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   2019| July-September  | Volume 10 | Issue 3  
    Online since March 11, 2020

 
 
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CASE REPORTS
The pterygoid hamulus syndrome – An important differential in orofacial pain
Prajwalit Kende, Neha Aggarwal, Vikas Meshram, Jayant Landge, Vijaylaxmi Nimma, Paul Mathai
July-September 2019, 10(3):571-576
DOI:10.4103/ccd.ccd_796_18  
The purpose of this review was to document cases of pterygoid hamulus (PH) syndrome and to describe the various etiology, differential diagnosis, and management strategies so far reported in literature. Here, we also present two case reports of PH syndrome. A comprehensive search in PubMed/Medline database was done using MeSH terms such as “Pterygoid Hamulus,” “Pterygoid Hamulus Syndrome,” and “Hamular Bursitis” using various Boolean operators such as “AND” and “OR”. Till date, 31 cases of this entity including the present cases have been found. Conservative management was followed in the earlier reported cases; however, most cases were treated by surgical resection.
  1,625 51 -
Plasma-cell gingivitis a challenge to the oral physician
Bhupender Singh Negi, Nileena R Kumar, PS Haris, Jiwane Achal Yogesh, C Vijayalakshmi, Jeswin James
July-September 2019, 10(3):565-570
DOI:10.4103/ccd.ccd_776_18  
Plasma-cell gingivitis (PCG) is an uncommon inflammatory condition of idiopathic etiology. PCG is a rare condition, appearing as erythema (redness) and edema (swelling) of the attached gingiva. The diagnosis of PCG is based on arrant history taking, clinical examination, and appropriate diagnostic tests. Here, we are presenting a case of PCG in a 12-year-old boy, its management and treatment outcome after 3 years of regular follow-up in tertiary health-care center in North Kerala.
  1,499 62 -
ORIGINAL ARTICLES
Applicability of Tanaka–Johnston, Moyers, and Bernabé and Flores–Mir mixed dentition analyses in school-going children of Sri Ganganagar City, Rajasthan (India): A cross-sectional study
Ashish Kakkar, Kanika Gupta Verma, Purshottam Jusuja, Suruchi Juneja, Nishtha Arora, Shobhit Singh
July-September 2019, 10(3):410-416
DOI:10.4103/ccd.ccd_654_18  
Background: The orthodontic diagnosis and treatment planning are the fundamental goals during the mixed dentition period. Numerous methods have been proposed till date such as Nance method, Moyer's method, Staley–Kerber and Tanaka–Johnston's method, and Bernabé and Flores–Mir method. Aim: The aim of the study is to determine the mesiodistal widths of the lower permanent canines and premolars from Tanaka–Johnston, Moyers, and Bernabé E and Flores–Mir C mixed dentition analysis and to determine the correlation coefficients and the new prediction equation for Sri Ganganagar population. Setting and Design: A total of 3572 children were clinically examined from the contemporary population of Sri Ganganagar city and Outpatient Department of Pediatric and Preventive Dentistry in Sri Ganganagar, Rajasthan. A total of 150 individuals were randomly selected for the study based on the inclusion and exclusion criteria and were designated as “study samples. Materials and Methods: A total of 150 children aged 11–16 years of Sri Ganganagar city were randomly selected. The mesiodistal width of permanent incisors, canines, premolars, and molars was measured with the help of digital vernier caliper with an accuracy of ±0.01 mm. The measurements of canines and premolars were summed up and compared with those derived from Tanaka and Johnston equations, Moyers probability tables, and Bernabé and Flores-Mir equations. Statistical Analysis: The data obtained were subjected to statistical analysis using IBM SPSS Statistics Windows version “20.0” using Student's t-test, Pearson correlation coefficient, and Kruskal–Wallis test. Results: All the three methods overestimated the actual sum of permanent canine and premolars in both the arches in our population. The correlation coefficients and the new regression equations were derived for both maxilla and mandible in males and females for Sri Ganganagar population. Conclusion: The predicted values obtained from all the three methods overestimated the actual values.
  1,193 146 -
CASE REPORTS
Vestibular Incision Subperiosteal Tunnel Access (VISTA) for Surgically Facilitated Orthodontic Therapy (SFOT)
Homayoun H Zadeh, Ali Borzabadi-Farahani, Mehdi Fotovat, Seong-Hun Kim
July-September 2019, 10(3):548-553
DOI:10.4103/ccd.ccd_720_18  
Surgically Facilitated Orthodontic Therapy (SFOT) in combination with bone augmentation and the placement of anchorage devices installed into bone have been used to accelerate and facilitate orthodontic treatment. This is usually performed after flap surgery, which is associated with moderate morbidity, as well as possible negative sequale such as gingival recession. The present case report illustrates the clinical benefits of vestibular incision subperiosteal tunnel access (VISTA) for SFOT, and tissue augmentation to facilitate orthodontic therapy. VISTA entails making vertical incision(s) in the vestibule followed by subperiosteal elevation of tunnels to provide direct access to the facial alveolar bone. Unlike previously reported vestibular access surgical procedures, VISTA allows for wider elevation of an access tunnel for clear visual and surgical access to perform careful inter-radicular corticotomy. The present report describes VISTA for corticotomy surgery (anterior mandible and maxillary teeth) in combination with the placement of titanium fixation devices and bone augmentation to facilitate orthodontic treatment of an adult female with borderline Class II Division 1 malocclusion, with excessive overjet and deepbite. In view of the fact that VISTA does not require surface incisions in the gingival margins or papillae, it potentially minimizes gingival recession that sometimes accompanies flap surgery.
  1,105 68 -
ORIGINAL ARTICLES
Communicating risk: Assessing compliance of tobacco products to cigarettes and other tobacco products act (Packaging and labelling) amendment rules 2015 in Delhi, India
Puneet Chahar, Manasi Karnani, Vikrant R Mohanty
July-September 2019, 10(3):417-422
DOI:10.4103/ccd.ccd_668_18  
Background: Tobacco is a public health problem with both health and economic consequences. Pictorial health warning (PHW) under cigarettes and other tobacco products Act, May 2003 (COTPA), offers advantages of being more universally available, low cost, and high exposure. The current study aims to assess compliance of smoking and smokeless tobacco products to Section 7, 8, and 9 of COTPA Amendment Rules 2015. Materials and Methods: This cross-sectional study was conducted in the city of New Delhi during November–December. 2017. All nine districts were included in the study and in each districts, three public places, a Metro station, a hospital, and a public park, were randomly chosen for tobacco products collection. A standardized protocol was implemented for acquiring tobacco products from these 27 diverse points. Data collected were entered into MS Excel to make digital spreadsheets and were analyzed using SPSS version 21. Results: Among 98 tobacco products, 57 (58%) and 41 (42%) were smoke form and smokeless form, respectively. Foreign Cigarette Brands and Beedi showed the least compliance followed by khaini and Gutkha. PHW was absent on 12 products (8 foreign brands of smoking type and 4 smokeless type). 42.8% (n = 42) of packaging was found to contain promotional inserts, while just 20.4% (n = 20) of the total sample size contained the presence of legislative information. Conclusions: Foreign brands and locally manufactured products (Beedi and Khaini) showed low compliance to new amendments of COTPA. Along with this, the presence of promotional inserts on tobacco packaging might be another issue to be dealt with in the future.
  1,074 68 -
Correlation of mother and child's taste perception and their caries experience
K Abhiram, AJ Sai Sankar, E Sridevi, M Sridhar, K Pranitha, D Aruna
July-September 2019, 10(3):440-445
DOI:10.4103/ccd.ccd_726_18  
Aim and Background: Nowadays, clinical assessment of caries susceptibility is evaluated by the individuals taste perception. As food habits of the child are mostly influenced by the parents (mothers), it would be beneficial to assess the relation between mother and child's taste status and their caries experience to predict the caries susceptibility of the child. Methodology: A convenience sample of 310 mother–child dyads of both the sexes were selected. After obtaining the data on the taste preferences, dietary habits, and oral hygiene practices, caries experience of both the mother and child were recorded using the DMFT and defs indices, followed by the taste assessment using 6-n propylthiouracil (PROP) tester strips. Results: Irrespective of the taste status, the majority of the mother and child dyads showed preference to sweet foods. A statistically significant relationship between taste status and caries experience was noticed among mothers and children individually. However, there was no significant association between mother and child taste status. Whereas, a weak-positive correlation is observed between the mother and child's caries experience. The children of supertaster mothers have relatively less caries experience compared to children of moderate and nontaster mothers, which was not statistically significant. Conclusion: Mother's taste perception or caries experience may not always be a risk predictor for their child's caries experience, but the PROP tester strips were very effective in predicting the caries risk of an individual.
  987 59 -
Comparative evaluation of cleaning efficacy of self-adjusting file and waveone file: An in vitro scanning electron microscopic study
Balakrishnan Bakthavatchalam, Muthukrishnan Sudharshana Ranjani, Krishnan Amudhalakshmi
July-September 2019, 10(3):542-547
DOI:10.4103/ccd.ccd_160_19  
Aim: This study aims to compare the cleaning efficacy of root canal walls using two rotary single file systems: self-adjusting file (SAF) and WaveOne (WO). Materials and Methods: Forty extracted human premolars with similar range of canal curvature were selected, decoronated, working length determined and roots were divided into two groups of 20 samples each: Group I - SAF and Group II - WO. All root canals were irrigated with 3% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA).The roots were sectioned longitudinally and subjected to scanning electron microscopic examination. The amount of debris and smear layer was evaluated using five score index at coronal, middle and apical third levels. Statistical analysis was performed using the Chi-square test and significance was set at a P < 0.05. Results: Statistically significant difference was observed between the groups in cleaning the apical third. Group I (SAF) showed better canal cleanliness compared to Group II (WO) in the apical third. Conclusion: Within the limitations of this study, SAF in combination with 3% NaOCl and 17% EDTA irrigating solution had significantly better cleaning efficacy in the apical third of root canals when compared to WO rotary file system.
  953 42 -
Fluoride concentration in saliva following professional topical application of 2% sodium fluoride solution
Manjit Talwar, Amrit Tewari, HS Chawla, Vinod Sachdev, Suresh Sharma
July-September 2019, 10(3):423-427
DOI:10.4103/ccd.ccd_681_18  
Background: Topical fluoride application in moderate and high-risk individuals and in those living in low-fluoride communities has been a common practice by dental professionals. Objectives: The objective of this study was to assess fluoride concentration available in saliva after a professional 2% sodium fluoride solution application (9000 ppm), and the duration of its availability to have an evidence-based practice for application. Materials and Methods: Two percent sodium fluoride application was carried out in 45 participants residing in a boarding school. The participants were non tea drinkers and nonfluoride users. Water fluoride of the area ranged from 0.34 ppm to 0.38 ppm. Whole mixed saliva samples were collected at baseline and various time intervals postapplication of 2% sodium fluoride solution. Fluoride in saliva was estimated using the fluoride combination electrode (Orion model 94–09, 96–09) coupled to an ionanalyzer. Results: IBM SPSS statistics version 23.0 was used for the analysis. Normality of the data was assessed using the Kolmogorov–Smirnov test and box plot, and it was found to be nonnormal. Wilcoxon signed-rank test was used to compare all time intervals with baseline, and statistically significant differences were observed (P = 0.0001). Salivary fluoride according to this study showed a biphasic clearance pattern with a peak at 15 min and a rapid fall in 60 min followed by a slow, consistent decline over a 20-h period. The fluoride concentration in saliva remained elevated above baseline from 0.03 ppm to 0.076 ppm even 3 months after application. Conclusion: Findings of this study show that, in this population, the frequency of application should be between 2 and 3 months (four applications per year).
  879 91 -
A comparative evaluation of efficacy of gingival retraction using polyvinyl siloxane foam retraction system, vinyl polysiloxane paste retraction system, and copper wire reinforced retraction cord in endodontically treated teeth: An in vivo study
Sonal Mehta, Hemali Virani, Sarfaraz Memon, Narendra Nirmal
July-September 2019, 10(3):428-432
DOI:10.4103/ccd.ccd_708_18  
Purpose of the Study: The purpose of the study is to evaluate the efficacy of three gingival retraction systems such as polyvinyl siloxane foam retraction system (magic foam cord; Coltene/WhaledentInc), polysiloxane paste retraction system (GingiTrac; Centrix), and aluminum chloride impregnated twisted retraction cord (Stay-Put; Roeko) in endodontically treated teeth. Materials and Methods: Patients who were endodontically treated for molars and requiring crown for the same, were selected for the present study with sample size of 45. The 45 participants were divided into three groups. Group 1 was treated with Stay-Put, Group 2 with Magic Foam, and Group 3 with GingiTrac. About 90 elastomeric impressions of the participants were taken—45 impressions before retraction and 45 impressions after retraction. The sulcus width was measured on the die obtained from the elastomeric impressions by placing the dies under OVI-200 optical microscope in combination with X soft imaging system software attached to a computer. Results: The study indicated 0.465627 mm ± 0.063066 mm of gingival retraction for aluminum chloride impregnated retraction cord, 0.210993 mm ± 0.067358 mm of gingival retraction for GingiTrac paste, and 0.294147 mm ± 0.056697 mm of gingival retraction for magic foam cord. Conclusion: The study data indicated that the new retraction systems are not as effective as the standard retraction cord; however, of the two new systems the Magic Foam system did prove to be effective enough for clinical use. The GingiTrac system failed to achieve the minimum gingival retraction required and hence may not be suitable for clinical use.
  835 104 -
GUEST EDITORIAL
Current therapeutic modalities of immunobullous lesions
Jayachandran Sadaksharam
July-September 2019, 10(3):407-409
DOI:10.4103/ccd.ccd_464_19  
  848 86 -
ORIGINAL ARTICLES
Evaluation of efficacy of curcumin along with lycopene and piperine in the management of oral submucous fibrosis
Basudev Mahato, Chandraday Prodhan, Samir Mandal, Avirup Dutta, Parna Kumar, Tushar Deb, Tarun Jha, Keya Chaudhuri
July-September 2019, 10(3):531-541
DOI:10.4103/ccd.ccd_937_18  
Context: Oral submucous fibrosis (OSMF) is a high-risk premalignant condition of the oral cavity and oropharynx. Complete regression of the disease is still not possible with available treatment modalities. Aims: The aim of the study was to evaluate the efficacy of curcumin, lycopene, and piperine as a combination in the management of OSMF. Settings and Design: Efficacy was evaluated on the basis of improvement in clinical parameters (i.e., visual Analog Scale [VAS]) score for burning sensation, mouth opening (MO), mucosal flexibility (MF), and tongue protrusion [TP]). Materials and Methods: Forty patients clinically and histopathologically diagnosed with OSMF were included in the study; patients were administered with the above-stated drug combination, and clinical parameters were evaluated at regular intervals to compare the pre- and post-treatment measurements. Statistical Analysis Used: Paired t-test was done to evaluate significance of the results. Results: Highly significant improvement was observed for posttreatment reduction in VAS score for burning sensation and increase in MO (P < 0.001). Significant improvement was also observed in the increase of MF and TP. Posttreatment histopathological evaluation also revealed reepithelialization, indicated by significant increase in the epithelial thickness as found through quantitative image analysis. Immunohistochemical studies with Col1A1 showed decrease in collagen deposition. Conclusions: Taken together, the present study proposes the usage of combination drug therapy for the management of OSMF as an effective and affordable way.
  752 61 -
Comparative evaluation of extrusion of apical debris in primary anterior teeth using two different rotary systems and hand files: An In Vitro study
Ahsana Asif, Ganesh Jeevanandan, Lavanya Govindaraju, R Vignesh, EM G. Subramanian
July-September 2019, 10(3):512-516
DOI:10.4103/ccd.ccd_884_18  
Background: The success of endodontic treatment depends on the chemomechanical preparation of the tooth. However, the debris produced during canal preparation may extrude through the apical foramen causing postoperative complications. Aim: The aim of this study is to compare the apical debris extrusion during root canal preparation in primary anterior teeth using hand files, rotary ProTaper files, and rotary Kedo-S files. Materials and Methods: Forty-five freshly extracted primary canine with mature apices and a single canal were randomly divided into three groups for instrumentation as follows (n = 15): Group 1: hand files; Group 2: rotary ProTaper files; and Group 3: rotary Kedo-S files. Myers and Montgomery experimental model was used for this study. Apically extruded debris collected in a preweighed Eppendorf tubes was placed in the incubator at 70°C for 5 days. The weight of the debris collected was determined by subtracting the pre- and post-instrumentation weight of the Eppendorf tubes. The data collected were analyzed using the analysis of variance and Tukey's post-hoc tests. Results: Hand files produced more apical debris extrusion than ProTaper and Kedo-S files (P < 0.05) while Kedo-S produced the least (P < 0.05). Conclusion: All instrumentation systems cause apical debris extrusion. Kedo-S produced less apical debris extrusion when compared to the hand files and ProTaper files.
  735 57 -
CASE REPORTS
Management of subgingival root fracture with decoronation and orthodontic extrusion in mandibular dentition: A report of two cases
Gaurav Kumar, Neha Verma, Sachin Parashar
July-September 2019, 10(3):554-557
DOI:10.4103/ccd.ccd_736_18  
Incidence of horizontal root fracture in permanent dentition is relatively uncommon with reported incidence being <7%. Treatment and prognosis of such injuries vary with the location of fracture line. More apical the fracture lines more likely the favorable outcome. Treatment includes immobilization for 2–4 weeks and root canal treatment to allay any chance of failure. Subgingival root fracture with possible bacterial contamination and insufficient crown height require multidisciplinary approach for the successful treatment and help patients to retain their natural dentition. In cases of extreme mobility of coronal fragment, endodontic treatment, decoronation, and orthodontic extrusion provides clinicians easy and conservative treatment option to functionally and esthetically rehabilitate the fractured tooth. This case report describes similar treatment plan in the management of subgingival root fracture in two different cases involving mandibular lateral incisor and mandibular premolar.
  696 72 -
Feeding difficulty in an infant with stickler's syndrome
Parvathy Vijay, Parvathy Kumaran, Arun Mamachan Xavier, R Balagopal Varma, J Suresh Kumar
July-September 2019, 10(3):558-560
DOI:10.4103/ccd.ccd_749_18  
Stickler syndrome or hereditary progressive arthro-ophthalmopathy is an autosomal dominant condition characterized by ocular manifestations, arthritic changes, orofacial features, and deafness, in variable degrees. This is a case report of a 48-day-old infant who presented with severe feeding difficulty. It also details the clinical, diagnostic features, and management of an infant with Stickler syndrome.
  703 30 -
ORIGINAL ARTICLES
Impact of oral health educational intervention on smoking among male adolescents
Hassan AlAbdullah, Ali Sadeq AlFahid, Abdulaziz AlQarni, Muhammad Ashraf Nazir
July-September 2019, 10(3):502-506
DOI:10.4103/ccd.ccd_863_18  
Objective: To evaluate the impact of oral health educational intervention on smoking among male Saudi adolescents. Methods: This study included participants from male public high schools (10–12-grade students) in Dammam, Dhahran, and Al Khobar, Saudi Arabia, between March 2018 and May 2018. Multistage random sampling was used to recruit the students. The participants received two sessions of oral health educational intervention, which was based on educating the adverse effects of smoking on oral health. A pilot-tested questionnaire was used to collect preintervention and postintervention data. McNemar's test was performed for statistical analysis. Results: There were 432 participants in the study with a mean age of 10.18 ± 8.44 years. The prevalence of smoking was 31.7% in the preintervention stage. Over half the participants (60.6%) had family history of smoking. There was no reduction in smoking prevalence after the educational intervention. A significant improvement in the awareness about the effects of smoking on oral health was observed after the intervention (P < 0.05). The proportion of smokers willing to quit smoking significantly increased from 34.3% in the preintervention stage to 55.5% in postintervention stage (P = 0.021). Similarly, the percentage of smokers willing to join smoking cessation program increased after the intervention. Conclusion: There was a significant improvement in the awareness about the effects of smoking on oral health. The study found significantly higher percentage of adolescents willing to quit smoking after oral health educational interventions. The smoking cessation campaigns should include the education of adverse effects of smoking on oral health.
  676 47 -
CASE REPORTS
Prosthetic lip with the retentive attachment for a unilateral cleft lip patient: A clinical report
Khushboo Singh, Nayana Prabhu, Dhanasekar Balkrishanan, Aparna I Narayana, S Pradeep
July-September 2019, 10(3):577-581
DOI:10.4103/ccd.ccd_801_18  
Patients afflicted with congenital cleft lip defect experience disfigured facial esthetics and lack of oral competency that could reduce the speech intelligibility. Rehabilitation of such cosmetic deformities condition often encountered with dental abnormalities becomes the challenge. When surgical treatment is not desired, prosthetic reconstruction turns out to be an economical option. This clinical treatment describes the fabrication of a maxillary lip prosthesis supported by a cast partial denture retained with magnetic attachment in a cleft lip patient. The use of intraoral magnets placed labially on the cast partial denture and on the counterpart of the prosthesis improved the retention. Moreover, the biomedical-grade silicone prosthesis used to blend closely with the patient's skin shade fulfilled the esthetic needs.
  666 56 -
ORIGINAL ARTICLES
Clinical and radiographic success of three adhesive restorative materials in primary molar proximal lesions: A randomized clinical trial
SK Inthihas, S V. S G. Nirmala, Venkata Ratnakumar Rudhravarm
July-September 2019, 10(3):483-488
DOI:10.4103/ccd.ccd_809_18  
Aim: The aim of this study was to evaluate and compare the clinical and radiographic success of primary molar proximal lesions in 4–8 years children restored with three adhesive restorative materials followed up for 12 months. Materials and Methods: This study was carried out on 102 primary molars of 51 children in the age range of 4–8 years. In all the participants, Class II lesions were restored and randomly allocated into three material groups as giomer group, nano-ionomer group, and light-cured glass-ionomer cement (LC-GIC) group based on the restorative material used. All the restorations were evaluated and scored according to federation dentaire internationale (FDI) criteria for clinical and radiographic success rate at 3, 6, and 12 months' interval. Data were formulated in a predesigned format and were subjected to statistical analysis using the Chi-square test and Fisher's exact test. Results: There was no statistically significant difference observed among the restorative material groups to all the properties of FDI criteria. The overall success rates of restorative materials at 3, 6, and 12 months' interval were as follows: giomer – 100%, 100%, and 94.1%; nano-ionomer – 97%, 94%, and 85.3%; and LC-GIC – 100%, 94%, and 88.2%. Conclusion: The highest clinical success rate was found for the giomer group followed by LC-GIC group and the least for the nano-ionomer group, whereas the highest radiographic success rate was found for giomer as well as LC-GIC group and the least for nano-ionomer group.
  671 44 -
Regenerative capacity of leukocyte-rich and platelet-rich fibrin in indirect sinus elevation procedure may be dependent on model-specific modification of the centrifugation cycle
Rampalli Viswa Chandra, Varanasi Vaishnavi, Y S. H S. Chakravarthy
July-September 2019, 10(3):433-439
DOI:10.4103/ccd.ccd_715_18  
Context: To compare optical density (OD) and fibrinogen content of leukocyte-rich and platelet-rich fibrin (L-PRF) generated by standard protocol (2700 rotations per minute [RPM] for 12 min) versus relative centrifugal force (RCF)-adjusted protocol across two widely used laboratory centrifuges with swing-out rotors. Aims: Centrifuges for PRF production generate forces in excess of 800 g. The study aimed to evaluate OD, fibrinogen content and effectiveness in bone-added osteotome sinus floor elevation (BAOSFE) of leukocyte-rich and platelet-rich fibrin (L-PRF) generated by the standard protocol (2700 RPM for 12 min) versus a RCF-adjusted protocol to generate precisely 400 g of force across two centrifuges with swing-out rotors. The outcomes were compared to a standard centrifuge configured to generate L-PRF as per the original Choukroun guidelines. Settings and Design: Sample size for the present study was calculated using proportional power calculation. A minimum sample size of 8 per group was needed to detect a bone height difference of 2 mm when the power of the test is 0.80 at a significance level of 0.05. Subjects and Methods: Based on the centrifuge and protocol used to generate L-PRF, 10 participants were assigned to each of the following groups are as follows: D group, fixed angle centrifuge (DUO Quattro®) at default setting. R-O group: Swing-out centrifuge (Remi 8C®) + standard protocol. R-A group: Remi 8C® centrifuge + RCF-adjusted protocol. C-O group: Swing-out centrifuge (Remi C854®) + standard protocol. and C-A group: Remi C854® + RCF-adjusted protocol. OD, fibrinogen content, and gain in bone fill and bone height after BAOSFE were the evaluated outcomes. Statistical Analysis Used: Data were analyzed using GraphPad Prism® Software version 6.0 (GraphPad Software Inc., La Jolla, USA) and SAS Software® version 9.3 versions (SAS, New Delhi, India). Data were summarized by mean ± standard deviation for continuous data and median ± inter-quartile range for the score data. The comparison between different time points was done by analysis of one-way repeated measures test, followed by post hoc test for score data. The comparison between two groups for repeated data was made by analysis of two-way repeated measures test and followed by post hoc test. Spearman's Rho correlation test was used to test the correlation between prognosis and the other variables. Results: L-PRF from the Remi C854® centrifuge with RCF-adjusted protocol showed OD (P = 0.152) and fibrinogen content (P = 0.232) identical to those from the DUO Quattro® centrifuge. L-PRF from Remi 8C® centrifuge with the RCF-adjusted protocol resulted in maximum postoperative bone height gain (7.01 ± 1.44 mm) and bone fill (13.50 ± 4.51 mm2) which was higher than that of the outcomes from the DUO Quattro® centrifuge (6.82 ± 2.92 mm and 12.32 ± 5.31 mm2). Conclusions: A reduction in RCF resulted in a less dense clot and had a positive influence on the regenerative potential of L-PRF in BAOSFE procedure.
  671 41 -
Comparative evaluation of boric acid gel versus chlorhexidine gel in the treatment of chronic periodontitis: Randomized, placebo-controlled clinical study
Alefiya Mamajiwala, Kunal Sunder Sethi, Swapna A Mahale, Chetan Purushottam Raut, Prerna A Karde, Aishwarya M Kale
July-September 2019, 10(3):457-464
DOI:10.4103/ccd.ccd_752_18  
Background: Over the years, various antimicrobials have been tried and tested in the treatment of periodontitis. Chlorhexidine (CHX) has emerged as the gold standard. In recent years, trend has shifted toward the use of agents with antibacterial, anti-inflammatory, and osteoblastic activity. Boric acid (BA) is one such agent which possess all such properties and thus been evaluated in the treatment of periodontitis. Aim and Objective: The aim of the study is to compare and evaluate the efficacy of 0.75% BA gel versus 1% CHX gel as an adjunct to scaling and root planing in patients with chronic periodontitis both clinically and microbiologically. Materials and Methods: The present study was a randomized, placebo-controlled clinical trial where 45 systemically healthy patients with chronic periodontitis were included in the study. About 15 patients each were divided into three groups, that is, Group I received BA gel, Group II received CHX gel, and Group III received placebo gel as a local drug delivery agent. Clinical parameters such as gingival index, plaque index, modified sulcus bleeding index, probing pocket depth, and clinical attachment level were evaluated at baseline and 6-month follow-up. Microbiological analysis to check for mixed anaerobic flora was done using subgingival plaque samples at baseline and 3 months after treatment. Results: Significant reduction was seen in all clinical parameters in both BA and CHX gel groups as compared to control group (P < 0.05). However, on comparing BA gel group with CHX gel, the results were statistically insignificant (P > 0.05). Conclusion: BA gel and CHX gel both were equally effective in improving the clinical and microbiologic parameters in patients with chronic periodontitis when used as a local drug delivery agent.
  650 46 -
Degree of conversion and polymerization shrinkage of low shrinkage bulk-fill resin composites
Haidy N Salem, Sherif M Hefnawy, Shaymaa M Nagi
July-September 2019, 10(3):465-470
DOI:10.4103/ccd.ccd_756_18  
Background: The effectiveness of each resin composite material composition in enabling homogeneous monomer conversion and reducing polymerization shrinkage (PS) is an important issue. Thus, this study aimed to evaluate the degree of conversion (DC) and PS of low-shrinkage bulk-fill composites (BFCs) in 4-mm thickness. Materials and Methods: Four bulk fill (Tetric EvoCeram Bulk Fill, Sonic Fill, XTra Fill, and Venus Bulk Fill) and one conventional (Filtek Z350 XT) resin composites were tested in this study. Teflon molds of 4-mm depth were used to prepare resin composite specimens. All tested resin composites were packed in bulk then light cured for the recommended time by their manufacturers. DC% was determined by Fourier transform infrared spectroscopy; PS was determined using the strain gauge method. Data were subjected to one-way ANOVA/Tukey's test (α = 0.05). Results: DC% results were as follows: Venus Bulk Fill > XTra Fill > Sonic Fill > Tetric EvoCeram Bulk Fill > Filtek Z350 XT with a significant difference between each others at P ≤ 0.001. For PS %, significant difference resulted between tested groups at P ≤ 0.001. Where Venus Bulk Fill < XTra Fill = Sonic Fill < Tetric EvoCeram Bulk Fill < Filtek Z350 XT. Conclusions: Low-shrinkage resin monomers seem to be beneficial for reducing PS with enhancement in the DC. Increased filler loading in BFCs had a positive effect on reducing PS, while its effect on the DC was material dependent.
  649 46 -
Caries risk factors among children aged 3–5 years old in Indonesia
Sri Ratna Laksmiastuti, Tri Erri Astoeti, Heriandi Sutadi, Sarworini B Budiardjo
July-September 2019, 10(3):507-511
DOI:10.4103/ccd.ccd_877_18  
Background: Dental caries is the most common oral disease in children. Dental caries is a multifactorial disease both etiologic factor and risk factor. Other factors that could not find in clinical examination or radiograph, but contribute to the disease are assumed as risk factor. A child as an un independent individual will be influenced by external risk factor, especially from the mother. Mother is an important figure for children character building. Risk factor detection is an essential effort to decrease the prevalence of dental caries. Aim: The aim of this study is to identify caries risk factor in children aged 3–5 years old in Indonesia. Setting and Design: A descriptive, cross-sectional study was conducted using a universal sampling protocol. Methods: Subject is 248 pairs of mother and children. Clinical examination and questionnaire interview are applied on the subject. Statistical Analysis: The association between caries risk factors and caries cases on children were tested using bivariate analysis, followed by identifying the most dominant factors using logistic regression multivariate analysis. Results: Each caries risk factor has a significance level which could distinct to children's caries case. After multivariate logistic regression, maternal attitude and how to drink milk bottle were the most risk factors to childhood caries (odds ratio: 3.61; 95% confidence interval [CI]: 1.18–11.01 and 7.69; 95% CI: 1.84–32.13 respecting). Conclusions: Many risk factors contribute to childhood caries, originated from both children themselves and mothers. Caries risk factor identification is an important role in preventing childhood caries.
  610 38 -
Role of dental discomfort questionnaire-based approach in recognition of symptomatic expressions due to dental pain in children with autism spectrum disorders
Chandana Penmetsa, Sarada Penmetcha, Sampath Reddy Cheruku, Sreekanth Kumar Mallineni, Anil Kumar Patil, Srinivas Namineni
July-September 2019, 10(3):446-451
DOI:10.4103/ccd.ccd_728_18  
Aim: The aim of this study is to investigate whether the Dental Discomfort Questionnaire (DDQ) could help to identify toothaches in children with autism spectrum disorder (ASD). Materials and Methods: This study involved sixty children between the age groups of 6–16 years, attending the day-care schools diagnosed with ASD. Five different groups of children were identified based on the presence of a toothache and/or carious teeth. The DDQ-8 was completed by parents and evaluated by a single examiner. Data were analyzed using descriptive statistics (SPSS version 17), and a correlation was observed between the total DDQ score and the decayed, missing, and filled teeth (dmft–DMFT) score. Results: Analysis of the data showed that DDQ-8 had a significant correlation with that of DMFT score in a group “with carious teeth but no toothache” (r = 0.497, P = 0.019) and group “with carious teeth and a toothache” (r = 0.682 P = 0.043). A group “without carious teeth where the parents were not sure whether or not the child had a toothache” had higher mean compared to other groups with DDQ-8 scores. Conclusion: There was a significant difference in the total mean DDQ scores when they were compared with that of the control group. Children with high DDQ-8 often had a high DMFT/dmft score. A significant correlation was found when the total DDQ-8 scores were compared with that of the DMFT score.
  598 40 -
Effect of indigenously developed nano-hydroxyapatite crystals from chicken egg shell on the surface hardness of bleached human enamel: An In Vitro study
Divya Kunam, Vidhya Sampath, Sujatha Manimaran, Mahalaxmi Sekar
July-September 2019, 10(3):489-493
DOI:10.4103/ccd.ccd_810_18  
Objective: The objective was to evaluate the effect of nano-hydroxyapatite (nHA) derived from chicken eggshell on bleached human enamel in comparison with commercial casein phophopeptide-amorphous calcium phosphate (CPP-ACP) paste using Vickers microhardness test. Materials and Methods: nHA powder was prepared from chicken eggshell using combustion method. nHA slurry was prepared by mixing 1.8 g of nHA powder with 0.3 ml of distilled water. Forty intact maxillary anterior teeth were collected and decoronated, and the crowns were embedded in acrylic mold with the labial enamel surfaces exposed. Baseline microhardness evaluation was done (T0). The specimens were randomly divided into the following four groups (n = 10) based on the surface treatment of enamel: Group 1: no bleaching treatment; Group 2: bleaching with 30% hydrogen peroxide (HP) solution; Group 3: bleaching followed by the application of CPP-ACP; and Group 4: bleaching followed by the application of nHA. The specimens were stored in artificial saliva at 37°C for 2 weeks, after which they were subjected to Vickers microhardness test (T14). One-way ANOVA and Tukey's post hoc multiple comparison tests were used for statistical analysis (P < 0.05). Results: Bleaching with HP significantly decreased the enamel microhardness. CPP-ACP and nHA derived from chicken eggshell increased the enamel microhardness significantly. There was no significant difference in microhardness values among the CPP-ACP and nHA groups. Conclusion: Nano-hydroxyapatite sourced from chicken eggshell was as effective as CPP-ACP in remineralizing and restoring the lost microhardness of bleached enamel.
  590 41 -
Effect of dentifrice containing crab-shell chitosan on the accumulation of dental plaque in fixed orthodontic appliances patients: A randomized controlled trial
J C. P Heryumani Sulandjari, Afina Zahra Chairunnisa, Ananto Ali Alhasyimi
July-September 2019, 10(3):452-456
DOI:10.4103/ccd.ccd_740_18  
Background: Patients with fixed orthodontic encounter problems in cleaning their teeth and mouths. Dental plaque tends to accumulate on wires, brackets, and surfaces between bonding materials and brackets. Plaque accumulation increases the risks of decalcification, caries, and gingivitis. Chitosan extract is a potential antibacterial agent and inhibitor of dental plaque formation. This study aims to assess the effectiveness of chitosan-containing dentifrice in decreasing plaque accumulation in patients with fixed orthodontic appliances. Materials and Methods: This was a prospective, randomized, double-blind study which involved 32 samples (randomly allocated to the control and chitosan groups, after the power of the study was considered) from patients with orthodontic appliances undergoing the last stage of fixed active orthodontic treatment. Plaque accumulation before and after dentifrice use was measured using a plaque index according to O'leary, before and after using toothpaste within 5 days. The patients were instructed to brushing with chitosan-containing dentifrice and chitosan-free dentifrice as a control. Washout period that needed between brushing with chitosan-containing dentifrice and chitosan-free dentifrice as a control was 7 days. Each mouthwash used routinely for 5 days with the same duration and intensity. The data obtained was then analyzed with one-way analysis of variance followed by post hoc least significant difference. The level of significance was set as 0.05. Results: Plaque accumulation before and after dentifrice use significantly differed (P < 05) between the control and chitosan groups. The average reductions in plaque accumulation were greater in the chitosan group and control group brushing using chitosan-containing dentifrice. Conclusion: Dentifrice-containing chitosan more effectively reduces dental plaque accumulation in patients with fixed orthodontic appliances than dentifrice without chitosan.
  587 33 -
Quantification and comparison of the impact of the smoking status on oral polymorphonuclear leukocyte and malondialdehyde levels in individuals with chronic periodontitis: A double-blinded longitudinal interventional study
Ninad Milind Padhye, Ashvini Mukul Padhye, Himani Swatantrakumar Gupta
July-September 2019, 10(3):517-524
DOI:10.4103/ccd.ccd_906_18  
Background: The formation of reactive oxygen species by oral polymorphonuclear leukocytes (oPMNs) is amplified in smokers with chronic periodontitis (CP) causing tissue damage which can be measured by quantifying levels of malondialdehyde (MDA). Objective: To quantify and compare the impact of smoking status on oPMN and MDA in individuals with CP before and after scaling and root planing (SRP). Materials and Methods: Sixty individuals were divided into four groups, namely, periodontally healthy (Group A), current smokers with CP (Group B), former smokers with CP (Group C), and nonsmokers with CP (Group D). Parameters assessed were bleeding on probing (BOP), gingival index (GI), probing pocket depth (PPD), clinical attachment level, gingival recession, periodontal inflamed surface area, salivary MDA, and oPMN at baseline and 6 and 12 weeks after SRP. Results: Increased PPD (P = 0.01) and decreased GI (P = 0.021) was noted in Group B as compared to C and D at baseline. Periodontal intervention caused a greater resolution of inflammation in Groups C and D as compared to B as noted from the GI and BOP. A reduction in MDA (P = 0.074) was noted in Groups C and D as compared to B, and oPMN levels were higher (P = 0.009) in Group C and D as compared to B. Conclusion: Greater periodontal destruction is seen in current smokers than former and nonsmokers with CP. MDA can be considered as a reliable biomarker for oxidative stress as it directly correlates with the oPMN levels.
  584 33 -
Evaluation of primary stability of cylindrical and tapered implants in different bone types by measuring implant displacement: An In vitro study
Tsutomu Sugiura, Kazuhiko Yamamoto, Satoshi Horita, Kazuhiro Murakami, Tadaaki Kirita
July-September 2019, 10(3):471-476
DOI:10.4103/ccd.ccd_788_18  
Aims: The purposes of this study were to investigate the primary stability of cylindrical and tapered implants in different bone types by measuring implant displacement and to examine the relationship between insertion torque value (ITV) and implant displacement. Materials and Methods: Four different polyurethane bone models consisted of low-density or low-to-medium-density cancellous bone with or without a cortical bone layer. A total of 120 cylindrical and tapered implants were placed into bone blocks (n = 15 in each group), and the ITV was measured. A lateral load of 15 N was applied to the top of the abutment, and implant displacement was recorded. Results: Implant displacement was significantly affected by cancellous bone density and to a lesser degree by cortical bone thickness. The displacement of tapered implants was significantly smaller than that of cylindrical implants in the presence of cortical bone. However, both implant groups showed similar ITV in the low-density cancellous bone model with the cortical bone layer. There was a correlation between ITV and displacement in the cylindrical and tapered implants. However, no correlation was observed between ITV and displacement within each bone type. Conclusions: Implant stability depended mainly on the bone type, whereas implant design had a limited influence on primary stability. The use of tapered implants may be advantageous for improving primary stability in patients with low-density cancellous bone only when crestal cortical bone exists. The same ITV of cylindrical and tapered implants did not necessarily represent similar primary stability in the bone type.
  578 36 -
Root anatomy of mandibular second premolars in french subpopulation: A retrospective observational case series
Naji Kharouf, Youssef Haikel, Davide Mancino
July-September 2019, 10(3):494-497
DOI:10.4103/ccd.ccd_841_18  
Aims: The purpose of this in vivo study is to illustrate endodontic anatomical variants in French subpopulations of human mandibular second premolars to show if the literature matches our findings. Setting and Design: This was an observational retrospective study. Subjects and Methods: This study was performed from September 2016 to September 2017. It was conducted on 56 successive cases of root canal therapies on the mandibular second premolars. All procedures were done in conformity with current state-of-the-art practices in endodontics. These included rigorous clinical and radiographic preaccess analysis, appropriate tooth restoration to insure watertight rubber dam installation, surgical microscopic manipulations for precision, systematic use of ultrasonic endodontic tips to manage cavity access preparation, and step-down technique to shape the root canal systems. Statistical Analysis Used: Fifty-six mandibular second premolars were treated: 76.8% had one canal, and 23.2% had two or more canals. Conclusions: The incidence of two or more canals on mandibular second premolars could be underestimated as our results show. To prevent any missing canals, clinicians must have a perfect knowledge of anatomic variants of the root canal system. Moreover, the systematic use of a surgical microscope, ultrasonic endodontic tips, and a modern step-down technique should facilitate and standardize access cavity preparation, canal localization, and instrumentation.
  578 30 -
Antibacterial and mechanical properties of pit and fissure sealants containing zinc oxide and calcium fluoride nanoparticles
Dara Lakshmi Swetha, C Vinay, KS Uloopi, Kakarla Sri RojaRamya, Rayala Chandrasekhar
July-September 2019, 10(3):477-482
DOI:10.4103/ccd.ccd_805_18  
Context: Pit and fissure sealants (PFSs) are the most effective preventive materials in dentistry. Secondary caries around the sealed pits and fissures at the material–tooth interface and the wear of the material remains the common problems. To address these problems, efforts have been made by incorporating zinc oxide (ZnO) and calcium fluoride (CaF2) nanoparticles (NPs) into the sealants to develop caries-inhibiting and stress-bearing sealants. Aim: Evaluation of antibacterial and mechanical properties of PFS containing ZnO and CaF2 NPs. Settings and Design: This was an in vitro study. Materials and Methods: A total of 196 fissure sealant samples were divided into six test groups and a control group. The test group samples were prepared by incorporating two concentrations (0.5 wt% and 1 wt%) of ZnO and CaF2 NPs into the sealants. The antibacterial activity was evaluated by direct contact test; compressive and flexural strengths were evaluated by a universal testing machine. Statistical Analysis Used: Statistical analysis was done by one-way ANOVA and post hoc Tukey test. Results: Sealants containing 1 wt% ZnO and CaF2 NPs and their mixture exhibited significantly higher antibacterial activity against Streptococcus mutans and Lactobacillus acidophilus when compared to control group (P < 0.001). Samples with ZnO NPs exhibited similar mechanical properties as conventional sealant (control group); however, the samples with CaF2 NPs showed inferior mechanical properties (P < 0.05). Conclusion: The observations of the study infer that sealants containing 1 wt% ZnO and CaF2 NPs and their mixture exhibited superior antibacterial activity. The mechanical properties of samples containing ZnO and mixture of ZnO and CaF2 particles remained comparable to the conventional sealants.
  560 44 -
CASE REPORTS
Rehabilitation with fixed prosthodontics associated with removable partial prosthesis: A 5-year follow-up clinical evaluation
Tassiana Cançado Melo Sá, Francisco Ivison Rodrigues Limeira, Ricardo Antonio Alpino Rodrigues, Júlio Celso Melo de Sá, Cláudia Silami de Magalhães, Allyson Nogueira Moreira, Monica Yamauti
July-September 2019, 10(3):561-564
DOI:10.4103/ccd.ccd_750_18  
Dental implants are a common and successful option for the rehabilitation of edentulous areas. However, there are some limitations to their use. The present clinical report describes a 5-year follow-up of maxillary rehabilitation using an attachment-retained removable partial denture (RPD) associated with fixed partial denture (FPD) units as an alternative to orthodontic treatment associated with orthognathic surgery and dental implant placement. Rehabilitation with fixed prosthodontics associated with a removable partial prosthesis was proposed. For greater precision and stability, a gold attachment was prepared. The patient was very satisfied with the rehabilitation and has been clinically followed for 5 years. In cases where the use of dental implants and/or conventional FPDs is limited or not indicate the association between an FPD and an RPD by means of attachments remains an important alternative to conventional clasp-retained RPDs.
  555 35 -
ORIGINAL ARTICLES
Salivary interleukin-6 levels among polycystic ovary syndrome patients with and without chronic periodontitis – A comparative study
Arun Varghese, Pratebha Balu, R Saravanakumar, Jananni Muthu, K Vineela
July-September 2019, 10(3):498-501
DOI:10.4103/ccd.ccd_848_18  
Background: Periodontitis is associated with various systemic diseases one of which is poly cystic ovarian syndrome (PCOS). PCOS is a genetically complex endocrinopathy of uncertain etiology affecting women of the reproductive age group which results in the most common cause of anovulatory infertility, menstrual dysfunction, and hirsutism. PCOS has a close association with cardiometabolic risk profile, insulin resistance (IR), hyperinsulinemia, central obesity, dyslipidemia, and increasing the prevalence of cardiovascular risk factors. The common pathway is the chronic low-grade inflammation which is constituted by pro-inflammatory cytokine interleukin (IL)-6. Aim: The aim of the study was to compare salivary IL-6 levels among polycystic ovary syndrome (PCOS) patients with and without chronic periodontitis. Materials and Methods: Newly diagnosed PCOS patients were selected for the study, and the periodontal parameters were recorded. Group A consists of 42 patients of PCOS with periodontitis and Group B consists of 42 patients of PCOS without periodontitis. Salivary levels of IL-6 were compared between the two groups and were assessed by enzyme-linked immunosorbent assay kit (bioassay). Results: The mean pocket depth in Group A was 4.23 ± 0.134 and that of Group B was 1.30 ± 0.06. The mean bleeding on probing in Group A was 1.40 ± 0.40 and in Group B it was 0.91 ± 0.18. The mean clinical attachment level in Group A was 4.87 ± 0.124 and that of Group B was 1.30 ± 0.06. The mean difference in clinical parameters was statistically significant between the groups (P ≤ 0.001). IL-6 level in group A is 102.59 ± 18.2 and in Group B it was 51.3 ± 25.3. Conclusion: Salivary IL-6 levels show a double-fold increase in PCOS with periodontitis than in PCOS without periodontitis. This study reflects the importance of periodontal health and the prevention of periodontal disease so as to minimize IR in PCOS patients with periodontitis.
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High-mobility group box 1 expression in mandibular bone cells of experimental periodontitis
Yuliana Mahdiyah Da'at Arina, Mohamad Rubianto, F Ferdiansyah, I Ketut Sudiana, Retno Pudji Rahayu, Hari Basuki Notobroto
July-September 2019, 10(3):525-530
DOI:10.4103/ccd.ccd_907_18  
Background: High-mobility group box 1 (HMGB1) was suggested to be associated with the pathogenesis of chronic periodontitis which characterized by alveolar bone loss. HMGB1 was defined as a bone-active cytokine, but the rule of HMGB1 in bone loss of chronic periodontitis is still understood. Aim: The aim of this study is to investigate the expression of HMGB1 on osteoblasts and osteoclasts in the mandible of chronic periodontitis. Methods: This experimental study was conducted to rats injected by Porphyromonas gingivalis into the buccal and lingual subgingival area at a concentration of 2 × 109 CFU/mL three times a week with 2-day apart for 2, 3, 4, and 6 weeks as chronic periodontitis group and injected by normal saline as control group. Analysis of variance was used to examine the differences between groups followed by least significant difference post hoc test with the level of significance was <0.05. Results: The HMGB1 expression was found in both osteoclasts and osteoblasts of mandibular bone by immunohistochemistry analysis. There was a difference of HMGB1 expression on osteoblasts and osteoclasts of chronic periodontitis. HMGB1 expression was found increased significantly in mandibular osteoblasts of chronic periodontitis, whereas the HMGB1 expression in mandibular osteoclast is higher in 2 and 3 weeks, but it was lower in 4 and 6 weeks. Conclusions: This study indicated a potential role for HMGB1 in bone loss of chronic periodontitis. HMGB1 on mandibular osteoclasts and osteoblasts may play different rules in the onset and progression of chronic periodontitis.
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