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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 12 | Issue 2
Page Nos. 103-209

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EDITORIAL  

Are we “CLUE” less? Highly accessed article p. 103
Girish Malleshappa Sogi
DOI:10.4103/ccd.ccd_421_21  
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SYSTEMATIC REVIEW ARTICLE Top

Sedative and behavioral effects of intranasal midazolam in comparison with other administrative routes in children undergoing dental treatment – A systematic review Highly accessed article p. 105
Neethu Ann Preethy, Sujatha Somasundaram
DOI:10.4103/ccd.ccd_470_20  
Aim: The aim of this study was to systematically identify and evaluate the available literature on the effectiveness of intranasal midazolam sedation compared with midazolam administered through other routes in the sedation and behavior management of children during dental treatment. Materials and Methods: The search was done using electronic databases such as PubMed Central, Cochrane Database of Systematic Reviews, LILACS, ScienceDirect, and SIGLE. All studies comparing the sedative effect and behavior management effectiveness of intranasal midazolam with midazolam administered through other routes in children were included. Results: Electronic database search identified 163 articles, out of which 143 were excluded after reading titles and removing duplication. The remaining 20 studies were evaluated in detail. A final of 13 studies were included based on the inclusion criteria. Among the 13 studies included in the present review, a high risk of bias was noted in all the 13 articles. There was no adequate blinding of personnel and participants in the study, allocation concealment was improper and presence of inadequate blinding of the outcome assessment. . Statistically, no significant difference was observed between intranasal midazolam and other midazolam routes on behavior and sedation level in the studies included in this review. Conclusion: Limited studies are available pertaining to the sedative and behavioral effects of intranasal midazolam, and thus, this review recommends need for more research evaluating the sedative effect of intranasal midazolam in comparison with midazolam administered through other routes in the behavior management of children during dental treatment.
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ORIGINAL ARTICLES Top

Oral microbial shift following 1-month supplementation of probiotic chewable tablets containing Lactobacillus reuteri UBLRu-87 as an adjunct to phase 1 periodontal therapy in chronic periodontitis patients: A randomized controlled clinical trial p. 121
A Aysha Jebin, KJ Nisha, Shyam Padmanabhan
DOI:10.4103/ccd.ccd_135_20  
Context: Although Lactobacilli as a probiotic was established as a treatment for a wide range of systemic infections, its role in periodontitis and oral microbiota is still under investigation. Aims: The present randomized clinical trial was aimed to evaluate the effects of probiotic chewable tablets containing Lactobacillus reuteri UBLRu-87 along with initial periodontal therapy on clinical parameters and oral microbiota of chronic periodontitis (CP) patients. Settings and Design: The randomized controlled clinical trial. Subjects and Methods: Thirty CP patients were selected who received scaling and root planing (SRP) and were randomly allocated into two treatment groups; Groups A and B. Group A received L. reuteri-containing chewable probiotic tablets. The clinical parameters (plaque index, gingival index, probing pocket depth, clinical attachment level), and microbiological parameters (Porphyromonas gingivalis and L. reuteri levels using real-time polymerase chain reaction) were evaluated at baseline, following treatment at 1 month and 3 months in both groups. Statistical Analysis: Paired t-test and unpaired t-test were used for the statistical analysis. Results: On intergroup analysis, statistically significant improvement in clinical as well as microbiological parameters was observed in Group A (SRP + PROBIOTIC) compared to Group B (SRP ALONE) at all evaluation time points. Conclusion: Probiotic chewable tablets containing L. reuteri may be a useful adjunct along with initial periodontal therapy to slow recolonization of periopathogens along with improvement in clinical outcomes of CP. Further long-term trials are necessary to establish the optimal dosage of probiotics.
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Appearance of mandibular para-radicular third molar radiolucencies on cone-beam computed tomography p. 128
Fatemeh Salemi, Maryam Foroozandeh, Maryam Mirzaee, Maryam Farhadian, Paria Makateb, Marjan Mostafapour
DOI:10.4103/ccd.ccd_156_20  
Aims: Mandibular para-radicular third molar radiolucencies (MPRs) may be mistaken for pathological lesions, leading to misdiagnosis and mistreatment. This study sought to assess the appearance of MPRs on cone-beam computed tomography (CBCT). Settings and Design: This was a descriptive, cross-sectional study. Materials and Methods: This study evaluated 770 CBCT of patients presenting to the dental school of Hamadan University of Medical Sciences. Demographic information, unilateral or bilateral presence, shape and prevalence of MPRs observed on axial and sagittal sections, their density, thinning of cortical margin, internal trabeculation, bony expansion, and mean height and width of MPRs were all evaluated. Statistical Analysis Used: Data were analyzed using SPSS version 22.0 and descriptive statistics. Chi-square test was used. Results: Seventy (9.1%) patients had a total of 82 MPRs, including 51 (72.86%) females. The prevalence of MPRs in females was more than males (P = 0.011). The majority of MPRs were unilateral 58 (70.73%), mostly round in shape 48 (58.54%), and were mostly associated with third molars with distoangular impaction 47 (57.31%); this difference was statistically significant (P < 0.001). Furthermore, in 47 (57.32%) patients, MPRs had less density than the surrounding bone. MPRs were not associated with expansion or root resorption in any patient. Conclusion: Differentiation of MPRs from the pathological lesions is important to make a decision about further imaging or referral for surgical treatment. MPRs are often considered normal since they do not cause root resorption or bone expansion and do not affect the lamina dura. MPRs are more commonly found adjacent to third molars with distoangular impaction.
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Morphometric analysis comparing human mandibular deciduous molars using cone beam computed tomography p. 133
Hend El-Messiry, Eman Alaa
DOI:10.4103/ccd.ccd_243_20  
Background: The presence of variations in crown and root measurements in deciduous teeth usually leads to complications during and after treatment. Hence, in order to improve the success rate in pediatric treatment, there must be proper knowledge of dental morphological and morphometric characteristics of deciduous teeth among different populations. Objective: The aim of the present study was to assess length of the crowns, length of the roots, roots to crown (R/C) ratio, and distance between the floor of pulp chamber to furcation using cone beam computed tomography (CBCT). Materials and Methods: Extracted deciduous molar teeth were collected and divided into: group I: Deciduous mandibular first molars (lower D) (n = 16) and Group II: Deciduous mandibular second molars (lower E) (n = 21). The length of the crowns, length of the roots, R/C ratio and distance between the floor of pulp chamber and furcation were measured using CBCT. Data were statistically analyzed. Results: Lower D showed smaller crown length with a mean of 4.87 mm, longer mesial root length with a mean of 9.68 mm and greater R/C ratio with a mean of 2 mm when compared to lower E. As for the distal root length and the distance between the floor of the pulp chamber and the furcation area, both molars closely resembled each other. There was a statistical significant difference between both molars regarding mesial root length, crown length, and R/C ratio. Conclusion: The current study concluded that dental morphological characteristics are important in research as they provide valuable information about diversities within a population.
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Association of nucleotide variants of GRHL3, IRF6, NAT2, SDC2, BCL3, and PVRL1 genes with nonsyndromic cleft lip with/without cleft palate in multigenerational families: A retrospective study p. 138
Praveen Kumar Neela, Srinivas Reddy Gosla, Akhter Husain, Vasavi Mohan, Sravya Thumoju, BV Rajeshwari
DOI:10.4103/ccd.ccd_329_20  
Background: Several genes are associated with the etiology of cleft lip and palate (CLP) in different populations. Many nucleotide variants on genes such as GRHL3, IRF6, NAT2, SDC2, BCL3, and PVRL1 were reported in different populations, but not studied in multigenerational cases in the Indian population. Aim and Objective: The aim of this study is to evaluate whether nucleotide variants rs41268753, rs861020, rs1041983, rs1042381, rs2965169, and rs10790332 are involved in the etiology of nonsyndromic CLP (NSCLP) in multigenerational Indian families. Study Design: Retrospective genetic study. Materials and Methods: Based on inclusion and exclusion criteria, 20 multigenerational families with nonsyndromic cleft lip with or without cleft palate (NSCL/P) were selected. Blood samples from both affected and unaffected participants were collected as a source of genomic DNA. Six nucleotide variants on these genes were genotyped to test for the association with NSCL/P. Genotyping was performed with the MassArray method. Genotype distribution was used to calculate the Hardy–Weinberg equilibrium using PLINK, a whole-genome association analysis toolset. The allelic association was compared among cases and controls using Chi-square test as implemented in PLINK. P ≤ 0.05 indicates statistical differences between groups. Results: No significant associations were found between individual single-nucleotide polymorphisms and NSCL/P. The odds ratio was 1.531, 1.198, 0.8082, 1.418, 1, and 0.5929 for polymorphisms rs41268753, rs861020, rs1041983, rs1042381, rs2965169, and rs10790332, respectively. Conclusion: Our findings suggest that among the multigenerational families in our population, the high-risk nucleotide variants GRHL3 rs41268753, IRF6 rs861020, NAT2 rs1041983, SDC2 rs1042381, BCL3 rs2965169, and PVRL1 rs10790332 are not associated with increased risk of NSCL/P.
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Allogeneic bone application in association with platelet-rich plasma for alveolar bone grafting of cleft palate defects p. 143
Cimara Fortes Ferreira, Joăo Luiz Carlini, Ricardo de Souza Magini, José Nazareno Gil, André Luis Zétola
DOI:10.4103/ccd.ccd_342_20  
Aim: The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP). Materials and Methods: The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil). Patients: Thirty out of 46 patients with 8–12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP. Interventions: Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved. Results: There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%). Conclusion: ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.
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Clinical and radiographic analysis of novabone putty with platelet-rich fibrin in the treatment of periodontal intrabony defects: A randomized control trial p. 150
Vibhor Hazari, Anushree Choudhary, Rohit Mishra, Kabbur Thipanna Chandrashekar, Ashima Trivedi, Pranshu Kumar Pathak
DOI:10.4103/ccd.ccd_101_20  
Background: Periodontal regeneration remains one of the crucial issues in the field of periodontology. Periodontal intrabony defects could be treated by surgical intervention through various alloplastic bone graft substitutes. The Food and Drug Administration approved, Novabone putty is one of the recently marketed bone graft substitutes, which has been used in the present study. This study also incorporates the placement of platelet-rich fibrin (PRF) in combination with Novabone putty. Materials and Methods: Twenty patients were included in the study and were allocated to either Group A or Group B through randomization. Group A included the placement of Novabone putty in the periodontal intrabony defects, whereas Group B included the placement of Novabone putty along with PRF. Statistical analysis of plaque index, gingival index, probing pocket depth, relative attachment level, and intraoral periapical radiographs was performed. Results: Statistical more significant difference (P < 0.05) in probing pocket depth, and relative attachment level was observed in Group B (Novabone putty and PRF) in comparison to Group A (Novabone putty). Conclusion: Evaluation of efficacy of Novabone putty along with PRF produced more favorable results in relative attachment level gain and more reduction in probing pocket depth when compared to Novabone putty alone.
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Comparison of oxidant stress levels among healthy, chronic periodontitis, and ischemic heart disease subjects with presence or absence of chronic periodontitis p. 157
Priyanka Pampani, Santhosh Shenoy, Anahita Punj, Vinayak B Kamath
DOI:10.4103/ccd.ccd_192_20  
Objective: To investigate the total oxidant levels in healthy, chronic periodontitis (CP), and ischemic heart disease (IHD) and to check for any correlation among them. Materials and Methods: A sample of 80 were split into four groups of healthy subjects (Group I), CP subjects (Group II), IHD subjects (Group III), and IHD subjects having periodontitis (Group IV). The serum and saliva samples collected were analyzed for levels of hydrogen peroxide (H2O2), hydroxyl radical (OH-), nitric oxide (NO), and superoxide radical (O2-). Results: There were significant (P < 0.05) variances in the mean serum and salivary levels of hydrogen peroxide, hydroxyl radical, NO, and superoxide within the 4 groups. Oxidant levels of both serum and saliva were lower in disease groups of Group II, III, and IV as compared to healthy controls, with different patterns. Conclusion: The oxidant levels (H2O2, OH-, NO, and O2-) are significantly hampered in periodontitis and IHD subjects as compared to healthy subjects. The oxidants, whether serum or salivary, did not always show the proportional change as a result of change in oxidant stress due to disease as positive correlation was observed only in the serum H2O2 and salivary NO radical levels and between serum superoxide dismutase radical and salivary H2O2 in Group I. In Group III, there was a positive correlation between serum NO radical and salivary H2O2.
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An In vitro evaluation to compare the surface roughness of glazed, reglazed and chair side polished surfaces of dental porcelain p. 164
Varsha Rani, Sanjeev Mittal, Urvashi Sukhija
DOI:10.4103/ccd.ccd_86_20  
Aim: The aim of this study was to evaluate the effect of glazing, reglazing, and chairside polishing on the surface roughness of dental porcelain. Materials and Methods: A total of 50 discs of feldspathic porcelain were fabricated using a metal mold of dimension 10 mm × 2 mm. Based on the surface treatment, the samples were divided into five groups. Group A – Glazed (control), Group B – Abraded and reglazed, Group C – Abraded and polished with porcelain adjustment kit (Shofu Dental Corp. PN 0301 Classic Plastic HP Kit, Shofu Inc., Kyoto, Japan), Group D – Abraded and polished with diamond polishing paste (Shofu Dental Corp. PN 0558 DirectDia, Shofu Inc., Kyoto, Japan), Group E-Abraded and polished with the combination of porcelain adjustment kit followed by diamond polishing paste. The surface roughness (Ra) values (μm) were evaluated by a profilometer (Mitutoyo Surftest SJ-310, Tokyo, Japan). The data obtained were statistically analyzed using one-way ANOVA and post hoc Tukey's test. Results: The mean surface roughness (Ra) of Groups A, B, C, D, and E was 0.567 ± 0.078 μm, 0.433 ± 0.059 μm, 0.882 ± 0.126 μm, 2.361 ± 0.195 μm, and 0.438 ± 0.043 μm, respectively. The samples of Group D (Polished with polishing paste alone) had the highest surface roughness (Ra value). Whereas the samples of Group B and E had similar surface roughness (Ra) value. Differences between Groups A, B, and E were statistically insignificant (P > 0.05). Conclusion: After adjustment of ceramic restorations in dental clinics, diamond polishing paste, when used after porcelain adjustment kit, could provide the marked finish equal to glazed or reglazed surface.
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CASE REPORTS Top

Treatment effect of combined surgical maxillary expansion and mandibular setback in skeletal class III p. 169
Tejashri Pradhan, Ajith R Gowda, Vijay Jayade, K Gopalkrishnan, Anand K Patil
DOI:10.4103/ccd.ccd_290_20  
The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.
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Predictable treatment of gingival recession using titanium prepared platelet-rich fibrin in combination with coronally advanced flap p. 174
Shiva Shankar Gummaluri, Hirak S Bhattacharya, Geetika Kumar, Bharti Chaudhary, S S Sai Karthikeyan
DOI:10.4103/ccd.ccd_297_20  
Treatment for receding gums is always a challenging task for a periodontist. To fulfill this, many surgical techniques such as free gingival grafts, connective tissue grafts, pedicle flaps, and lateral sliding flaps have been used. For better prevention of relapse of these procedures and to improve the gingival biotype, various biomaterials such as platelet-rich fibrin, collagen matrix, and amnion chorion membranes have been additionally utilized. Due to advancements in preparation of platelet concentrates titanium platelet-rich fibrin, a third-generation platelet concentrate was introduced. Unlike other biomaterials, it has thicker fibrin meshwork with greater cellular entrapment and thicker membrane. Present case reports depict the usage of titanium platelet-rich fibrin as a biomaterial along with coronally advanced flap in the treatment of millers Class-I gingival recessions. Patients were followed up to 6 months after performing recession coverage treatments.
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“Crawling attachment” during periodontally accelerated osteogenic orthodontics procedure p. 179
Cimara Fortes Ferreira, David Wong, Lesley H Binkley
DOI:10.4103/ccd.ccd_376_20  
The present clinical case reports an increased zone of keratinized gingiva that was generated following surgical excision of the gingiva during periodontally accelerated osteogenic orthodontics. The present case consists of angle Class I with mal-aligned teeth and impacted #11. The patient was evaluated up to 2 years and 1 month (2.1) showing a stable increased zone of keratinized tissue. Possible causes for this event are discussed in this case report. Additional long-term clinical studies are necessary to support these results.
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Bone regeneration in an extreme dental clinical condition p. 184
Clara I Vergara-Hernandez, Adel A Martinez-Martinez, Antonio J Diaz-Caballero
DOI:10.4103/ccd.ccd_283_20  
Here, the authors present the clinical case of a 45-year-old woman with a diagnosis of a chronic periodontal abscess of the tooth #8. After atraumatic dental extraction and bone regeneration with the use of platelet-rich fibrin and bone graft, the area showed excellent bone regeneration with adequate stability of the soft tissue, even 4 months after the surgery.
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Intraoral management of latrogenic tooth displacement: A report of two cases and a brief review of literature p. 187
Abira Chattopadhyay, Md Arif Hossain, Aritra Chatterjee, Mohsina Hussain, Sanjit Barman, Anirban Raha
DOI:10.4103/ccd.ccd_384_20  
Iatrogenic displacement of a tooth or tooth fragment is a rare but well-recognized complication that occurs during exodontia. The most common sites of dislodgment of a mandibular third molar fragment are the sublingual, submandibular, and pterygomandibular and lateral pharyngeal spaces. Removal of a displaced tooth from these spaces may be complex due to poor visualization and limited access. A thorough evaluation of all significant risk factors along with precise localization of the tooth by clinical and radiographic means should be performed to prevent untoward complications. This paper reports two cases of iatrogenic displacement of mandibular third molar teeth, in the sublingual space and lingual pouch. Both the cases were managed intraorally under general anesthesia, and the postoperative healing was satisfactory and uncomplicated. A brief review of literature is also provided in this paper.
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Preauricular intraparotid schwannoma: A rare presentation with literature review p. 191
Mun Bhawni Bagga, Dipti Bhatnagar, Shiva Katoch
DOI:10.4103/ccd.ccd_519_20  
Schwannoma is a benign tumor rarely found in the intraparotid facial nerve region. It clinically presents as a slow-growing, asymptomatic mass. Due to its rare presentation, preoperative diagnosis is often unclear before surgical removal and histopathological examination. Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) play an important role in suggesting the nature of mass and narrowing down the differentials. The CT scan offers the advantage to detect the relationship of the facial nerve and osseous changes within the bone, however MRI shows a mass relative to brain type of tissue. We report a rare case of intraparotid facial nerve schwannoma in a 17-year-old female who had sustained swelling in her left preauricular area for 5 years. Ultrasonography and CT findings revealed the impression of pleomorphic adenoma. However, MRI and histopathological findings were characteristic of schwannoma. Thus, this article provides an insight into a rare presentation of schwannoma with literature review.
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Endocrown – A paradigm shift in rehabilitation: A report of two cases p. 195
Rahul Gupta, Sophia Thakur, Nitish Kumar Pandey, B Roopa, KT Fares
DOI:10.4103/ccd.ccd_557_20  
Along with the advent of dentistry, the ideal restoration of an endodontically treated tooth has been a widely discussed and controversial topic. Coronal rehabilitation of an endodontically treated tooth is quite a challenge for clinicians as considerations should be taken for its minimally invasive preparation and the retention and stability of the restoration. With the development of adhesive systems, the need for intraradicular anchorage and thus the post-core system is greatly reduced. Endocrown is a restorative option for an endodontically treated tooth, and it serves as a suitable alternative to the conventional post-core restoration and full-coverage restoration. This novel approach promotes the stability and retention of the indirect restoration without the need of a cast metal core or reconstruction with intracanal post, thereby reducing the treatment time. Thus, endocrown has become a promising alternative in the esthetic and functional rehabilitation of an endodontically treated tooth.
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Mini-implant assisted gummy smile and deep bite correction p. 199
S B. V Ramana Reddy, Venkata Naga Sravanthi Jonnalagadda
DOI:10.4103/ccd.ccd_630_20  
This article demonstrates the noninvasive means of correction of gummy smile and deep bite by using mini-implants in a relapsed patient. Intrusion of the maxillary arch was achieved by using mini-implants in the anterior and posterior region. Significant reduction in the gingival and incisal display was seen with improved smile esthetics and ideal overbite and overjet by the end of the treatment. The aim of the article is to present a case where gummy smile was effectively treated by mini-implants without undergoing invasive surgical procedures.
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SHORT COMMUNICATION Top

Embracing psychological ownership in dental education: A potential game changer p. 205
MS Muthu, KC Vignesh, Latha Nirmal, G Felsypremila
DOI:10.4103/ccd.ccd_1023_20  
Psychological ownership (PO) is conceptually defined as the state in which individuals feel as though the target of ownership or a piece of it is “theirs” (i.e., “It is MINE!”). Theoretical dimensions of PO are promotion oriented (self-efficacy, self-identity, belongingness, accountability, autonomy, and responsibility) and prevention oriented (territoriality). This paper describes the application of PO in dental education and assists us to establish or master numerous aforementioned skills during the learning process in dental school. This PO system will facilitate a gradual transition of students from the dental school environment to private practice smoothly without any apprehensions.
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LETTER TO EDITOR Top

Integral steps for planning a case of full mouth rehabilitation with implants: A prosthesis driven approach p. 208
Uvashri Selvaraj, Gunjan Pruthi, Radhika Jain
DOI:10.4103/ccd.ccd_780_20  
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