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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 12 | Issue 1
Page Nos. 1-101

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INVITED GUEST EDITORIAL  

The enigma of molar incisor hypomineralization p. 1
Ashima Goyal
DOI:10.4103/ccd.ccd_179_21  
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SYSTEMATIC REVIEW Top

Evaluation of postoperative pain after pulpectomy using different file systems in primary teeth: A systematic review Highly accessed article p. 3
Lakshimi Lakshmanan, Sujatha Somasundaram, Ganesh Jeevanandan, E MG Subramanian
DOI:10.4103/ccd.ccd_561_20  
Objective: The purpose of this systematic review was to compare the incidence and intensity of postoperative pain after pulpectomy using different instrumentations in primary teeth. Materials and Methods: An extensive literature search in PubMed, Cochrane Library, Science Direct, LILAC, SIGLE, and Google Scholar was performed to identify English language articles with human subjects that evaluated the effects of different instruments on postoperative pain after pulpectomy. Results: The search retrieved 187 references. After screening of the abstracts and articles, based on the inclusion and exclusion criteria, a total of three articles were included in the systematic review. Of the three included studies, two of them had a moderate risk of bias and one showed a high risk of bias. Conclusion: The use of rotary instruments contributed to a lower incidence and intensity of postoperative pain than did the hand instruments in all the three studies. More high-quality randomized clinical trials are needed in this field in future studies to support the evidence.
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ORIGINAL ARTICLES Top

Distribution pattern and its correlation for oral cancer rate and human development rank for countries: An ecological approach Highly accessed article p. 9
Jacob Kuruvilla, Kesavan Rajasekharan Nayar
DOI:10.4103/ccd.ccd_1_20  
Introduction: There is a general interpretation that the distribution and pattern of various cancers exhibit geographical variations between developed and developing countries. However, as far as oral cancer is concerned, these differential patterns of distribution are not much documented. Aim and Objective: This review is aimed to bring in the existence of geographical disparities and its pattern for oral cancer incidence and mortality. The objectives of this review are: (1) To compare and comment on the trends in estimates for oral cancer incidence and mortality for the years 2002, 2008, and 2012. (2) To correlate oral cancer incidence and mortality values for 2012 with the human development index (HDI) scores for 2012 for each country. Design: Ecological approach and entire review was carried out using two secondary data sets, and they were (i) Age-standardized oral cancer incidence and mortality value for all countries published by the International Agency on Cancer Research for the years 2002, 2008, and 2012. (ii) HDI score for all countries for the year 2012 released by the United Nations Development Program. Results: A diametric pattern of distribution was observed across the two strata of countries. When developed countries have higher rates for incidence, low developed countries have higher rates for mortality.
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Comparative assessment of canal transportation, dentin loss, and remaining root filling material by different retreatment files – An In vitro cross-sectional study p. 14
Afzal Ali, Prahlad Saraf, Laxmikant Kamatagi, Sandhya Khasnis
DOI:10.4103/ccd.ccd_31_20  
Aim: The purpose of this study was to evaluate the centering ability, canal transportation and efficacy of re-treatment rotary and hand files in removing Gutta Percha from root canals using Cone Beam Computed Tomography(CBCT). Materials and Methods: Sixty extracted human maxillary anteriors were obturated and randomly divided into three groups. Root fillings were removed with ProTaper Universal retreatment system, R-Endo system, and Hedstrom files. CBCT scans were taken. Statistical Analysis and Results: The data were analyzed using the Statistical Package for the Social Sciences (SPSS 15.0, IBM). The mean and standard deviation among the groups was calculated by one-way analysis of variance, Kruskal–Wallis, and Mann– Whitney U-tests, and the comparison among the various groups was done by post hoc Tukey's test. A statistically significant amount of remaining root canal filling material and canal transportation was noted (P < 0.05). Conclusion: No system completely removed the root filling material from root canals. Manual instrumentation resulted in more dentin loss and canal transportation than rotary file system.
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New experimental zirconia-reinforced rice husk nanohybrid composite and the outcome of its surface roughness and microhardness in comparison with commercialized nanofilled and microhybrid composite resins p. 21
Galvin Sim Siang Lin, Nik Rozainah Nik Abdul Ghani, Noor Huda Ismail, Kiran Singbal, Tahir Yusuf Noorani, Noraida Mamat
DOI:10.4103/ccd.ccd_298_20  
Background: An ideal composite resin should demonstrate smooth surface after polishing and high hardness value to provide long-term success. Thus, this study aimed to compare the surface roughness and microhardness of new experimental zirconia-reinforced rice husk nanohybrid composite (Zr-Hybrid) with commercialized nanofilled (Filtek-Z350-XT) and microhybrid composite (Zmack-Comp) resins before and after artificial ageing. Methods: One hundred and eighty standardized disc samples were prepared, of which ninety samples each were used for surface roughness and microhardness test, respectively. They were divided equally into: Group 1 (Filtek-Z350-XT), Group 2 (Zmack-Comp), and Group 3 (Zr-Hybrid). For surface roughness test, all samples were polished with aluminium oxide discs and further subdivided into aged and unaged subgroups, in which composite samples in aged subgroups were subjected to 2500 thermal cycles. Next, all the samples were subjected to surface roughness test using a contact stylus profilometer. As for microhardness test, all the aged and unaged samples were tested using a Vickers hardness machine with a load of 300 kgf for 10 s and viewed under a digital microscope to obtain microhardness value. Data were analyzed using two-way ANOVA followed by post hoc Tukey's honestly significant difference and paired sample t-test with significance level set at P = 0.05. Results: In both the aged and unaged groups, Zr-Hybrid showed statistically significantly lower surface roughness (P < 0.05) than Filtek-Z350-XT and Zmack-Comp, but no statistically significant difference was noted between Filtek-Z350-XT and Zmack-Comp (P > 0.05). A similar pattern was noted in microhardness test, whereby Zr-Hybrid showed the highest value (P < 0.05) followed by Filtek-Z350-XT and lastly Zmack-Comp. Besides, significant differences in surface roughness and microhardness were noted between the aged and unaged groups. Conclusion: Zr-Hybrid seems to demonstrate better surface roughness and microhardness value before and after artificial ageing.
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Comparison of jet injection technique with conventional injection technique in patients undergoing endodontic therapy p. 28
Mahaboob Shahul Hameed, Senthil Kumar, C Charanya, M Muthalagu, M Anitha
DOI:10.4103/ccd.ccd_466_19  
Background: In order to reduce the fear and anxiety of injection during root canal procedures, Madajet injection technique was substituted for the first time among the adult patients to obtain its efficacy and to overcome the painful procedure during the conventional syringe technique. Aim: The aim of this study is to compare the clinical efficacy and level of patient acceptance of jet injections with conventional syringe technique in patients with symptomatic pulpitis. Methodology: Seventy patients were randomly divided into needleless pressure injection technique using Madajet XL and conventional syringe technique. The onset of anesthesia was evaluated using the electric pulp tester, and the pain was assessed using the Visual Analog Scale scoring criteria. Statistical Analysis: The obtained data were tabulated and subjected to the statistical analysis using the Chi-square test. Results: Needleless pressure injection technique (Madajet XL) proves to be effective in patients with symptomatic irreversible pulpitis during endodontic procedure. Conclusion: It can be concluded that the needle-less pressure injection technique (Madajet XL) promises to be a viable mode of pain control during endodontic procedures as it converts the solution to a tiny droplet which is then carried by the myelin sheath.
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Comparative evaluation of osteogenic potential of conventional glass-ionomer cement with chitosan-modified glass-ionomer and bioactive glass-modified glass-ionomer cement – An In vitro study p. 32
Muthukrishnan Sudharshana Ranjani, Mahendran Kavitha, Srinivasan Venkatesh
DOI:10.4103/ccd.ccd_474_19  
Aim: The aim of this study was to compare the osteogenic potential of conventional glass-ionomer cement (GIC) with chitosan-modified GIC (CH-GIC) and bioactive glass-modified GIC (BAG-GIC) as a function of time in varying proportions. Materials and Methods: CH-GIC was prepared by adding 10 v/v% (Group II) and 50 v/v% (Group III) CH to the commercial liquid of GIC. BAG-GIC was prepared by the addition of 10 wt% (Group IV) and 30 wt% (Group V) of BAG to the GIC powder. Conventional GIC was kept as Group I. Nine round-shaped samples measuring 2 mm thick and 5 mm in diameter were prepared for every experimental material. Human osteosarcoma cells were cultured and cell proliferation was assessed at 24, 48, and 72 h using 3-(4,5-dimethylthiazol-2-yl)- 2,5-diphenyltetrazolium bromide (MTT) assay, and cell differentiation was assessed at 7,14, and 21 days using alkaline phosphatase (ALP) assay. All experiments were done in triplicate. The data obtained were analyzed using one-way analysis of variance and Tukey honestly significant difference post hoc multiple comparisons at 0.05 level significance. Results: Cell culture studies showed a significant increase in proliferative activity and ALP activity in Group II, III, IV, and V than Group I at all-time intervals (P < 0.05). There was no statistically significant difference in osteogenic potential between CH-GIC and BAG-GIC groups. Conclusion: The osteogenic potential was significantly higher in CH-GIC and BAG-GIC compared to conventional GIC.
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Grading of oral leukoplakia: Can it be improvised using immunohistochemical markers p63 and CD31 p. 37
Radhika Manoj Bavle, K Paremala, Reshma Venugopal, Amulya S Rudramuni, Nawal Khan, Sreenitha S Hosthor
DOI:10.4103/ccd.ccd_493_19  
Introduction: Oral squamous cell carcinoma is usually preceded by potentially malignant disorders (PMDs), the most common being oral leukoplakia. A conservative management protocol is followed for milder dysplastic cases, while severe dysplastic lesions are surgically excised. Several classification systems have been developed based mainly on histopathological features with a lot of inter-observer variations. The present study was done to assess the use of immunohistochemical (IHC) markers in grading leukoplakic lesions in addition to histopathological grading. Aims and Objectives: To grade leukoplakia using different grading systems and assess if IHC markers can aid in categorizing leukoplakia. Materials and Methods: Thirty-five cases of leukoplakia were graded using Ljubljana, 2005 World Health Organization (WHO), and Binary System followed by IHC staining with p63 and CD31. Results and Statistics: Variation was noted in 12 cases while using WHO, 11 using Ljubljana, and 7 using Binary System and was significant on Cohen-Kappa statistics, with the least significant variation noted on Binary System. p63 staining assisted to group doubtful cases and even identify variation in cases graded positively on histopathology. In total, 17 cases stained one-third (mild/low), while 15 cases stained one-half or more (higher grade) epithelial thickness. A weak correlation was observed between all grading systems and p63 on Kendall's Tau-b analysis and the weak correlation was significant for the WHO and binary grading systems. Analyzing p63 and CD31 using Kruskal–Wallis test, an increase in mean vessel density (MVD) was noted for mild/moderate cases but decreased for severe cases. Conclusion: Addressing histological categorization of PMDs assisted by IHC markers to understand the biological behavior of the tissues is currently essential with studies on more markers to assist in the management protocol.
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Efficacy of laser photoacoustic streaming in paediatric root canal disinfection - An Ex-Vivo study p. 44
Chandrashekar Murugesh Yavagal, Viplavi Chavan Patil, Puja Chandrashekar Yavagal, N Kiran Kumar, Madhu Hariharan, Sachin B Mangalekar
DOI:10.4103/ccd.ccd_498_19  
Background: Various techniques have been employed to enhance the root canal disinfection rate using sodium hypochlorite (NaOCl) as an irrigant. Photon initiated photo-acoustic streaming using lasers is a newer method of endodontic disinfection. Aim: The aim of this study is to evaluate and compare the efficacy of photo-initiated photoacoustic streaming and conventional irrigation technique using 2.5% NaOCl for root canal disinfection in primary teeth. Setting and Design: Laboratory setting and ex-vivo design. Materials and Methods: Twenty extracted primary teeth were selected in which Enterococcus faecalis incubation was done in the root canals and bacterial counts were obtained before the intervention. The teeth were randomly allocated into two groups. Group I samples were irrigated with conventional syringe method using 2.5% NaOCl and Group II samples were irrigated using photon-initiated photo-acoustic streaming method with erbium-doped yttrium aluminum garnet laser (wavelength - 2940 nm). Postintervention samples were obtained, and bacterial colony count was done. Wilcoxon Signed- Ranks Test and Mann–Whitney test were applied to test the intragroup and intergroup differences in the bacterial counts. Results: Postintervention results showed no bacterial growth in the canals irrigated using Laser (P = 0.004) whereas, fewer bacterial colonies were observed in NaOCl group (P = 0.005). There was statistically significantly higher reduction in E. faecalis counts in Laser Activated irrigation (LAI) group compared to NaOCl group (P < 0.05). Conclusion: Total elimination of E. faecalis counts was obtained by the use of laser activated NaOCl irrigation in the infected root canals, hence, it can be considered as an effective method for pediatric endodontic disinfection.
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Effect of cathodic arc plasma deposition on shear bond strength between palladium cobalt chromium coated with titanium nitride and titanium aluminium nitride with ceramic p. 49
Vaishnavi Prabhakar, Ahila Singaravel Chidambaranathan, Muthukumar Balasubramanium
DOI:10.4103/ccd.ccd_79_20  
Background: The success of esthetic ceramo-metal restoration is strongly influenced by its bond strength. The success of ceramo-metal restoration is subjective to its bond strength. Aim and Objectives: The aim of this study is to evaluate the shear bond strength between palladium-based cobalt chromium (Co-Cr) alloy coated with titanium nitride (TiNi) and titanium aluminum nitride with feldspathic ceramics. Materials and Methods: According to the International Organization for standardization 9693; technical report 1,140,640 samples were prepared using Palladium-based Co-Cr alloy with ×4 vertical projection resting on 5 mm diameter base. The samples were divided into Group: A (control), Group: B (Sandblasted), Group: C (TiNi coated), and Group: D (titanium aluminum nitride coated by cathodic arc plasma deposition, following which feldspathic ceramic application was performed. Shear bond test was performed using universal testing machine and surface analysis was performed using scanning electron microscope. Results: The mean shear bond strength for Group A was 172.994 ± 3.739 N, Group B 209.485 ± 5.913 N, Group C 176.536 ± 4.780 N, and Group D 260.576 ± 16.351 N. Comparison within the groups was made using one-way ANOVA, and multiple group comparisons were made using Tukey's honestly significant difference Post hoc test where the P < 0.001was considered statistically significant. Conclusion: Palladium based Co-Cr alloy coated with titanium aluminum nitride by cathodic plasma arc deposition showed maximum shear bond strength with feldspathic ceramic compared to noncoated, sandblasted, and TiNi coated alloy.
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Comparative evaluation of instrumentation time, obturation time, and radiographic quality of obturation using two rotary systems and manual technique for primary molar pulpectomies – In vivo study p. 55
Heeral Sureshkumar Shah, Vishwas Mohanrao Patil, Ananth P Kamath, Aditi Anmol Mathur
DOI:10.4103/ccd.ccd_83_20  
Background: Ideal pulpectomy for primary dentition demands fast, simple procedures, with short treatment times and minimal appointments. Recently, exclusive pediatric rotary files are available for use in primary teeth. There is a paucity of literature on the clinical efficacy of pediatric rotary files. Hence, this study was planned to evaluate and compare pediatric rotary files and K-files. Aim: The aim of this study was to evaluate and compare instrumentation time, obturation time, and radiographic quality of obturation using rotary systems (Kedo-S; Pro-AF Baby GOLD files) and manual (K-files) technique in primary molar pulpectomies. Materials and Methods: Forty-five primary mandibular molars from 42 children aged 5–9 were selected. Single-visit pulpectomy was performed after dividing selected teeth into three equal groups: (i) K-files, (ii) Kedo-S files, (iii) Pro-AF Baby GOLD files. Instrumentation and obturation times were recorded during the procedure. Immediate postoperative radiographs were taken and evaluated later for obturation quality by two independent evaluators blinded to the instrumentation technique. The results were then statistically analyzed. Results: Kedo-S (Group II) files required the least instrumentation time followed by Pro-AF (Group III) and K-files (Group I). The superior quality of obturation in lesser time was achieved using Pro-AF files (Group III) followed by Kedo-S (Group II) and K-files (Group I). Conclusion: Pediatric rotary files are efficient alternatives to hand instrumentation and can be considered as the standard of care in pulpectomies of primary teeth.
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CASE REPORTS Top

Idiopathic gingival enlargement causing social stigma p. 63
Divya Kothari
DOI:10.4103/ccd.ccd_181_20  
Gingival enlargement can be multifactorial; it can be due to nutritional deficiency or can be because of several drugs. Poor oral hygiene may further worsen the gingival hyperplasia, because of which the patient may have difficulty in chewing the food, and the speech may get affected. It may end up in psychosocial stigma for the patient as the patient is even neglected by friends or relatives due to poor oral hygiene and horrifying look of gingival overgrowth. Here, we report a case of gingival enlargement in a 22-year-old married female. The enlargement was massive, such that the teeth were barely visible in the anterior mandible. Based on history and histological findings, the case was diagnosed as idiopathic gingival enlargement. Conventional gingivectomy was planned. The patient was kept on the maintenance phase, and no recurrence was recorded. During the whole treatment phase, there was a notable change in the behavior of the patient. Surgical correction and subsequent maintenance of good oral hygiene may improve the disease condition, which in turn helps the patient in not only improving the aesthetics but also results in better social acceptance.
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Prosthodontic rehabilitation of a patient with missing teeth and loss of vertical dimension using telescopic overdentures p. 67
Daniel Arunraj, Padmashini Gnanam, Gopi N Chander
DOI:10.4103/ccd.ccd_191_20  
Overdentures are one of the most sought-after treatment options for patients with few remaining natural teeth. They are desired as they tend to preserve the natural teeth and its intact periodontium. This helps in reducing the residual ridge resorption and preserve proprioception. These characteristics offer better masticatory ability in patients rehabilitated with overdentures when compared to conventional complete dentures. Enhancements such as telescopic denture for better retention prove to be efficient clinically. Telescopic dentures enable frictional type of retention. This is a case report of a partially edentulous patient with decreased vertical dimension, successfully rehabilitated with telescopic denture in relation to the maxilla and fixed partial prosthesis in the mandibular region.
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Chorea-acanthocytosis: A case report with review of oral manifestations p. 73
Aadithya B Urs, Jeyaseelan Augustine, Azhar Ahmed Khan
DOI:10.4103/ccd.ccd_207_20  
Chorea-acanthocytosis (ChAc) is an autosomal recessive, progressive neurological disorder due to mutation in VPS13A gene causing defects in sorting of protein making the cell membrane unstable, leading to star-shaped erythrocytes. This neurological disorder includes features such as elevated creatinine kinase, atrophy of basal ganglia, and oral manifestations such as frequent cheek and tongue biting. It is a rare neurological condition with an estimate of <1000 cases worldwide. A case of 47-year-old male patient with a history of seizures and neurological problems presenting with oral ulceration has been discussed. The diagnosis of ChAc was confirmed by molecular investigations showing VPS13A gene mutation. The physical appearance includes chorea and dystonia with impaired gait. We attempt to highlight the oral features of ChAc. The oral manifestations include frequent tongue and cheek biting occurring due to dystonia affecting the muscles of head and neck region.
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A fatal case of infant oral mutilation practice p. 76
Arthur Musakulu Kemoli, Immaculate Achieng Opondo
DOI:10.4103/ccd.ccd_319_20  
Infant oral mutilation (IOM) is a traditional dental practice where traditional healers enucleate primary canine tooth buds in children in the hope of preventing or curing childhood illness. The method applied is heinous, painful, and carried out in unsterile environment, and this increases the morbidity and mortality of children from the communities where IOM is rife. The case report described here arose from a village, where an infant with a medical issue ended up in the hands of a local traditional healer who enucleated her four primary canine tooth buds. The traditional treatment resulted in the fatality of the child in <24 h of the procedure, a testimony that some traditional therapeutic procedures have no place in managing common childhood illnesses.
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A rare case of peripheral ossifying fibroma in an infant p. 81
Khushboo Singh, Shikha Gupta, Itrat Hussain, Jeyaseelan Augustine, Sujoy Ghosh, Sunita Gupta
DOI:10.4103/ccd.ccd_364_20  
Peripheral ossifying fibroma (POF) associated with natal/neonatal teeth is extremely rare. In general, POF occurs as a soft-tissue gingival nodule occurring in young adults. We report an unusual and a rare case in a 5-month-old male child who had two, localized, soft-tissue growth over the mandibular anterior alveolar ridge. History revealed the presence of natal teeth in the same mandibular anterior region, which exfoliated at the age of 2 months. Intraoral periapical radiograph showed soft tissue density with evidence of calcifications that also corroborated with the histopathological finding of masses of mineralized areas. Excision of the lesions followed by histopathological examination proved the final diagnosis of POF. Inspite of being a benign reactive lesion, a high recurrence rate has been reported. Such lesions require long-term follow-up subsequent to excision with histopathological examination due to a high recurrence rate.
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Nonsurgical management of strip perforation using platelet-rich fibrin and MTA by matrix concept – A case report with one year follow-up p. 84
Kavalipurapu Venkata Teja, Sindhu Ramesh
DOI:10.4103/ccd.ccd_392_20  
Iatrogenic errors happen especially during endodontic treatment even with the experienced clinicians. It is impossible to predict the occurrence of an event. Although many of them can be corrected and managed successfully, few conditions might have the worst prognosis leading to uneventful extraction. The present case report highlights a 1-year follow-up of managed strip perforation in mesial canals of mandibular first molar, nonsurgically using MTA obturation. The present challenging case gives an insight on the importance of regenerative capacity and osteogenic potentiality of bioactive materials, when appropriate tissue engineering concepts are applied.
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The resistance of succedaneous teeth to periapical infection: A series of seven cases p. 88
Paul Chalakkal, Neil De Souza, Ida de Noronha de Ataide, Francis Akkara, Roshni Chandran
DOI:10.4103/ccd.ccd_68_20  
Pediatric dental procedures are carried out largely to prevent the adverse effects of primary teeth infection on succedaneous teeth (ST). The existing literature on how and when periapical infection (PI) from primary teeth affect ST is conflicted. A series of seven case reports on PI (abscesses and radicular cysts) from primary molars, until the eruption of the premolars, have been illustrated. The resistance of ST to PI based on their developmental stages is also discussed.
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Pulp regeneration in an immature maxillary central incisor using hyaluronic acid hydrogel p. 94
Harveen Singh, Kirti Rathee, Amandeep Kaur, Neha Miglani
DOI:10.4103/ccd.ccd_149_20  
Pulp regenerative procedure is one of the treatment options for endodontically involved immature permanent teeth. The regenerative endodontic procedure was performed in a child of 9 years. After thorough canal disinfection using triple antibiotic paste for 21 days, bleeding was induced from the apex to provide for the stem cells. After that hyaluronic acid (HA) hydrogel was introduced into the canal space to act as injectable scaffold for pulp regeneration. This was followed by mineral trioxide aggregate placement to provide tight seal from the coronal aspect. Later, the tooth was restored with composite restoration. This approach offers the clinicians great opportunity to physiologically strengthen the immature root walls. The present report presents a regenerative endodontic procedure with HA hydrogel for a traumatized central incisor with arrested root development. The continued root development in the present case suggests that this treatment option may be able to resume the root maturation process in immature teeth with open apices.
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Intestinal-type adenocarcinoma presenting as a mandibular mass: An unusual presentation p. 99
Nouman Rashid, Adity Bansal, Ashi Chug
DOI:10.4103/ccd.ccd_217_20  
Intestinal-type adenocarcinoma is an aggressive malignancy with the rare possibility of metastatic spread to the mandible. We represent a case of a 30-year-old female patient who reported with a chief complaint of a right mandibular mass for 4 months. Orthopantomogram X-ray observed an ill-defined lytic lesion with severe periosteal reaction. Incisional biopsy revealed “colonic variant of intestinal-type adenocarcinoma.” Expression of cytokeratin 20 and caudal type homeobox transcription factor 2 (CDX-2) markers was seen on immunohistochemistry. Biochemical markers such as serum cancer antigen 125, serum alkaline phosphatase, and serum carcinoembryonic antigen were raised. Contrast-enhanced computed tomography of the thorax and abdomen suggested cavitary lesions in the bilateral lungs, right adrenal gland, and mediastinum. Positron emission tomography revealed multiple lesions in the body, hence confirming the diagnosis. The patient was kept on palliative chemotherapy. It is concluded that prompt diagnosis and initiation of treatment increases the chances of survival in such cases.
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