacial microsomia that has caused the severe facial asymmetry. Moreover, special attention has to be given to a patient-centric outcome.
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Pycnodysostosis with osteomyelitis of maxilla: Case report of radiological analysis p. 395
Nidhi Bhoyar, Anuj Garg, Mahesh Verma, Sunita Gupta
DOI:10.4103/ccd.ccd_382_17  
Pycnodysostosis is an autosomal recessive, rare genetic osteosclerotic disorder that caused by mutation in gene coding for Cathepsin K. The bones in pycnodysostosis are abnormally dense and brittle because of insufficient reabsorption process. This syndrome has a number of characteristic clinical and radiographic signs that differentiate it from other osteosclerotic conditions. This is a rare case report of a male patient with a history of multiple fractures of bones and osteomyelitis of maxilla which is a rare entity.
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Management of ductal sialolith simplified: A new technique p. 399
Koijam Sashikumar Singh
DOI:10.4103/ccd.ccd_716_17  
Sialolithiasis is a common salivary gland disease. It may cause swelling of the gland, infection of the gland, or even death of glandular parenchymal cells. Various treatment modalities are available for management of sialolithiasis such as extracorporeal shock wave lithotripsy, sialoendoscopy, laser intracorporeal lithotripsy, interventional radiology, the video-assisted conservative surgical removal of the parotid, and submandibular calculi. These sophisticated procedures may not be available in all health-care centers. In this article, a new simple yet precise technique for management of ductal sialolith with minimum armamentarium is introduced.
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Unveiling the impacted canine – Eyelet chain guide: Concepts and clinical application p. 403
Sunil Chandy Varghese, G Preethi, K Balaji, Job Jacob Anison, R Rajesh, K Mahalakshmi
DOI:10.4103/ccd.ccd_52_20  
Impaction of canine is frequently encountered clinical problem in orthodontics. Canine usually erupts when two third of the root development is complete. It is considered as impacted if the root development is completed, but unaided eruption is not expected to occur. Surgical exposure of impacted canine and orthodontic traction to align the tooth is a major challenge in which the management requires a multidisciplinary approach. This article presents a case of impacted canine in a 20-year-old female patient. Impacted canine was aligned by orthodontic traction using a modified eyelet attachment and guided eruption without repeated surgical intervention or tissue damage. In the clinical case discussed, the bonding attachment used was a low-profile Begg bracket containing multiple eyelets for varying the force of traction and also to apply force along the long axis of the tooth. An ideal traction force was applied for the adequate period of time thus minimizing the side effects. This method proved to be efficient in maintaining good periodontal and mucogingival health and thus satisfying both esthetic and function goals.
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