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   Table of Contents - Current issue
January-June 2022
Volume 16 | Issue 1
Page Nos. 1-95

Online since Tuesday, April 5, 2022

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COVID-19 pandemic: 2022 and beyond, perspectives and reflections p. 1
Anmol Kalha
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Rapid Maxillary Expansion, Sleep-Disordered Breathing and Conductive Hearing Loss in Children: A Correlation p. 3
Mohit Sharma, Balakrishnan Jayan, Sanajeet Kumar Singh, Shelka Dua
Aim: To evaluate the effects of Rapid Maxillary Expansion (RME) with respect to improvement in sleep disordered breathing(SDB) and conductive hearing loss in children Material & Methods: The study was carried out at a tertiary care centre in the Dept of Orthodontics & Dentofacial Orthopedics in collaboration with the Dept of ENT and Dept of Physiology after due clearance from the institutional committee. A sample of 30 children between age of 8 to 15 years seeking orthodontic treatment, treated with RME and evaluated for improvement in SDB, conductive hearing loss and decrease in AHI parameters using pre and post lateral cephalograms, PA cephalograms and Acoustic Pharyngometry. Data acquired was statistically evaluated and presented along a median with p-value at 0.05 and the hypotheses were formulated using two tailed alternatives against each null hypothesis. Results: Wilcoxon's signed rank test, showed that the distribution of post-treatment maxillary dentoalveolar parameters was significantly higher compared to the pre-treatment maxillary dentoalveolar parameters, post treatment cephalometric nasal and upper airway parameters were significantly higher compared to the pre-treatment, a positive impact on the upper airway especially NAS and VAS was observed, post treatment acoustic pharyngometry parameters (such as Mean volume, Mean area and Minimum area) which were significantly higher compared to the average pre-treatment parameters, AHI was significantly lower compared to the pre-treatment AHI showing marked improvement and conductive hearing loss improved post RME, leading to near normalization. Conclusion: All maxillary dentoalveolar parameters, nasal width and transverse maxillary width improved, Nasopharyngeal and Velopharyngeal airway space showed improvement as the maxillary trnasverse width improved post RME, tongue posture improved to a more downward and forward position significantly. Apnea-Hypopnea Index reduced leading to improvement in sleep parameters and its associated signs and symptoms. Post RME, changes in the maxillary transverse width also improved the anatomical relationship of the associated muscle attachments especially the tensor and levator palatani muscle attachments, thereby improving the conductive hearing loss in the subjects.
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Analysis of cell cycle activity by expression of p-53 protein in different gingival overgrowths: An immunohistochemistry-based pilot study p. 12
Sunny Bhatia, Manish Mukherjee, Partha Roy, Parvez Shaikh, Priyanka Prakash
Context: It is a crucial protein expressed in cells to prevent tumor formation. Hence, the study of expression of p-53 protein is of high importance in gingival cells in various conditions such as drug-induced gingival enlargement and nondrug-induced gingival enlargements. Aims: This study aimed to analyze the cell cycle activity for the p-53 protein expression in the cells of drug-induced and nondrug-induced gingival overgrowths as compared to healthy subjects. Settings and Design: This was a single-blinded observational pilot study. Subjects and Methods: Patients were included on the basis of various inclusion and exclusion criteria and divided into three groups. Inclusion Criteria:
  1. Group A (patients with drug-induced gingival overgrowth)
    • Patients on drugs such as anticonvulsant, immunosuppressants, and calcium channel blockers ≥6 months.
  2. 2. Group B (patients with nondrug induced gingival overgrowth)
    • Patients not on drugs such as anticonvulsants, immunosuppressants, and calcium channel blockers ≥1 year.
  3. Group C (healthy subjects)
Exclusion Criteria: Patients on antibiotics and edentulous patients. Protocol:
  • Gingival samples were collected after obtaining consent from patients and were stored in 10% formalin
  • The samples were blinded and the assay for the expression of p-53 was done by immunohistochemistry along with histopathological examination.
Statistical Analysis Used: Statistical analysis was conducted by using SYSTAT-13 software. Results: Expression of p-53 protein in each group was analyzed after preparing slides for immunohistochemistry examination. A total of 10 samples were analyzed in each group to check for the expression of p-53 protein in basal as well as suprabasal cell layers. Each sample was then correlated with the corresponding slides for histopathological examination of each sample for each group. Conclusions: The p-53 protein expression in the hyperplastic gingival epithelia noted in our present study suggests that gingival hyperplasia induced by drugs or by inflammation has possible implications for pathogenesis accompanied with impaired DNA. On the other hand, our study also suggests that the growth arrest takes place in the representative rete pegs deeply elongated into lamina propria of hyperplastic gingival tissues, which contributes to the inhibition of DNA damaged cell expansion within gingival tissues followed by promoting the tumorigenic aberrations of gingival hyperplasia.
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Cytokeratins: A potential biomarker among smokers – An observational study in Indian population p. 19
Parvez Hasib Shaikh, Manish Mukherjee, Partha Roy, Sunny Bhatia, Priyanka Prakash
Introduction: Gingival epithelium is made up of stratified squamous epithelium consisting of specific cytokeratins (CKs), as intermediate filament proteins of the cytoskeleton. These CKs are involved in transduction signals and transport of nutrients from inside to outside the cell and vice versa. Their expression varies in diseased and inflammatory conditions and can serve as prognostic markers in various diseases. Objectives: The objective of the study is to evaluate the alteration of CK pattern and topographical distribution of individual CK among smokers and nonsmokers of Indian population. Subjects and Methods: Gingival tissue samples from smokers and nonsmokers were obtained after taking their consent and segregated as healthy and inflamed into four groups depending on probing depth, clinical attachment loss, and bleeding on probing based on well-defined inclusion criteria such as young, systemically healthy participants and exclusion criteria such as old edentulous patients suffering from systemic disease. Each tissue sample was blinded and subjected for histopathological and immunohistochemical analysis. Results: Immunohistochemical analysis for CKs CK19, CK8, and CK18 for their pattern and topographical distribution in gingival tissues were obtained using specific antibodies. Histopathological examination was done to study aberration in tissue morphology. Conclusions: Data were collated from all the groups and CK was analyzed for decreased or increased expression, topographical distribution, in various cell layers, and association with other diseases among Indian population was evaluated.
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Effect of visual enhancement on root surface instrumentation: An in vitro scanning electron microscope study p. 24
Sunil Kumar Goyal, MP Prasanna
Aim: The aim of this study was to compare the efficacy of various magnifying tools in periodontal mechanotherapy. Materials and Methods: A total of 30 single-rooted extracted teeth were equally divided into six groups. The root surfaces were subjected to manual as well as ultrasonic instrumentation under unaided eye, magnifying loupes, and dental operating microscope (DOM). Then, the teeth samples were evaluated for the surface properties and for the presence of smear layer with a scanning electron microscope using magnification of ×100 and ×3000. Statistical Analysis: Data were subjected to statistical analysis using Kruskal–Walli's Analysis of variance and Mann–Whitney's test. Results: The mean roughness and loss of tooth substance index scores for the manual instrumentation performed under unaided, loupe, and surgical microscope were 1.8, 1, and 1, respectively. The mean scores for the power-driven instrumentation performed under unaided, loupe, and surgical microscope were 1.2, 1.2, and 1, respectively. Statistically significant (P < 0.05) difference was found when root planing was performed by hand instrumentation under DOM when compared to unaided vision. Comparison between manual and ultrasonic instrumentation was nonsignificant (P > 0.05) under magnification. Conclusions: All treatment modalities were effective in mechanical debridement of the root surface. The result favored the use of ultrasonic instrumentation as compared to manual instrumentation under unaided vision. Whereas under magnification, both manual instrumentation and ultrasonic instrumentation produced similar root surface smoothness.
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Evaluation of characteristics and clinical implications of endodontic emergencies during COVID-19 pandemic p. 30
Seema Chaudhary, Sonali Sharma
Background: The spread of a new coronavirus named Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) was detected in China in late 2019, which later spread to other parts of the world. Affected persons present with symptoms such as dry cough, malaise, and a high fever. During the various phases of the pandemic, patients presented with the symptomatology of a plethora of dental emergencies including endodontic emergencies to the dental institute. Aim: The present study aimed to analyze the nature and characterize endodontic emergencies. Materials and Methods: Patients reporting with pain and swelling of endodontic nature were included in the study. Information about patients was collected and systematized by date of visit, gender, age, and diagnosis. Only the patients exhibiting emergencies of endodontic origin were included in the study. Emergencies were divided into three groups: Group I: Preoperative, Group II: Intraoperative and Group III: Postoperative. These groups were further stratified according to the final diagnosis. A numerical rating scale (NRS) was used to record pain levels. Results: A total of 4274 patients were attended for endodontic emergencies. The age group which presented with maximum number of endodontic emergencies was 30–39 years (37%). The majority of endodontic emergency diagnoses were diseases of symptomatic irreversible pulpitis (57%). Patients who were diagnosed with symptomatic irreversible pulpitis showed higher mean verbal NRS scores than that of other groups although the difference was statistically nonsignificant. Conclusion: The type of endodontic emergencies varies depending on the inflammatory status of the pulp. Keeping in mind the characteristics of endodontic emergencies, treatment protocols can be formulated and patients can be managed taking care of all due precautions to reduce the risk of infection transmission.
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Functional evaluation of edentulous Patients rehabilitated with immediate loaded implant retained mandibular overdenture: An in-vivo study p. 36
Kiran Laxmikant Awchat, SR Iyer, Dinesh Kumar, VS Legha, KV Arun Kumar, Vinay Wadhwa, Deepa Bhat
Background: Implant number, loading time and patient satisfaction are the critical issues in management of completely edentulous patients with implant prosthesis. Literature has mentioned the success of immediately loaded implant overdenture but only few studies are there in Indian scenario. Methods: 15 completely edentulous patients in the age range of 40-70 years were selected for this study. Balanced occlusion Complete dentures were fabricated and inserted in the patient's mouth. Same patients were taken up for implant placement after 2 months and implants were evaluated for clinical parameters Results: The patient responded favourably to this modality of treatment. The questionnaire method used for assessing masticatory capacity and general satisfaction showed positive impact at 6-month and 12-month follow-up compared to the baseline scores (P-value<0.001 for both). Conclusion: Patient's satisfaction and masticatory capacity improved significantly with immediately loaded implant overdenture in this study. Study with more elaborate sample size is recommended to verify the results of this study.
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Can associated pathology influence pain perception and oral health-related quality of life after surgical removal of impacted mandibular third molars? A comparative study in a Saudi Arabia population p. 43
Ramat Oyebunmi Braimah, Dawood Ali-Alsuliman, Reham Mohammed Makrami, Abdullah Saleh Alwalah, Saeed Turki Al-Sagoor, Abdurrazaq Olanrewaju Taiwo, Adebayo Aremu Ibikunle
Background: Influence of over-erupted/buccally erupted maxillary third molar and distal surface caries (DSC) of mandibular second molar on oral health-related quality of life (OHRQoL) is not found in the literature. Materials and Methods: This prospective study was to evaluate the influence of associated pathology on OHRQoL after impacted mandibular third molar (IMTM) surgery. Demographics, indication for seeking IMTM removal, and presence of DSC and over-erupted/buccally erupted maxillary third molar were recorded. The Numeric Pain Scale and Arabic version of UK-OHRQoL instruments were used to evaluate pain and QoL after IMTM surgery. Analysis of variance was used statistically. Results: A total of 90 (41 [45.6%] males and 49 [54.4%] females) patients were recruited. The mean age was 31.3 ± 6.7 years. Patients with no associated pathology had lesser pain and better QoL scores. The domain scores became significant at: symptom level, body function level, and personal level on postoperative day (POD) 5; symptom level, body function level, personal level, and social level on POD 7; and at social level only on POD 14. Mean overall QoL was significant on POD 5 and 7. Conclusion: An over-erupted/buccally erupted maxillary third molar and mandibular second molar with DSC negatively affected pain perception and overall OHRQoL after surgical removal of IMTMs.
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Knowledge, attitude, and perception of orthodontists toward coronavirus disease 2019 pandemic: A cross-sectional study p. 49
Ashish Kamboj, Mohit Sharma, Balakrisnan Jayan, Sukhbir Singh Chopra, Paras Angrish, Pritam Mohanty
Background: Coronavirus disease 2019 (COVID-19) is a global pandemic with more than 30,300,000 cases in India and continuously affecting the dental community. Objectives: The aim of present study was to assess the knowledge, attitude, and perception (KAP) of orthodontists of India, regarding COVID-2019 pandemic. Methods: An online questionnaire was distributed among Orthodontists, using a combination of convenience and snowball sampling. The questionnaire had 31 questions depicting knowledge, awareness, attitude, and perception regarding COVID-19. The descriptive statistical analysis was done to compute frequency and percentages. Results: Around 101 orthodontists participated in the study, out of 101 responders, 1 did not respond to even one question. Only 72% showed accurate knowledge with respect to the common symptoms of coronavirus. Mix responses regarding knowledge of sanitization of environment in clinic were reported among responses. Eighty-three percentage of orthodontist responded that COVID-19 pandemic has impact on orthodontic practice. Ninety-three percentage believe that they could transmit infection to their family members. Only 52% of the participants feels that they are safe at work. Conclusion: Results of the present study suggest that COVID-19 is a major challenge to all the dental practitioners including orthodontists. This study is highlighting the lesser known facts about orthodontic practitioners, i.e., only half (52%) of them feel safe at work and majority of them feel that they can transmit the infection to their families from orthodontic setup. Moreover, a larger part of orthodontists feels that COVID-19 will permanently change the contemporary orthodontic practice.
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Orthodontic treatment needs in primary school children of Udhampur, India p. 57
Vineet Sharma, Vishwaroop
Objective: Early detection of developing malocclusions and its subsequent management with relatively low cost and uncomplicated orthodontic treatment procedures has the potential to minimize future costly and complicated treatment. The present study was aimed to assess the potential for this approach in children having access to orthodontic care at no cost by the government. Methods: Each child was independently assessed by an experienced examiner for multiple components of his or her occlusion, including molar relationship, overbite, overjet, open bite, deep bite, and crossbite. DEFT scores were also noted. Informed consent was obtained and all 738 children of ages 7–11 years present at school on the day of the field study were included. Results: A DEFT score of 1655 (2.24%), potential crowding in 471 (63.82%), retained deciduous teeth in 25 (3.38%), anterior crossbite in 32 (6.79%), and posterior crossbite in 13 (2.76%) was observed. Conclusions: Most of the developing malocclusions identified in this study would be managed with simple, relatively low-cost interceptive orthodontics, consisting of space maintenance, crossbite correction, and arch expansion.
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Short implants a plausible alternative to conventional dental implants - A review p. 61
Sheetal Anand Asija, Subrata Roy
The success rate of implants positioned in reduced bone quality can be highly compromised especially as observed in the posterior dental arches. A critical aspect in implant placement and design like bone length can be augmented using various bone reconstructive procedures like sinus lift, bone grafting, alveolar distraction, and many more but attached with these techniques comes a high rate of morbidity, lengthy treatment times, and healing periods to which the patient may not appear very pleased about. Hence, short implants can be used as a viable alternative utilizing all of the available bone and taking into account the biomechanics and biological conditions of each case. As compared to vertical bone augmentation of poorly resorbed ridges, short implants perform better, especially in areas of proximity to anatomical structures such as mandibular canal and maxillary sinus. The merits of short implants mainly include ease of insertion of implant fixture, not too elaborate an osteotomy, and less likelihood for undue heat generation in the alveolus. This article is an attempt to provide a review on short implants with the basic aim of overcoming the myths and barriers attached with this concept and will help to open global doors into this less ventured space for achieving a successful implant outcome.
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Mucormycosis and dentistry in the current pandemic scenario: A review of literature p. 66
Anup Gopi, Satish R Iyer, Amolika Choube
The treatment protocol for COVID-19 along with the presence of important confounders like diabetes and immunocompromised states may predispose individuals to COVID-19-associated mucormycosis. Since mucormycosis is a rapidly progressive and invasive infection with intracranial complications, early diagnosis followed by aggressive medical and surgical interventions is imperative to reduce the morbidity and mortality associated with the disease. The role of dental practitioners in early recognition and referral of the patient is thus paramount. A systematic investigation on the PubMed Database was undertaken and available data were compiled. This paper presents a review of mucormycosis in the current COVID-19 scenario, to act as a ready reference for dental practitioners.
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Musculoskeletal disorders in dentists and relearning the ergonomics p. 72
Omprakash Dulhani, Manish Mukherjee
Musculoskeletal disorders (MSDs) are one of the most common occupational diseases. It can cause pain and dysfunction of routine functioning of back/neck/limbs. MSDs can amount to loss of working period, increased labor costs, and human injuries. Unhealthy postures while working are the cause of MSDs among dentists. Ergonomics is an applied science concerned with improving productivity and safety and not just preventing work-related MSDs. Ergonomics ensure optimal working conditions along with physical and psychological comfort throughout the execution of the clinical acts.
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Achieving esthetics with computer-aided design-computer-aided manufacture ceramic veneers p. 77
Maninder Hundal, Vaibhav Jain
Continuous evolution of materials, laboratory techniques, and clinical procedures has made the ceramic laminate veneers a reliable modern technique. Veneers are mainly fabricated from conventional low fusing feldspathic porcelain. Two popular methods for fabrication of porcelain veneers are the platinum foil technique and the refractory die technique. However, these are time-consuming and technique sensitive. In contrast, the computer-aided design/computer-aided manufacture (CAD/CAM) restorations can be made in one visit, and the new equipment and softwares have shown to result in improved marginal fit. This scientific paper focuses on two case reports with different clinical indications restored successfully with two different types of CAD-CAM veneer materials.
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Solitary plexiform neurofibroma of the malar region: A rare and unusual presentation p. 81
Rajkumar K Prabhu, M Viswambaran
Plexiform neurofibromas are benign tumors of the peripheral nerves and are usually considered pathognomonic of neurofibromatosis type 1. We discuss the case of a young male patient presenting with a solitary mass over the malar region. Pathologic examination revealed a plexiform neurofibroma of the infraorbital nerve. No other signs or symptoms of neurofibromatosis were identified. Although rare, plexiform neurofibromas may rarely occur as solitary lesions not associated with the neurofibromatosis spectrum. It can be seen in unusual anatomic location such as the malar region and should be considered in the diagnosis of soft tissue facial tumors.
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Role of Photo Dynamic Therapy as an adjunct in periodontal therapy p. 84
T Prasanth, ID Roy, G Nanavati, TS Satisha
Antimicrobial photodynamic therapy (aPDT) is an emerging treatment modality in the field of Dentistry aimed at reducing the microbial load and accelerating the healing process, thereby widening its application base in the field of periodontics, oral surgery, endodontics, pedodontics, etc. The process involves the blending of a nontoxic photosensitizer dye with a suitable wavelength of a visible low-level laser, this combination helps in the formation of the reactive oxygen species, which causes lethal and irreversible damage to the bacterial cell. Various dyes and light sources of different wavelengths are used in several permutation and combination to achieve the desired results. In periodontology, aPDT has been used as an adjunct in the treatment of chronic periodontitis, peri-implantitis, red and white lesions etc. The aim of this case report was to highlight the uses of aPDT in such cases.
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A large obstructive hard palate Teratoma in a neonate p. 91
Pushpa Kumari, Anoop Singh Yadav, Jaskiran Singh Randhawa, Vivek Saxena, Ritu Mehta, Bal Mukund
A neonate female was born with congenital swelling of the hard palate. The baby did not cry immediately after birth, and she was in respiratory distress. The patient required positive pressure ventilation in bag and mask ventilation followed by endotracheal intubation. Noncontrast computed tomography of the head on the 7th day of life showed a soft tissue density fat-containing lesion over the roof of the oral cavity and bony defect in the hard palate. It was provisionally diagnosed as a case of soft tissue mass – hamartoma of the hard palate associated with complete cleft palate and acyanotic heart disease. The patient underwent excision of the mass on the 9th day of life. Histopathological report showed mature teratoma. Teratoma is a rare congenital malformation. At present, after 2 years of age, the patient shows no signs of recurrence.
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Full-arch implant rehabilitation p. 95
Avina S Banari
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