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   Table of Contents - Current issue
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August 2020
Volume 12 | Issue 5 (Supplement)
Page Nos. 1-655

Online since Friday, August 28, 2020

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EDITORIAL  

From the editorial desk Highly accessed article p. 1
Gobichettipalayam J Anbuselvan, Thangavelu Arthiie, Thuckanickenpalayam R Yoithapprabunath
DOI:10.4103/jpbs.JPBS_273_20  
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REVIEW ARTICLES Top

Is neutral zone, patients comfort zone? A feedback review Highly accessed article p. 2
V Beenu, Ajmal Khan S Kattak, Vishnu S Pattath, Shani J Nair, Rahul Das, MS Sreelekshmi
DOI:10.4103/jpbs.JPBS_56_20  
The technique of neutral zone is useful. It is the convergence of many concepts and ideas into a feasible and functional method. The technique aims to build a denture in accordance with the underlying oral structures that are formed by muscle function. It acts as an alternative technique in case of highly atrophic ridges. With a history of denture instability, it is most successful. This paper seeks to provide information with an enclosure of a patient input study to use the technique.
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Mandibular canine calcification stages as an indicator of skeletal maturity Highly accessed article p. 6
Supriya Gopalakrishnan, M Jayaram, Tojan Chacko, Jose Jacob, P Anuradha, Vineetha V Menon
DOI:10.4103/jpbs.JPBS_78_20  
Aims: The aim of this study was to verify whether there is significant relationship between stages of mandibular canine calcification and skeletal maturation and to determine whether the same can be used as a reliable diagnostic aid to assess skeletal maturity. Materials and Methods: The sample consisted of 50 males and 50 females aged between 8 and 15 years. Two radiographs namely orthopantomograph and handwrist radiograph were taken for this study. Skeletal age was ascertained from handwrist radiographs according to the method introduced by Fishman L.S. The developmental stages of mandibular canine were assessed according to Demirjian’s stages of dental calcification. Results: The relationship between canine stage calcification and skeletal maturity index was statistically significant in all stages. Interpretation and Conclusion: Mandibular canine calcification stages can be recommended as a supplemental diagnostic aid. Similar studies may be conducted in different population to rule out any possible racial and regional influences on growth characteristics.
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Review of metallic biomaterials in dental applications Highly accessed article p. 14
S Tharani Kumar, S Prasanna Devi, Chandrasekaran Krithika, RN Raghavan
DOI:10.4103/jpbs.JPBS_88_20  
Titanium and its alloys are mainly used in manufacturing dental implants. The fact that titanium implants are immunologically very effective, new methods are being experimented to achieve utmost success rate as a biomaterial. One fundamental indicator for clinical achievement of implant is the decision of composition decided for the implant with the objective to improve osseointegration. The main objective of this study was to explore literature on dental materials used for implants, contrast them with titanium dental implants, with the aim to improve osseointegration and mechanical quality using Ti–Ga–Si dental implant.
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Regenerative endodontics: A paradigm shift in clinical endodontics Highly accessed article p. 20
Manoj Kumar Pulyodan, Sunil Paramel Mohan, Dhanya Valsan, Namitha Divakar, Shabna Moyin, Shamsheer Thayyil
DOI:10.4103/jpbs.JPBS_112_20  
Preserving the natural dentition in its normal form and function is one of the major goals of endodontic treatment. Re-establishing the lost vitality and development of root maturation in immature permanent teeth with pulp necrosis/apical periodontitis is quiet challenging clinically. The very basis of regenerative endodontics relies on the concept of tissue engineering using stem cells, biomimetic scaffold, and bioactive growth factors to regenerate the pulp tissue damaged by microbial infection, injury, or developmental defects. In clinical endodontics, this approach is referred to as a “paradigm shift.” Even though repair instead of true regeneration is achieved with current protocols, it is hoped that further research in the area of stem-cell-based tissue engineering will allow for true regeneration and improved treatment outcomes. The aim of this review is to discuss about the various aspects of regenerative endodontics, current clinical protocols, and the future of pulp regeneration techniques.
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Regenerative capacity of dental pulp stem cells: A systematic review p. 27
Adlin S Rosaian, Gururaj Narayana Rao, Sunil P Mohan, Mahalakshmi Vijayarajan, Rebekkah C Prabhakaran, Anand Sherwood
DOI:10.4103/jpbs.JPBS_121_20  
Objectives: The dental pulp contains undifferentiated mesenchymal cells, blood vessels and so on, which are responsible for routine functions of a tooth. The determination of stemness and regenerative properties using biomarkers and further application in routine practice may unravel its potential. Materials and Methods: Inclusion criteria—original research articles published in English, from 2000 to 2019, were collected both manually and by electronic search from databases of Cochrane, Medline, Embase, and PubMed. Exclusion criteria—articles other than English and review manuscripts were omitted. The shortlisted articles were reviewed for specific biomarkers, to assess the regenerative potential, stemness, and lineage of dental pulp stem cells. Results: Of 512 articles, 64 were selected and reviewed to determine the mesenchymal, neurogenic, vasculogenic, hematopoietic, and stem cell potential. On the basis of the search analysis, a panel of markers was proposed. Conclusion: The application of proposed markers, on a pulpectomized tissue derived from human teeth, may be helpful to determine the regenerative potential and the usefulness in regenerative medicine and tissue engineering.
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The association of matrix metalloproteinase gene polymorphisms and periodontitis: An overview p. 37
Dalal H Alotaibi, Abdulaziz Mohammed Altalhi, Zainah Mohammed Sambawa, Pradeep Koppolu, Aljoharah Abdullah Alsinaidi, Preeti Krishnan
DOI:10.4103/jpbs.JPBS_136_20  
Periodontitis is a multifactorial inflammatory disease, pathogenic bacteria being the primary etiological agents. The host response and the severity of clinical manifestation are determined by genetic and environmental factors. There is some evidence that the individual response to environmental variations in the immune response in periodontitis is associated with genetic factors. Matrix metalloproteinases (MMPs) are a family of proteolytic enzymes located in the extracellular matrix. Their primary function is the breakdown of connective tissue components. Their role in the oral cavity is very vital. In this literature review, we summarized the contemporary knowledge on the function of MMPs in oral cavity and periodontal disease.
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Exosomes in the oral and maxillofacial region p. 43
Jaisanghar Suman Jhansi Lakshmi, Jaisanghar Nallusamy, Geetha Manivasagam, Murugan Ramalingam, Paramel Mohan Sunil, Arun Tom
DOI:10.4103/jpbs.JPBS_144_20  
Exosomes are a type of extracellular vesicles, released from different tissues in a living individual. By virtue of their ability to be released from both the normal and diseased individual, they play an inevitable role in the diagnosis, prognosis, and therapeutic aspect of a disease. With this background, the untapped role of exosomes in the field of oral and maxillofacial region is unveiled.
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Molecular insight into odontogenesis in hyperglycemic environment: A systematic review p. 49
Andamuthu Yamunadevi, Ramani Pratibha, Muthusamy Rajmohan, Nalliappan Ganapathy, Jeyachandran Porkodisudha, Dhanasing Pavithrah, Sengottaiyan Mahendraperumal
DOI:10.4103/jpbs.JPBS_159_20  
Diabetes mellitus is an endocrinal disorder affecting worldwide and the disease incidence is rising alarmingly high. The effects of diabetes on tooth development are explored by limited studies and their molecular insights are very rarely studied. This systematic review is aimed to provide the best scientific literature source on the molecular insights into odontogenesis in hyperglycemic environment caused by diabetes mellitus or by maternal diabetes on the offspring. The literature search was conducted on the databases, namely PubMed, PubMed Central, Cochrane, and Scopus. The original studies exploring the alterations in the molecular pathways of odontogenesis in diabetes mellitus were selected. Data were extracted, chosen, and evaluated by two independent researchers. At the end of thorough data search, four articles were eligible for the review. Three articles brought out the molecular pathways involved in the offspring of gestational diabetes through animal models. Fourth article was an in vitro study, which treated the stem cells in hyperglycemic environment and drafted the molecular pathway. The altered molecular pathways in dental epithelial stem cells (DESCs), dental papilla cells (DPCs), and stem cells from apical papilla were studied and empowered with statistical analysis. Thus with this systematic review, we conclude that apurinic/apyrimidinic endonuclease1 downregulation causing deoxyribonucleic acid hypermethylation and Oct4, Nanog gene silencing, activation of toll-like receptor-4/nuclear factor kappa B (TLR4/NF-κB) pathway are involved in suppressing cell proliferation and accelerated apoptosis in DESCs in high glucose environment. DPCs are suppressed from odonto differentiation by activation of TLR4 signaling and resulting inhibition of SMAD1/5/9 phosphorylation in diabetic condition. NF-κB pathway activation causes decreased cell proliferation and enhanced differentiation in apical papilla stem cells in hyperglycemia. Further studies targeting various stages of odontogenesis can reveal more molecular insight.
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Chlorhexidine: An elixir for periodontics p. 57
Arthiie Thangavelu, Sahaya Stelin Kaspar, Ramesh Periannan Kathirvelu, Bhuvaneshwari Srinivasan, Soundarya Srinivasan, Rajasekar Sundram
DOI:10.4103/jpbs.JPBS_162_20  
Chlorhexidine is a cationic bisbiguanide with broad antibacterial activity, and wide spectrum of activity encompassing gram-positive and gram-negative bacteria, yeasts, dermatophytes and some lipophilic viruses. Its antibacterial action is due to the disruption of the bacterial cell membrane by the chlorhexidine molecules, increasing the permeability and resulting in cell lysis. Thus, chlorhexidine plays a key role in the dentistry and is used to treat or prevent periodontal disease, and has earned its eponym of the gold standard. This article reviews in detail about the mechanism of action, indications, forms and various studies related to chlorhexidine.
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Dental pulp stem cells in neuroregeneration p. 60
Sunil Paramel Mohan, Murugan Ramalingam
DOI:10.4103/jpbs.JPBS_229_20  
Neurological diseases and injuries affect the routine life of patients. Current medical and surgical treatment has not improved the quality of life to desired limits. Neural regeneration through stem cells may be ideal choice in current scenario. Dental pulp stem cells (DPSCs), which are isolated from dental pulp, have shown excellent neuroregenerative properties in various animal studies. This review outlines the clinical perspective of DPSCs in neuroregeneration.
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ORIGINAL ARTICLES Top

Effect of novel cycloaliphatic comonomer on surface roughness and surface hardness of heat-cure denture base resin p. 67
Ranganathan Ajay, Karthigeyan Suma, Vikraman Rakshagan, Elumalai Ambedkar, Vellingiri Lalithamanohari, Murugesan Sreevarun
DOI:10.4103/jpbs.JPBS_20_20  
Background: Polymethyl methacrylate (PMMA) is a widely used resin in the field of prosthodontics for fabricating myriad orofacial prostheses. Albeit several advantages, it possesses certain lacunae concerning physicomechanical properties. Purpose: This in vitro research aimed to evaluate the surface roughness (SR) and hardness (SH) of heat-cured PMMA processed with a cycloaliphatic monomer, tricyclodecane dimethanol diacrylate (TCDDMDA), in methyl methacrylate at various concentrations. Materials and Methods: Groups have been divided into control (SRC and SHC) and experimental groups (SR10 and 20; SH10 and 20). Forty-five PMMA disc specimens were prepared. SR was assessed using a nanomechanical testing machine and the arithmetic roughness (Ra) was recorded. The same specimens were then subjected to Vicker’s microhardness testing and Vicker’s hardness number (VHN) was obtained. Data were compared using one-way analysis of variance (ANOVA) and post hoc Bonferroni tests (α=0.05). Results: The mean (standard deviation [SD]) of SRC, SR10, and 20 groups were 111.415 nm (0.789), 62.666 nm (0.482), and 41.004 nm (0.561), respectively. The mean (SD) VHN of SHC, SH10, and 20 groups were 21.003 (0.252), 23.975 (0.207), and 34.622 (0.079), respectively. Conclusion: The addition of TCDDMDA markedly decreased the SR and increased the SH of the experimental groups.
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Comparative evaluation of pH and in vitro cytotoxicity of zinc oxide–ozonated eugenol and conventional zinc oxide eugenol as endodontic sealers p. 73
Chandramohan Ravivarman, Athikesavan Jeyasenthil, Ranganathan Ajay, Nasir Nilofernisha, Radhakrishnan Karthikeyan, Durairaj Rajkumar
DOI:10.4103/jpbs.JPBS_21_20  
Background: Eugenol released from zinc oxide eugenol (ZOE)–based sealants may cause irritation to the periapical tissues and has cytotoxic potential. Ozone therapy has numerous clinical applications with humans because of its bactericidal action, detoxifying effect, stimulation of angiogenesis, and wound-healing capacity. Therefore ozone can be incorporated in ZOE sealer to exploit these properties. Materials and Methods: Eugenol was ozonated using ozonator machine and the samples were divided into two groups: Group I: zinc oxide eugenol (n = 10) and Group II: zinc oxide–ozonated eugenol (OZOE; n = 10). The pH of the fresh sealer samples and the set samples was measured using calibrated pH meter after predetermined time intervals. Cytotoxicity of the set sealer was evaluated on mouse L929 fibroblasts using cellular metabolic assay. Results: pH of the samples in Group II was higher when compared to Group I. Group II showed higher cell viability than the Group I. Conclusion: OZOE sealers can be used as an alternative to the conventional ZOE sealers.
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The effect of phase I therapy on the clinical parameters, VSC levels, and RBS levels in chronic periodontitis patients with diagnosed diabetes p. 78
Pushpalatha Tummakomma, Satyanarayana Durvasula, Neeharika Soorneedi, Khurramuddin Mohammed, Mohammed Abidullah, Syed Nazia Tabassum
DOI:10.4103/jpbs.JPBS_31_20  
Introduction: The relationship between chronic periodontitis and type 2 diabetes mellitus (DM) is bidirectional. Halitosis or oral malodor has an effect on psychological and social life of persons, and is seen in individuals with diabetes. Aims and Objectives: The aim of this study was to find out the effect of phase I therapy on the clinical parameters, volatile sulfur compound (VSC) levels, and random blood sugar (RBS) levels in chronic periodontitis patients with diagnosed DM. Materials and Methods: Our study included 80 patients with diabetes and chronic periodontitis. We collected subgingival plaque samples at 1 week and 1 month after scaling and root planing. The parameters measured were probing pocket depth and clinical attachment level for all the teeth at four sites per each tooth. RBS levels were recorded for all the patients. Malodor was measured with Tanita Breath Checker (Tanita India Private Limited, Mumbai, Maharashtra, India). Results: We found a statistically significant reduction in clinical parameter levels, VSC levels, and N-benzoyl-dl-arginine-2-naphthylamide (BANA) levels in both the groups from baseline to 4 weeks with highest levels in diabetic chronic generalized periodontitis (CGP) and lowest in nondiabetic CGP at baseline. The mean intergroup comparison of BANA levels was statistically significant at all intervals of time between the two the groups. Conclusion: There is a significant correlation observed between oral malodor levels, RBS, and clinical parameters in the diabetic group.
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Cytological and cytomorphometric study of exfoliated cells of the oral mucosa in diabetic patients p. 86
Kavitha Gaddikeri, Mohammed Abidullah, Deepak Bhorgonde
DOI:10.4103/jpbs.JPBS_32_20  
Background: Systemic disorder like diabetes mellitus is on the rise in developing countries like India and in many parts of the world. Early diagnosis of this disease will help to prevent the complications due to uncontrolled diabetes mellitus. Dentist helps in the early diagnosis of this disease as patients manifest several oral manifestations. Aims and Objectives: The aim of this study was to study the cytological and cytomorphometric changes of exfoliated cells of oral mucosa in diabetic patients. Materials and Methods: Thirty diabetic patients and 15 healthy controls were included in the study. From the buccal mucosa, smears were collected and Papanicolaou stain was used for staining. Cytological and cytomorphometric study was carried out. The cell diameter and nuclear diameter were measured on these smears and were compared with the control group with the help of “unpaired Student t test.”Results: Buccal mucosa exfoliated cells’ mean nuclear diameter of diabetic group and control group was 11.198 and 9.494 µm, respectively and the difference was highly significant. Conclusion: Our study suggests significant cellular changes in the diabetic patients, which may aid us in early detection of diabetes.
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Correlation between histological grading and ploidy status in oral leukoplakia, oral submucous fibrosis, and oral squamous cell carcinoma: A flow cytometric analysis p. 91
Surekha Velidandla, Sangameshwar Manikya, Nirosha Gajjada, Sridhar Reddy, Lavanya Gogulamudi, Shivaratna Mediconda
DOI:10.4103/jpbs.JPBS_33_20  
Background: Methods to analyze progression of carcinogenesis and stage of cancer are vital nowadays due to the high prevalence of these lesions. DNA ploidy analysis is one such important method in early diagnosis and improving prognosis. Aims and Objectives: The aim of this study was to correlate histopathological grading and DNA ploidy in oral leukoplakia, oral submucous fibrosis (OSMF), and oral squamous cell carcinoma (OSCC) cases. Materials and Methods: Our study included 80 subjects, grouped into 4 groups of 20 each of OSCC, leukoplakia, OSMF, and healthy individuals. Histopathological grading was carried out in study cases, DNA ploidy was estimated using flow cytometry, and both the findings were correlated. Results: Among the 20 cases of leukoplakia group, 6 cases showed aneuploidy and 14 showed diploidy. In the 20 cases of OSF group, 2 cases showed aneuploidy and 18 showed diploidy, and in the 20 cases of OSCC group, 10 showed aneuploidy and 10 showed diploidy. Most of the aneuploidy cases showed severe dysplasia. Conclusion: Analysis of DNA ploidy status can serve as a diagnostic tool for early detection of malignancies owing to the subjective nature of traditional histopathological grading.
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Three-dimensional evaluation of interradicular areas and cortical bone thickness for orthodontic miniscrew implant placement using cone-beam computed tomography p. 99
Garadappagari Dharmadeep, Moode Kaladhar Naik, Yellampalli Muralidhar Reddy, Sreekanth Cheruluri, Kranthi Praveen Raj, Badepalli Reddeppa Reddy
DOI:10.4103/jpbs.JPBS_36_20  
Background: Factors that influence anchorage of the orthodontic miniscrew implants are interradicular areas and cortical bone thickness. Aims and Objectives: The aim of this study was to evaluate the three-dimensional interradicular areas and the buccal cortical bone thickness in Indian patients using cone beam computed tomography (CBCT) images, and to find the suitable and safe sites for orthodontic miniscrew implant placement. Materials and Methods: CBCT images of 20 patients were divided into three planes as axial, coronal, and sagittal. Measurements, that is, mesiodistal distance and buccal cortical bone thickness were taken at five different heights from the cementoenamel junction (CEJ) toward apical region. Results: In the maxilla, the safe sites for placing miniscrew implant were between the second premolar and first molar at 10-mm height, whereas in the mandible, the safe sites for placing miniscrew implant were between the first and second premolar at 6-, 8-, and 10-mm height, between the second premolar and first molar at 10-mm height, and between the first and second molar at 8- and 10-mm height. Conclusion: CBCT can be effectively used to evaluate interradicular areas and cortical bone thickness in predicting the safe and suitable sites for placing orthodontic miniscrew implants.
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In vitro comparative evaluation of effectiveness of sodium hypochlorite with conventional irrigation method versus EndoVac and ultrasonic irrigation in the elimination of Enterococcus faecalis from root canals p. 105
Silppa Thulaseedharan, Pradeep Kabbinale, Anand Kumar Vallabhdas, Vijay Kumar Chittenahalli Ninge Gowda, Kusuma Shikaripura Chandrashekar, Rekha Marulappa
DOI:10.4103/jpbs.JPBS_37_20  
Aim: The aim of this study was to compare the decrease in bacterial population in the root canals with 2.5% sodium hypochlorite (NaOCl) and three irrigation systems: Conventional Needle Irrigation, Passive Ultrasonic Irrigation, and EndoVac Apical Negative Pressure Irrigation systemMaterials and Methods: Access open was carried out in 48 extracted single-rooted maxillary and mandibular human premolar teeth. The canals were instrumented 1 mm short of apical foramen up to No. 50 size file; irrigated and apical foramen was sealed with cyanoacrylate. The teeth were mounted in plaster and autoclaved for 20 min at 121°C. The plaster blocks containing the teeth were inoculated with Enterococcus faecalis and incubated at 37°C for 24 h. The specimens divided randomly into four groups (n = 12) depending on the type of irrigation system used: Group 1: Conventional Irrigation Needle, Group 2: Ultrasonic system, Group 3: EndoVac Negative Pressure Irrigation system used with 2.5% NaOCl, and Group 4: Control group, normal saline irrigation. The normal saline is used as control. The samples were collected using 45 size sterile paper points and quantitative bacterial assessment was carried out by seeding each dilution on plates containing brain heart infusion broth. Then, incubated at 37°C for 7 days and colony-forming units were counted. Data obtained were statistically analyzed. Results: Statistically, EndoVac irrigation systems were more effective in reducing the number of bacteria than the other irrigation systems. Conclusion: EndoVac irrigation system was more effective in reducing bacterial numbers in infected root canals than the other two irrigation systems.
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Evaluation of alteration in oral microbial flora pre- and postradiation therapy in patients with head and neck cancer p. 109
Ayanambakkam Hemasundar Harini Priya, Rajmohan , Hari Priya Arun Kumar, Shakthi Akash Raj, Sai Archana, Bharathwaj Venkatanarasu
DOI:10.4103/jpbs.JPBS_38_20  
Introduction: For decades now, head and neck cancer (HNC) remains to be one of the deadliest; per se the treatment for the same has been evolving for the past years. Radiation therapy (RT) has been one among the various treatment modalities adopted to treat HNC. The fact that RT can affect the quality of life in these patients cannot be denied. In patients with HNC, these can bring about a wide array of lesions in oral cavity and its associated structures as these areas are invariably affected due to exposure to radiation as such. These include alteration in salivary parameters, changes in microbial flora, and occurrence of radiation caries. Aim: In our study we aimed at assessing the alteration in oral microbial flora inclusive of Streptococcus mutans and Lactobacillus colony count before and after RT. Materials and Methods: Saliva and plaque samples were collected from patients with HNC, who were prescribed to undergo intensity-modulated radiation therapy (IMRT) amounting to a mean radiation dosage of 60 Gy units. The aforementioned samples were collected at three different intervals, before, immediately after, and 6 months after RT. The samples were cultured in selective media in three different dilutions (1:10, 1:100, and 1:1000). Following with colony counting is carried out using a standardized colony counter. Conclusion: The results showed a significant alteration in microbial flora pre- and post-RT. Individual parameters do not show a single stand in causing these changes. Moreover, these changes seem to have earned a multifactorial contribution.
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Surface characteristics and bioactivity of zirconia (Y-TZP) with different surface treatments p. 114
Gayathree Alagiriswamy, Chitra Shankar Krishnan, Hariharan Ramakrishnan, Sampath Kumar Jayakrishnakumar, Vallabh Mahadevan, Nagarasampatti Sivaprakasam Azhagarasan
DOI:10.4103/jpbs.JPBS_39_20  
Background: Zirconia being a bio-inert material needs to be surface treated to render it more bioactive and enhance its osseointegration potential. However, bioactivity studies focusing on the ability of sandblasting and ultraviolet photofunctionalization (UVP) surface treatments in inducing apatite precipitation using simulated body fluid (SBF) are lacking. Aim: The aim of the study was to comparatively evaluate the effect of two different surface treatments—sandblasting with 50 µm alumina and UVP with ultraviolet C (UVC) light on the bioactivity of zirconia. Materials and Methods: A total of 33 discs with dimensions 10 mm × 2 mm were obtained from zirconia blanks (Amann Girrbach, Koblach, Austria) and randomly divided into three groups (n = 11), namely Group I (untreated), Group II (sandblasted), and Group III (UVP). Surface characteristics of representative test samples were analyzed using X-ray diffraction (XRD), atomic force microscopy (AFM), contact angle goniometry, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDX), to assess type of crystal phase of zirconia, surface roughness, wettability, surface topography, and elemental composition, respectively. SBF was prepared and calcium content in SBF (Ca-SBF) was determined using inductively coupled plasma mass spectrometry (ICP-MS). Results: Data were analyzed by one-way analysis of variance (ANOVA), post hoc Tukey honestly significant difference (HSD), and Student’s t test for statistical significance (P < 0.05, significant; P < 0.01, highly significant). Surface characteristics analyses revealed that XRD showed predominant tetragonal (t) zirconia crystal phase for all test groups. Mean surface roughness (Sa) of Group I was 41.83 nm, and it was significantly lesser than that of Group II (115.65 nm) and Group III (102.43 nm). Mean contact angles were 98.26°, 86.77°, and 68.03° for Groups I, II, and III, respectively, and these differences were highly significant. Mean pre-immersion Ca content in SBF was found to be 159 mg/L. Mean post-immersion Ca content was 70.10, 60.80, and 56.20 mg/L for Groups I, II, and III, respectively. Significant differences were found between Group I as compared to both Groups II and III. Bioactivity of Group III was marginally, but insignificantly higher with respect to Group II. Groups II and III were insignificant with respect to each other. Post-immersion XRD revealed predominant “t” phase, and SEM-EDX revealed well-formed, abundant calcium apatite layer on the treated samples as compared to that on untreated sample and an increasing Ca/P ratio from 1.15, 1.79 to 2.08, respectively from Group I to Group III. Conclusion: Within the limitations of this study, both sandblasting and UVP significantly and similarly improved bioactivity of zirconia as compared to the untreated samples, which was corroborated by the SEM-EDX results.
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Comparative evaluation of the surface hardness of different esthetic restorative materials: An in vitro study p. 124
Anoop Samuel, Rinsa Raju, KB Sreejith, Binitha M Kalathil, Deepthi Nenavath, VS Chaitra
DOI:10.4103/jpbs.JPBS_40_20  
Aim: The aim of this study was to evaluate the surface hardness of a newly developed fiber-reinforced composite and bulkfill composites. Materials and Methods: Fiber-reinforced composite and other commercially available bulkfill composites were used. Fifteen cylindrical specimens (5 mm × 5 mm) were made from each material in metal template. Molds were filled in one increment for both bulkfill composites and fiber-reinforced composite and cured using Ivoclar blue phase light-curing unit at a wavelength of 850 mW/cm2. A dark container was used to store specimens to keep dry at room temperature for 24 h before testing. Vickers hardness number (VHN) on the top and bottom surfaces of each specimen was measured by a microhardness tester. Data for VHN were analyzed by using analysis of variance (ANOVA) and pair-wise Newman–Keuls test. Results: No significant difference was observed in Vickers hardness test. The mean value of VHN on the top and bottom surfaces showed significant difference from each other. Fiber-reinforced composite showed the highest VHN as compared with other materials. Conclusion: Fiber-reinforced composite has the highest Vickers hardness ratio indicating highest degree of conversion and better clinical performance.
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A comparative study to evaluate the effects of probiotic curd on Streptococcus mutans, Bifidobacterium dentium, and pH of saliva in caries-free children: An in vivo study p. 129
Nandhini B Selvarajan, Suresh Kumar Vasaviah, Ramesh Krishnan
DOI:10.4103/jpbs.JPBS_42_20  
Background: Dental caries is one of the commonest oral diseases that require early stages of prevention and intervention. The primary organisms related to dental caries are streptococcus mutans and lactobacilli. In the past decades, some of the non-pathogenic bacteria called probiotics have been added to the food products for the beneficial effect of human health. Intake of probiotic food products has been shown to have beneficial effects on the oral tissues. Hence the present study aimed to compare the levels of salivary pH, S. mutans, B. dentium counts in children consuming probiotic and non-probiotic curd. Methods and Material: 40 healthy caries free children were randomly allocated into two groups. First baseline salivary samples were collected from all the participants and tested for salivary pH, salivary B. dentium and S. mutans count. After collecting the baseline values test group of children were provided with probiotic curd whereas the control group were provided with non probiotic curd for 15 days. After 15 days of consumption of these dairy products, salivary samples were collected again and tested for salivary pH, salivary B. dentium and S. mutans count. Results: Probiotic curd was found to be more effective in reducing the colony counts of B.dentium and S.mutans .There was a marginal decrease in pH in both the groups but was well above the critical pH. Conclusions: Probiotic curd showed considerable level of decrease in colony counts of B.dentium, S.mutans and salivary pH when compared to normal curd.
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Biomechanical evaluation of stress distribution in subcrestal placed platform-switched short dental implants in D4 bone: In vitro finite-element model study p. 134
Manchala R Sesha, Rajashekar Sunduram, Hossam A Eid Abdelmagyd
DOI:10.4103/jpbs.JPBS_44_20  
The present study was carried out to assess stress distribution in the maxillary posterior bone region (D4 bone) with the help of a short platform switched subcrestal dental implants using the FEM model. Missing teeth surfaces related to the maxillary posterior region were stimulated. The bone model had a cancellous core of (0.5 mm) which represents D4 bone. A 7.5x4.6 mm screw type implant system with 3.5 platform switch abutment was selected. ANSYS WORKBENCH was used to model all the finite element structures. Force of 100 N was tested and adapted at an angle of 0º, 15º, 30º on the tooth model. Overall results from the current study showed that a high amount of stress was seen in cortical than in relation to cancellous bone. Stress values reduced from equicrestal to subcrestal (2 mm) placement of dental implants irrespective of angulation of load from 0o to 30o in both types of bone. However higher stress values were seen when force was applied in an oblique direction (30o) in comparison to a vertical load (0o). Least amount of stress was noticed when platform switched implants were placed 0.5 mm subcrestatlly irrespective of angulations of a load. Platform switched short subcrestal implants reduced the stress in the D4 cortical bone than in contrary equicrestal implant placement. This results in the preservation of marginal bone leading to implant success.
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Estimation of red-complex bacteria in diode laser treated chronic periodontitis patients: A clinical and microbiological study p. 140
M Rangaiah Mahalakshmi, Ravishankar P Leela, Pradeep K Yadalam, Prem Blaisie Rajula, Saravanan A Vadivelu, V Maharshi Malakar
DOI:10.4103/jpbs.JPBS_45_20  
Context: Laser has been widely accepted as a substitute to traditional periodontal treatment. Only a finite number of studies are available based on the use of diode laser as a supplement to scaling and root planing (SRP) in the reduction of red-complex bacteria. Aim: This split-mouth study was aimed to determine the clinical and microbiological effects of diode laser as a supplement to SRP. Materials and Methods: For this split-mouth study, systemically healthy 34 patients with chronic periodontitis were selected. In the test quadrant, SRP + laser therapy was carried out, whereas in control quadrants, SRP alone was performed. Clinical and microbiological data were acquired at baseline and 3 months postoperative, and statistical analysis was carried out on the findings. Results: The results showed that both the treatment modalities were impelling. Considerable reduction in the mean probing depth and a notable improvement in the attachment level were observed in both groups in comparison to baseline, with a statistically significant reduction in the laser group. Microbiological analysis results showed more reduction in red-complex bacteria in the laser group compared to the SRP group, but they were statistically insignificant. Conclusion: Within the limitation of this study, it is recommended that both the SRP and SRP + laser are effective in chronic periodontitis management, but using laser with SRP has propitious results. Thus, in the forthcoming years, clinical experiments with a greater sample size may be chosen to further analyze the fringe benefits of laser as a supplement to SRP.
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Acidogenic evaluation of pediatric medications in Saudi Arabia p. 146
Inderjit M Gowdar, Sulaiman A Aldamigh, Abdulrahman M Alnafisah, Mohammed S Wabran, Abdullah S Althwaini, Tamim A Alothman
DOI:10.4103/jpbs.JPBS_46_20  
Background: To gain patient compliance, pediatric medication preparations are made palatable by adding sugars such as sucrose, glucose, or fructose. These readily fermentable carbohydrates can significantly increase dental caries potential in the young and chronically sick children. Objectives: To evaluate acidogenic potential of commonly used pediatric liquid medicaments (PLMs). Materials and Methods: The acidogenic potential is assessed by estimating the endogenous pH of PLM. Results: The mean endogenous pH was higher in Azomycin (9.16 ± 0.25) and lowest in Lorinase (3.16 ± 0.15). Conclusion: Of nine, eight PLMs were acidic in nature.
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Knowledge, attitude, and management of general dentist toward medication-related osteonecrosis of the jaws p. 151
Nasser R Alqhtani, Abdulrahman K Almalki, Faisal A Zuhair, Adel A Alenazi, Abdullah Bin Nabhan, Mana Alqahtani
DOI:10.4103/jpbs.JPBS_47_20  
Background: Medication-related osteonecrosis of the jaw (MRONJ) is an intense negative drug response causing increasing bone destruction in the maxillofacial area of patients. Aims and Objectives: To evaluate the knowledge and attitude of dental practitioner regarding risk factors of MRONJ in Saudi Arabia. Materials and Methods: A cross-sectional, questionnaire survey was carried out in King Khalid Hospital, Al-Kharj among dental practioners. Results: Approximately 60% of the practioners had a poor knowledge and there was a weak positive correlation with work experience. Conclusion: Poor knowledge regarding the MRONJ invites a continuing dental education specially to focus on general practioners.
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A clinical and radiographic comparison of platelet-rich fibrin and lyophilized platelet-derived preparation as pulpotomy agent in primary molars p. 155
V Devi Praja, Anil L Muttath, Vinola Duraisamy, Nandhini B Selvarajan, V Suresh Kumar, John Baby John
DOI:10.4103/jpbs.JPBS_48_20  
Introduction: Vital pulpotomy in primary molar teeth is aimed to retain the tooth in function until it is replaced by its successors. Aim: The aim of this study was to evaluate and compare platelet-rich fibrin (PRF) and lyophilized platelet-derived preparation (LPDP) as a pulpotomy agent in primary molars. Materials and Methods: Forty primary molars from 20 healthy children aged 5–9 years requiring pulpotomy in the contralateral side of mandible were randomly selected. In both the groups, pulpotomy was carried out by removing coronal pulp and achieving hemostasis, the radicular part of pulp tissue was packed with PRF preparation in Group I and LPDP (Mothercell Research Centre, Trichy, Tamil Nadu, India) in Group II. The teeth were restored with zinc oxide eugenol and glass ionomer cement (GIC), followed by stainless steel crown in the same visit. Clinical and radiographic evaluation was undertaken at 1, 3, and 6 months interval. Results: The overall success rate was 90% in PRF group and 95% in LPDP group at the end of 6 months. The results were statistically nonsignificant between the groups (P > 0.05). Conclusion: The overall outcome of the study suggests that PRF and LPDP are acceptable pulpotomy agents and are promising in the era of new vital pulp therapy procedure.
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Airway analysis in skeletal Class I and Class II subjects with different growth patterns: A 2D cephalometric study p. 161
Swaroopa R Ponnada, Vivek R Ganugapanta, Kiran K Perumalla, Mohammed A Naqeed, T Harini, Shiva Praasad Mandaloju
DOI:10.4103/jpbs.JPBS_49_20  
Objective: A two-dimensional cephalometric study was carried out to assess the airway among individuals with Class I and Class II skeletal base. Materials and Methods: Class II subjects were further categorized into horizontal and vertical growers and average growth patterns to check the possible relationship between the facial skeleton and pharyngeal airway. Lateral cephalograms of 150 subjects were obtained using standard protocol in natural head position (NHP). Nasopharyngeal and oropharyngeal linear, and angular and nasopharyngeal area measurements were obtained using standardized tracing technique. Analysis of variance (ANOVA), level of significance, and post hoc Turkey’s test were performed to assess the correlation between skeletal pattern of the individual and airway dimension. Gender discrimination was assessed using independent sample t test. Results: In linear measurements, significant differences were observed among upper pharynx (0.039), adenoid tissue 1 (0.036), and adenoid tissue 2 (0.01). In angular measurements, differences were observed with angle of nasopharynx (0.008). The nasopharyngeal area measurements were also associated with significant difference (0.038) with Class II vertical growers less than those with Class I average and Class II horizontal groups. Conclusion: Class II vertical growers had significantly reduced nasopharyngeal airways.
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Effect of nicotine on the thickness of gingiva: A pilot study p. 168
Bhuvaneswari Birlabose, Juala C Jebaraj, Anitha Logaranjani Kannan, Shreemogana Shelvan, Syed Kuduruthullah, Anusha Challagulla, Chitraa R Chandran
DOI:10.4103/jpbs.JPBS_50_20  
Introduction: Gingival thickness plays a very important role in framing the protocol in various dental treatments such as implantology, prosthodontics, and more importantly in periodontics. During periodontal management, it is important to consider the gingival thickness of the patient, which can result in more satisfactory treatment outcomes. Smoking has its effect on periodontium, affecting the physical and functional properties. Assessing the relation between these two entities is becoming important. This clinical study is sought to compare the thickness of gingiva in systemically healthy smokers and nonsmokers. Materials and Methods: A total of 180 periodontally healthy patients were divided into smokers and nonsmokers, and subdivided into Group 1 (18–25 years), Group 2 (26–39 years), and Group 3 (>40 years). Gingival thickness was assessed 6 mm from the gingival margin in the midbuccal area between maxillary central and lateral incisor. Statistical analysis was performed to assess the difference in gingival thickness among smokers and nonsmokers and correlated with age. Results: The results showed the presence of changes in gingival thickness for all the age groups. But, a significant P value was not obtained for the age groups 18–25 and 26–39 years. In >40 years of age group, there was a statistically significant change in the P value (0.008) of the mean and standard deviation in smokers and nonsmokers ( significance: P < 0.001). Conclusion: On the basis of the results of this study, gingival thickness was decreased with age among smokers and nonsmokers. This study also proved that smoking has a negative influence on the gingival thickness.
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Evaluation of silver nanoparticles incorporated acrylic light cure resin trays p. 173
Ali S Alhawiatan, Omar S Alqutaym, Saad N Aldawsari, Faisal A Zuhair, Refdan O Alqahtani, Turki H Alshehri
DOI:10.4103/jpbs.JPBS_52_20  
The conventional denture base resins had many drawbacks. Hence, the objective of this study was to compare the effect of incorporation of silver nanoparticles on mechanical properties of light-cured resin material. Materials and Methods: Specimens of acrylic resin (control group) and acrylic resin reinforced with 2% silver nanoparticles (test group) were evaluated for mechanical properties such as impact strength, transverse strength, modulus of elasticity, and deflection. Unpaired t test was used for statistical analysis. Results: Mechanical properties of light cure reinforced with silver nanoparticles were significantly higher than conventional light-cured resin (P < 0.05). Conclusion: The incorporation of silver nanoparticles into light-cured resin increases the mechanical properties making it more stronger material.
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Dental caries and its association with body mass index among school children of Riyadh, Saudi Arabia p. 176
Hoda Abdellatif, Mamata Iranna Hebbal
DOI:10.4103/jpbs.JPBS_53_20  
Background: Few studies have investigated the relationship of dental caries with obesity among Saudi Arabian population. Hence, this study was conducted to assess the association of obesity with dental caries among school children. Materials and Methods: A cross-sectional, descriptive study was conducted among 12- and 15-year-old government school children of Riyadh. A total of 2247 children were examined from 24 schools of Riyadh. Caries status (decayed, missing, and filled teeth [DMFT]) was recorded according to World Health Organization (WHO) Oral Health Survey 2013. Height and weight measurements were recorded after clinical examination. According to body mass index (BMI) percentiles, the children were classified as underweight, normal weight, overweight, or obese. Chi-square test was used to find association between variables for categorical data. Mean ± standard deviation (SD) was calculated for continuous measurements and to find the difference between the groups unpaired t test/analysis of variance was used. A value of P < 0.05 was considered statistically significant. Results: Dental caries prevalence was 83.7% and mean DMFT was 5.31 ± 3.88 in the study population. A statistically significant difference was found for mean decayed, mean filled teeth, and overall mean DMFT between 12 and 15 years old (P < 0.001), but not for mean missing teeth (P = 0.137). There was no association between BMI categories and mean DMFT for both the age groups. Conclusion: The dental caries was found to be high among the study subjects compared to WHO norms. Older children had higher DMFT values than the younger children and there was no association between dental caries and BMI.
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Comparative evaluation of root caries remineralization effect of plain milk, 5ppm of fluoridated milk, and 5ppm of sodium fluoride in deionized water using surface microhardness test: An in vitro study p. 182
Jagadeson Mahesh, Dummi J Veeresh, Pallepati Akhil, Subramanian Vishnuprasad, Srinivasan Premkumar, Karmakar Shaswata
DOI:10.4103/jpbs.JPBS_54_20  
Background: There is an increase in longevity of teeth retained in elderly population, leading to increased risk of root caries. Therefore, new and affordable preventive strategies are in need to reduce this problem. Hence, the aim and objective of the study was to assess and compare the root caries remineralization effect of plain milk, 5ppm of fluoridated milk, and 5ppm of NaF in deionized water. Materials and Methods: The study was an in vitro experimental design. Sixty root samples were divided into five groups (sound root, demineralized root treated in deionized water, plain milk, 5-ppm fluoridated milk, and 5-ppm fluoridated deionized water) of 12 samples each after baseline surface microhardness analysis and standardization was carried out in the study. All groups except the sound root were subjected to demineralization procedure for 4 days at 37°C. The demineralized four groups were treated to test solutions and subjected to pH cycling for 14 days. This was followed with assessment of postintervention surface microhardness. Student’s paired t test was used for comparing surface within groups. One-way analysis of variance test and post hoc Tukey’s test were conducted for between groups’ comparison. Results: There was a significant difference between groups (P < 0.05). The results of post hoc showed that significant difference was found between the group sound root and demineralized treated with 5-ppm fluoridated milk and 5-ppm fluoridated deionized water with an effect size of 2.15 and 2.87, with CI (–26.8 to –8.1) and (–36 to –17.3), respectively. There was a significant difference in all the groups when compared within the group (P < 0.05). Conclusion: Plain milk, 5-ppm fluoridated milk, and 5-ppm fluoridated deionized water showed remineralizing potential against demineralized in vitro root caries samples. 5-ppm fluoridated deionized water and 5-ppm fluoridated milk have a better effect compared to plain milk.
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Reliability of orthopantamogram in lower third molar surgery: Inter- and intra-observer agreement p. 190
Prabakaran Sureshkannan, Kuriadom Samthomas, Pethagounder Thangavelu Ravikumar, Annamalai Thangavelu, Rajaram Mohan Karthik, Sambandham Thiruneelakanadan
DOI:10.4103/jpbs.JPBS_57_20  
Context: The evaluation of relationship between the roots of impacted lower third molar (IL3M) and inferior alveolar nerve injury (IAN) with orthopantamogram (OPG) is mandatory before performing de-impaction surgery. An investigation is considered reliable if it can be reproduced by various examiners. Assessment of OPG is subjective and varies among examiners. OPG is reliable to clinicians if the interpretation is not a product of guess work. Aim: The aim of this study was to evaluate the magnitude of agreement among oral surgeons and oral radiologist in observing intimate relationship between IL3M and mandibular canal. Materials and Methods: OPGs were evaluated by two oral surgeons and one oral radiologist for nerve root relationship. All the three were from different institutions with 10–15 years of experience. The three observers were blinded from each other’s findings. A total of 127 OPGs were evaluated for inter-observer agreement. Fifty OPGs were evaluated after 60 days for intra-observer agreement.The agreement was evaluated based on Cohen’s κ statistics. Results: Our results denote that the interpretation of OPG among specialists is not in good agreement. We suggest development of methods to standardize evaluation of OPG and the exposure technique to improve inter-observer agreement among the dental specialists.
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Tobacco cessation behavior among smoking and smokeless form tobacco users in the indigenous population of Ernakulam, India p. 194
Eby Aluckal, Civy Pulayath, P Chithra, MS Balakrishna, Alexander M Luke, Simy Mathew
DOI:10.4103/jpbs.JPBS_58_20  
Purpose: Tobacco usage is the leading preventable cause of death in the world today. The tribes in Kuttampuzha region are the aboriginal tribal community found predominantly in the south Indian state of Kerala, India, and this study was conducted to identify tobacco cessation behavior in smoking and smokeless form of tobacco users among them. Materials and Methods: A cross-sectional design survey was conducted among 516 indigenous community people of Kuttampuzha area of Kerala, India, for the outcome of quit attempts made by the current tobacco users. The sociodemographic variables and tobacco user data collected were subjected to statistical analysis using Open Source R Software. Results: When considered the quit attempts among current smoking and smokeless form of tobacco users, a statistically significant difference was found in subjects who had quit attempts of 1 day or longer in the previous year (P = 0.01) than who were in groups of quit attempts more than 30 days or more than 6 months. Smokers had higher probability predicted of attempting quitting in comparison to smokeless form of tobacco users (odds ratio [OR] = 1.24, confidence interval [CI] = 1.09–1.39). The probability of doing a quit attempt was higher among users of tobacco who were having a comparatively higher socioeconomic status (OR = 1.30, CI = 1.12–1.48). Conclusion: This study provides useful insights into different determinants for quit attempts of tobacco users in South India, exploring the sociodemographic features of attempts to quit. International prevention and cessation initiatives will need to be customized to the social-cultural context of these primitive tribal areas of Kuttampuzha, Kerala, to help in prevention and cessation of tobacco usage.
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Characterization and formulation of miswak film for the treatment of chronic periodontitis: An in vitro study p. 199
Santhosh Sekar, Siji Jacob, Thanga Kumaran Suthanthiran, Syed Dhasthaheer, Swathigan Vikraman, Kanimozhi Kaliappan
DOI:10.4103/jpbs.JPBS_59_20  
Introduction: Miswak is a tooth brushing stick that contains many ingredients that are beneficial for maintenance of oral hygiene. The aim of this study is to formulating a film containing miswak extract for treatment of chronic periodontitis. Materials and Methods: Here we tested the miswak raw extract invitro against Porphyromonas gingivalis and Herpes simplex virus-1 (HSV-1). The film was prepared using solvent casting method. Disintegration test was conducted to find the stability of the film. Results: Cytotoxicity of miswak was also tested. Minimum inhibitory concentration against P. gingivalis was 62.5 µg/mL. Therapuetic index against HSV-1 was 11.3 µg/mL. Cytotoxicity against 50% Vero cells was present at 210 µg/mL. Based on this invitro study 100 µg/mL dose was calculated to be incorporated in a film of size 0.5 mm × 0.4 mm. This film is made of polymers HPMC K 100 and Eudragit L 100. Disintegration test of the film showed that they remained stable for around 5 days. Conclusion: In the present study we formulated the miswak raw extract containing film that can act against P. gingivalis and HSV-1. So it can be used to treat chronic periodontitis by placing it in periodontal pockets.
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Morphometric analysis of suprabasal cell layer in oral epithelial dysplasia: A computer-assisted microscopic study p. 204
Viswanathan Prema, Thomson Thomas, Prasad Harikrishnan, Mani Viswanathan, Kenniyan Kumar Srichinthu, Krishnan Rajkumar
DOI:10.4103/jpbs.JPBS_60_20  
Background: Oral leukoplakia is the most common precancerous lesion. Various grading systems based on histological findings have been proposed for dysplasia. Recently, computer-assisted morphometric analysis has been established to reduce the interobserver and intraobserver variability during the histological grading of epithelial dysplasia. This study was undertaken to establish the morphometric changes in the suprabasal cell layer of different grades of oral epithelial dysplasia. Materials and Methods: Forty paraffin-embedded tissue sections (10 normal mucosa, 10 mild dysplasia, 10 moderate dysplasia, and 10 severe dysplasia cases) were stained using hematoxylin and eosin stain, and analyzed for cellular and nuclear morphometry using binocular microscope. Results: Our results showed that values of nuclear area, nuclear perimeter, nuclear volume density, and nuclear/cytoplasmic (N/C) ratio were increased gradually in dysplasia compared to control groups and the values were statistically significant (P = 0.001). Nuclear diameter and cellular area were increased in dysplasia when compared to control group (P = 0.001). Mild and moderate dysplasia showed decreased value of nuclear form factor compared to control group, whereas severe dysplasia showed highest value. A fair correlation was found when comparing histological grading and grouping based on nuclear area, nuclear perimeter, N/C ratio, and nuclear volume density. Conclusion: Nuclear features reflect cell behavior, and its morphometric analysis can be considered as a reliable tool for differentiating various grades of epithelial dysplasia.
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Evaluation of oral health-related quality of life in patient with removable prosthesis: A cross-sectional study p. 210
Sandhya P Naik, Sadananda Hota, Purnendu Bhushan, George Sam, Varadharaju Vinutha Kumari, Nitesh Shetty
DOI:10.4103/jpbs.JPBS_63_20  
Aim: This study aimed to evaluate the relationship between oral health and quality of life in removable prosthesis users. Materials and Methods: An investigative cross-sectional study was designed, and 200 participants were considered based on calculations from the studies in the past. The Oral Health Impact Profile (OHIP)-14 survey comprises two parts in the study. Questions related to sociodemographic factors that documented age, gender, and type of removable prosthesis were included in the initial part of survey. Questions related to impact of oral health on quality of life make up the latter part of the survey. The answers ranged from “Definitely no” to “Definitely yes” for every item on a scale having 5 points.The likely range of scores is from 14 to 70. Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 for Windows. A value of P < 0.05 was considered statistically significant. Results: A survey evaluating the relationship between oral health and quality of life was adequately completed by 200 participants. Of these, 18 (22%) were women and 154 (78%) were men. The parameters such as gender, age, and the relationship between oral health and quality of life did not show significant difference either within groups or between the groups. The enrolled participants were wearing different dental prostheses such as complete dentures (CDs) in both upper (U) jaw and lower (L) jaw (19%), U jaw (3%), L jaw (4%) and removable prostheses in both jaws (30%), U jaw (24%) and L jaw (20%). No statistically significant differences were seen between them. The scores for oral health-related quality of life (OHRQoL) were associated positively with removable prosthesis score (r = 0.122) and were statistically significant. Conclusion: This study concluded that the use of removable prosthesis may positively impact OHRQoL. The period of usage of removable dentures was the highly significant parameter affecting patient gratification, whereas the practice of using removable prostheses was the highly significant parameter affecting the relationship between oral health and quality of life.
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Prevalence of dental caries and treatment needs in Tibetan monks and nuns in Karnataka p. 214
Sneha Khanapure, Anna Abraham, Yousef H Abokhlifa, George Sam, M S Rami Reddy, Narne R Subhash
DOI:10.4103/jpbs.JPBS_64_20  
Aim: The aim of this study was to assess the prevalence of dental caries and treatment needs among Tibetan monks and nuns in Bylakuppe. Materials and Methods: In this cross-sectional study, stratified random sampling was used to obtain desired sample for the study. The clinical examination was carried out to obtain data regarding dental caries status and treatment needs using World Health Organization (WHO) Oral Health Assessment Pro forma 1997. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) software program, version 20.0. The data were statistically analyzed by using descriptive statistics and chi-square test. Results: The study population consisted of 345 Tibetan monks (men) and 35 Tibetan nuns (women). Prevalence of dental caries was 88.68% with mean decayed, missing, and filled teeth (DMFT) value of 6.06 ± 5.37. Assessment of dental treatment needs showed 82.3% of participants needed one surface filling, 11.9% of participants needed pulp care and restoration, and 9.3% of participants required extraction of teeth. Conclusion: The study population is characterized by high prevalence of dental caries and lack of awareness about treatment needs.
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Implementation of anthropometric measurements in anterior teeth selection in two ethnic groups: An in vivo study p. 218
Sadananda Hota, Purnendu Bhushan, Anjana Raut, Arun K Mohanty, Debashish Mishra, Lala Wage
DOI:10.4103/jpbs.JPBS_65_20  
Aim: The aim of this study was to evaluate whether there is any consistent relationship between interalar distance and six maxillary anterior teeth in two ethnic groups. Materials and Methods: Two hundred subjects (Assamese 100 and Nyishi 100) of different age and sex ranging from 18 to 33 years were identified for this study. The distance between two widest points marked on the alae of nose was measured by means of sliding digital caliper. Statistical analysis of variance was the testing method to determine whether the nasal width and intercanine distance were different in various racial groups. Results: The mean nasal width dimension in Assamese group was 36.38 mm (range 28.55–50.00 mm). The mean nasal width dimension in Nyishi group was 35.73 mm (range 31.34–41.90 mm). For the nasal width, no significant difference was observed between two races. For the canine cusp tip to cusp tip distance, the mean value of Assamese subjects was 43.63 mm (range 39.02–50.02 mm), whereas the Nyishi presented 41.77 mm (range 36.69–47.05 mm). Conclusion: For the two racial groups studied, the measurements of the interalar width showed a weak correlation with the canine to canine distance, not sufficiently high to be used as a predictive factor. It suggests to select wider artificial teeth. Practitioners can use ethnic norms as guides, not absolute values.
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An analytical study of etiopathological factors responsible for oral squamous cell carcinoma in Bihar population p. 222
Tanoj Kumar, Sanjay Manohar Kanade, Rohit Singh, Alisha Singh, Avanindra Kumar, Vardar R Hiremath
DOI:10.4103/jpbs.JPBS_66_20  
Background: Squamous cell carcinoma (SCC) of maxillofacial region is the most usual form of neoplasia causing malignancies in India and Asian continent. An increased prevalence of mortality rate by cancer of maxillofacial region was observed in various parts of the world. Objectives: Our aim was to correlate age and gender with etiopathological factors contributing to oral squamous cell carcinoma (OSCC) in the urban population of Patna in 2 years. Materials and Methods: Data were extracted from hospital records. A total of 236 cases of histologically confirmed mild to advance stage of OSCC in either gender of 15–80 years of age range were evaluated. Results: Out of 236 histopathologically confirmed patients with OSCC, 172 were male and 64 were female. Insignificant difference was found in all age-groups and in all locations. Most common site was found to be buccal mucosa in both genders. Bony invasion was found to be least common. In our study, it was found that habits of chewing areca nuts, nicotine smoke addiction, consumption of alcohol, combination of chewing nuts and nicotine smoke addiction, and combination of alcohol and nicotine smoke addiction are significantly related to the development of OSCC. No significant association was found between histopathological conclusion and gender in all the four groups, and the prevalence was directly proportional to advancement of age. Conclusion: We concluded that the OSCC do not have any significant relation with the age and gender. The habit of nicotine and areca nut chewing, nicotine smoke addiction, and combination of nicotine smoke addiction and alcohol and chewing nut and nicotine smoke addiction has significant relationship in the development of OSCC.
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Evaluation of effectiveness of intracanal medicaments on viability of stem cells of apical papilla p. 228
Gaurav Jain, Akriti Goel, Balakrishnan Rajkumar, Ravinder Singh Bedi, Divya Bharti, Anuradha Sawardeker
DOI:10.4103/jpbs.JPBS_67_20  
Introduction: Regeneration, in the field of endodontics, is the process of restoring and maintaining both architectural form and biological functions of damaged tooth. Presently, regenerative endodontics is not hypothetical and is an alternative to conventional apexification procedures. There is a deficient knowledge concerning the role of intracanal medicaments and their effect on dental stem cells. Aim: The aim of this study was to evaluate the effectiveness of commonly used intracanal medicaments on the viability of dental stem cells of the apical papilla (SCAPs). Materials and Methods: SCAPs were cultured and subjected to various concentrations including triple antibiotic paste, double antibiotic paste, Augmentin, and calcium hydroxide (Ca(OH)2). Viable percentage of stem cell counts was obtained 3 days after treatment. Results: All three antibiotics used hereby significantly decreased SCAP cell survival at particular concentrations, whereas Ca(OH)2 showed stimulating effect on SCAP survival. Conclusion: As per results obtained within limitations of this study, use of Ca(OH)2 in regenerative endodontics in comparison to different commonly used antimicrobial combinations is recommended. Hereby, for clinical use, we suggest adequate concentrations of antimicrobials with adequate antibacterial efficacy should be used.
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Assessment of constant periapical lesions and their connection with endodontic failures after apical microsurgery p. 233
Neetu Kharat, Pallavi Waghmare, Mousumi Sarkar, Sangeeta Nawal, Trilok Sahu, Munish Dheeraj
DOI:10.4103/jpbs.JPBS_68_20  
Background: Periapical lesions can be appreciated in the teeth that have underwent root canal treatment leading to more complications. Radiographic as well as histological evaluation is important for definitive diagnosis. Aim: The aim of this study was to examine the histology of constant periapical radiolucent lesions that are associated with root canal treated teeth and also to find association between histological findings and radiographic size of lesion as well as existence or nonappearance of a radiopaque lamina. Materials and Methods: The study included 60 incisors and canines allotted for apical microsurgery. Two observers studied the diameter of periapical radiolucent lesions and the existence or nonappearance of radiopaque lamina. During apical microsurgery, biopsy specimens were collected and after tissue processing oral pathologist examined the specimen under a light microscope. Histological features of the specimen were taken into consideration, and the diagnosis of abscess, cyst, granuloma, and scar tissue were given. Pearson’s chi-square test was used to study the established relationship between histological diagnosis and lesion size. Results: Results indicated that 68.33% of lesions were granulomas, 23.33% were cysts, 5% were abscesses, and 3.33% were scar tissue. Conclusion: According to histological results, most of the lesions in this study were granulomas, followed by cysts. Abscesses and scar tissues were rare.
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Variations of mandibular first molar root canal in school children: An observational study p. 238
Santosh Kumar, Alisha Singh, P Mohammed Ashik, Sarin Koroth, Akash Narayan Dutta Barua, Amitabh Kumar Sinha
DOI:10.4103/jpbs.JPBS_71_20  
Background: Root canal (RC) treatment is most common and effective method for treatment of diseases related to periapical area and pulp of teeth. With the increase in age, the formation of secondary dentin, calcification of canals, and reduction of medullary cavity volume, it becomes increasingly difficult to accomplish a perfect RC treatment, hence the understanding of RC variation and changes in variation with increasing age improves the success rates. Aim: The aim of this study was to study the RC variation in the age-group of 10–14 years and to find if the gradual increase in age plays a role in increasing the complexity of RC variation. Materials and Methods: This study was carried out in Government Medical College, Patna, Bihar, India, from January 2018 to April 2019. Subjects within the age range of 10–14 years were selected conferring to predetermined inclusion and exclusion criteria. The subjects were divided into the groups according to age—Group I: 10–11 years, Group II: 11–12 years, Group III: 12–13 years, and Group IV: 13–14 years. The subjects were further divided into Group A and B according to sex to study if there is any significant difference in RC variation. Three intraoral periapical (IOPA) radiography with radiovisiography (RVG) of each subject were taken from three different predetermined angles and these IOPAs were then analyzed by three independent observers and the most agreed on value was included. The IOPAs were analyzed for the number of roots, the number of canals in each root and the variation of each RC were classified according to Vertucci’s Classification. Results: The most common T of RC variation in mesial root of mandibular first molar was T IV succeeded by T II and T I. For distal canal of mandibular first molar, the most common variation was T I, followed by T II and T III. In our study we found that 98.88% of mandibular molars were having two roots. No significant difference was found in the variation of canal according to age or sex in our study. Conclusion: Hence, we conclude that no significant difference is seen in RC variation according to sex and age. As the groups we included in our study were not wide apart enough in age, a further long-term study is needed to ascertain if the complexity of RC increases with age.
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Immediately loaded single unit dental implants: A clinical study p. 245
Shweta Rai, Anurag Rai, Tanoj Kumar, Minti Kumari, Muthyalu Kumar Somanna, Subhash Bandgar
DOI:10.4103/jpbs.JPBS_72_20  
Background: Immediate loading of dental implants is an obvious advantage. A long treatment period that involves the wearing of a temporary prosthesis may be of great inconvenience, and is sometimes the reason for not choosing implant-supported restorations at all. Aim: In our study, an attempt was made to immediately load single tooth implants in the aesthetic zone of the dentition. Materials and Methods: Patients were selected from Government Dental College, Patna. Twenty-four single tooth implants were placed in 24 patients; 12 male and 12 female patients desiring replacement of one or more missing teeth in anterior region were selected. Surgery for the placement of the implant was carried out, and implants of the Uniti Implant System were placed. The abutment was then attached and the flap was sutured. A temporary acrylic resin crown was fabricated and cemented on the same day. Permanent prosthesis was inserted on sixth month after implant placement. Results: A clinical study was performed to evaluate the treatment outcomes of dental implants installed according to a one-stage surgical procedure followed by immediate loading with prosthesis. Of the 24 implants, 23 showed signs of successful osseointegration over a 1-year follow-up. Conclusion: Within limits of the evaluated data, it was observed that immediately loaded implants osseointegrate, so this alternative was used over conventional procedures that take 6 months for osseointegration. This has advantages, both for patient and practitioner.
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Evaluation of efficacy of four disinfectants on striated and non-striated orthodontic instruments: An in vitro study p. 254
Nagaraj Venkatachalam, Niveddha Ramesh, Prasanna Turuvekere, SM Vignesh Prasad, Mohamad Ramees, Chethan Kumar
DOI:10.4103/jpbs.JPBS_75_20  
Introduction: To achieve effective infection control only disinfecting instruments is not perfect when sterilization is an ideal method. Few chemical disinfection methods have disadvantage of not killing spores as cross infection is of great importance in dentistry; Standard sterilization and disinfection protocols must be followed by dental health care professionals for efficient infection control. Aim: The aim of this study was to evaluate the efficacy of undiluted concentrations of Durr Dental system, Bacillol, Savlon, and Dettol for disinfection of striated and nonstriated orthodontic instruments. Materials and Methods: Orthodontic instruments were divided into two groups. Each group of instrument was exposed to three microbes: Streptococcus mutans, Candida albicans, and Bacillus subtilis. Once the instruments were exposed to bacterium, they were immersed in four commercially available disinfectants: Durr Dental solution, Bacillol, Dettol, and Savlon. Culture streaks were taken at 5, 10, and 15 min of contact time and growth of organisms was observed on culture media. Results: All the four disinfectants showed no growth of bacteria and all were significantly effective. As per the immersion time factor, Durr system and Bacillol were more efficient than Dettol and Savlon. Conclusion: Study concluded that there was no growth of bacteria after disinfecting in all the four disinfectants. Dettol and Savlon were unable to eliminate B. subtilis at 5 min of contact time. All the disinfectants were effective in eliminating the microorganisms at 10 and 15 min postexposure.
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Detection of dentinal microcracks in radicular dentin after shaping with XP-endo Shaper, Neoendo flex files, and Hero Shaper using scanning electron microscope: An in vitro study p. 259
Sruti S Bal, Sharath Pare, Arya Unnikrishnan, Divya Shetty, Harish G Kumar, Mallikarjuna Ragher
DOI:10.4103/jpbs.JPBS_76_20  
The study aimed to compare the extent of dentinal microcracks in the radicular dentin using hand K files and various types of rotary nickel-titanium (NiTi) file systems. Forty mandibular incisor teeth (human) were grouped for the study. The root apices were closed, and the canals were straight (<5°). The samples were divided into four groups (n = 10). Group 1—Hand K file system (SybronEndo, SA), Group 2—XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland), Groups 3—Neoendoflex file (Neoendo, Orikam, India), and Group 4—Hero Shaper files (Micro-Mega, Becacon, France). Sectioning was done at 3, 6, and 9 mm from the apex, perpendicular to the long axis using a diamond disc under water coolant. The cut samples were then observed through a scanning electron microscope at ×50 enlargement. The control group showed no microcracks except one sample in the coronal third, which was less significant. The difference in the amount of crack detected on comparing the different groups was significant. In the experimental groups, XP-endo Shaper group showed significantly less number of cracks than the Neoendo flex, and Hero Shaper groups. Within the limitations of this study, all the system, except hand K files, produced remarkable dentinal microcracks. Least cracks were seen in canals instrumented with XP-endo Shaper. It can also be noted that single file system causes less number of microcracks.
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Evaluation of the efficacy of loricrin as a diagnostic marker in patients with oral submucous fibrosis p. 264
Niva Mahapatra, Kailash C Dash, Lipsa Bhuyan, Abikshyeet Panda, Shyam S Behura, Pallavi Mishra
DOI:10.4103/jpbs.JPBS_79_20  
Introduction: Loricrin is usually observed in abundance in keratinizing epithelium in response to mechanical stress, which may be associated with development and malignant transformations in conditions such as oral submucous fibrosis (OSMF). Therefore, understanding of various molecular mechanisms associated with difference in gene expressions between OSMF and that of normal oral tissue is important. Aim: The aim of this study was to evaluate of the efficacy of loricrin as a diagnostic marker in patients with OSMF. Materials and Methods: Fifty formalin-fixed paraffin-embedded tissue blocks were obtained from the archives of the department. The study sample was grouped into two groups of normal mucosa (group I; n = 20) and OSMF (group II; n = 30) specimens. The study tissues were immunohistochemically stained with loricrin antibody and were further graded on basis of staining intensity. Results: Loricrin immunostaining was observed significantly more in OSMF cases and even in stratum granulosum in comparison to normal mucosa. Conclusion: Loricrin can act as an early indicator and a prognostic marker for detection of deleterious changes within epithelium in OSMF.
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The relationship between volatile sulfur compounds and the severity of chronic periodontitis: A cross-sectional study p. 268
M Alrashidi Abdullah, Mohammed Alasqah, M Shafshak Sanaa, Khalid Gufran
DOI:10.4103/jpbs.JPBS_81_20  
Background: Halitosis is a problem that is often ignored or undervalued. It is not considered a major clinical issue; thus, little is carried out to eradicate it. Little is known about the relationship of malodorous breath with the severity of periodontitis. Hence, the study aimed to investigate the relationship between volatile sulfur compounds (VSCs) and chronic periodontitis. Materials and Methods: According to the severity of chronic periodontitis, 80 patients were categorized into four groups (mild, moderate, severe, and control). Probing depth and clinical attachment level were measured. Portable sulfide monitor (Halimeter) is used to assess VSCs. Statistical analyses were conducted using R studio (Northern Ave, Boston). Results: The differences in the VSC levels among the four groups were found to be statistically significant. The greater the severity of periodontitis, the higher the VSC levels found (P < 0.001). Male had higher levels of VSCs than female (225 and 180.53 parts per billion [ppb], respectively). The lowest mean level of VSCs was found in the subjects aged 15–29 years (161.79 ppb); the mean values increased with the age, reaching 282.89 ppb in subjects aged >59 years. Conclusion: Highly significant differences were found in the VSC levels among different severities of chronic periodontitis. Moreover, an age-related increase in the VSC levels was determined. In addition, male had higher concentration of VSCs than female.
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An immunohistochemical study showing Ki-67 as an analytical marker in oral malignant and premalignant lesions p. 274
Kailash C Dash, Niva Mahapatra, Lipsa Bhuyan, Abikshyeet Panda, Shyam S Behura, Pallavi Mishra
DOI:10.4103/jpbs.JPBS_83_20  
Introduction: Ki-67 is a nuclear protein. It is a proliferation marker that has an essential function in tumorigenesis due to its positive connection with tumor expansion. Aim: The aim of this study was to evaluate the articulation of Ki‑67 as prognostic marker in various grades of oral epithelial dysplasia (OED) and in oral squamous cell carcinoma (OSCC). Materials and Methods: A total of 100 histologically affirmed samples of normal oral mucosa (NOM), OED, and OSCC were divided into three groups—Group I (10 samples of normal oral mucosa), Group II (45 samples of OED), Group III (45 samples of OSCC). Routine hematoxylin and eosin and immunohistochemical staining with Ki-67 monoclonal antibody were carried out in all the samples. Results: Within Group I, articulation of Ki-67 was constrained to the basal layers. In Group II, cells showing positive expression of Ki-67 were available in the basal, suprabasal, and spinous layers. Cells showing positive expression of Ki-67 among well-differentiated OSCC were presented mainly in the periphery of the tumor nests; in moderately differentiated OSCC, cells were located in both peripheral and part of a center of the tumor nests; and in most cases of poorly differentiated OSCC, cells were diffused. Statistically significant difference in positive expression of Ki-67 was appreciated between three groups. Conclusion: Ki-67 antigen may perhaps be used as a marker for the histological reviewing of OED and OSCC. With the increase in the severity of OED, cells showing positive expression of Ki-67 also increased.
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Assessment of malocclusion and orthodontic treatment needs among subjects with dental aesthetic index: A clinical study p. 279
Sukhpreet Dhanwant Mangat
DOI:10.4103/jpbs.JPBS_84_20  
Background: Malocclusion is commonly seen condition in young adults. This study aimed to assess malocclusion and orthodontic treatment needs among subjects with dental aesthetic index (DAI). Materials and Methods: This study comprised 486 subjects with an age range of 16–24 years of either genders. A careful oral examination was performed and all findings were recorded based on Oral Health Survey—Basic Methods. DAI was used to assess orthodontic treatment needs among subjects. Results: A maximum of 129 (26.5%) patients (male, 47 [22.8%], female, 82 [29.2%]) had DAI score of >36. Missing teeth was the most commonly observed condition, especially in females. There was a significant difference in spacing, crowding, maxillary, mandibular irregularity, overjet, and spacing between both genders. Conclusion: It was found that maximum patients had severe malocclusion with DAI score >36. This indicates the orthodontic treatment needs among subjects.
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Evaluation of efficacy of microwave staining over conventional staining in replicating tissue architecture: A prospective study p. 283
A H Harini Priya, V Bharathwaj Venkatanarasu, Sreeja Chellaswamy, Merlin Jeyaraj, Serena Florence Francis, Sudharsan Rajasekaran
DOI:10.4103/jpbs.JPBS_86_20  
Introduction: The use of microwave in the field of diagnostic pathology has gained a huge response in recent times. Use of domestic microwave ovens in the same is being widely studied. Unveiling the use of the microwave in improving the staining quality of tissue sections in the field of pathology can aid in precise diagnosis of complex conditions. Aim: The main aim of this study was to study the efficiency of microwave staining to reproduce the tissue architecture compared to that of conventional staining techniques. Materials and Methods: Thirty different tissue blocks (including 10 mucocele tissue blocks) were used to prepare 30 pairs of slides for three different stains, namely hematoxylin and eosin, Van Gieson’s, 0.1% toluidine blue and periodic acid–Schiff and 10 pairs of slides for mucicarmine stain. From each pair of slides, one slide was stained routinely, and the other was stained inside a microwave. Two pathologists evaluated the stained slides, and the results so obtained were analyzed statistically. Results: Microwave staining considerably cut down the staining time from hours to seconds. Microwave staining showed no loss of cellular and nuclear details, uniform staining characteristics, and was of excellent quality. Conclusion: The microwave stained slide showed no significant difference in terms of cell outline clarity, cytoplasmic staining, nuclear outline, nuclear staining, nuclear chromatin, and staining intensity compared to that of routine staining method, and a significant difference was observed in the total staining time consumed by all the stains that were used.
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Postoperative healing after surgical removal of mandibular third molar: A comparative study between two proteolytic enzymes p. 289
S Tharani Kumar, R Ashok Prasanna, Joshua Rohan Kirubanandan, U Elaveyini, S Prasanna Devi, Murali Balasubramaniam
DOI:10.4103/jpbs.JPBS_87_20  
Objective: The postoperative symptoms after third molar removal surgery were commonly uneventful. The aim of this study was to compare two proteolytic enzymes from different origin and to prove which enzyme provides a faster healing. One of the proteolytic enzymes involves a combination with a flavonoid. This involves trypsin, bromelain, along with a flavonoid rutin. Another proteolytic enzyme is serratiopeptidase that helps in degradation of insoluble proteins causing reduced swelling in the operated site. Materials and Methods: In this study, voluntary subjects of clinically indicated bilateral lower third impaction were selected. The subjects were recommended to undergo extraction of impacted teeth in two sittings, one extraction per visit. In the first sitting, subjects were prescribed trypsin, bromelain, and rutin combination after removal of 48 teeth and in the second sitting subjects were prescribed serratiopeptidase after removal of 38 teeth. There was a time interval of 2–3 weeks in between the sittings. The post findings such as mouth opening, swelling, and pain scale were noted. Results: The results showed that the proteolytic enzyme combination of trypsin, bromelain, and rutin is better than serratiopeptidase. Conclusion: It is recommended that trypsin, bromelain, and rutin combination can be used effectively for postoperative purpose to facilitate wound healing.
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“Laser dentistry”—The need of the hour: A cross-sectional study p. 295
Aparnna Dhayanidhi, Narmatha Mudiarasu, Abirami Mathivanan, Janani Rajeswari Gopalkrishnan, Saranya Kulandaivelu Kasinathan Nagarajan, Khaniya Bharathan
DOI:10.4103/jpbs.JPBS_89_20  
Aim: The increase in the technological development in dentistry has led to a better and efficient treatment being rendered to the patient. One such development is the application of laser in the field of dentistry. The introduction of laser has provided various advantages to the dentist. Therefore, a study was conducted to assess awareness among the dentists in Coimbatore district about the application of laser. Materials and Methods: A cross-sectional study was conducted among the dentists in Coimbatore district. A questionnaire consisting of three parts was used to assess the knowledge, attitude, and practice of laser dentistry. Results: The results were tabulated, and the percentages were statistically analyzed. The knowledge of laser usage and application of laser was present for almost 55% of the dentist. The attitude of dentist toward the advantage of laser was less. The practice of laser dentistry was poor among dentists, and only 10% were effectively practicing laser dentistry. Conclusion: The advantages of laser in daily dental practice are more advantageous than the disadvantages such as cost of equipment and material handling. Therefore, there is a great need for creating awareness of laser dentistry. Cost-effective equipment is the need of the hour to promote laser dentistry.
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The effect of root end cavity preparation using Er,Cr:YSGG laser, ultrasonic retrotip, and bur on the apical microleakage of retrograde cavity filled with MTA Plus p. 299
Premjith, Divya Shetty, Ashika Kailar, Sharath Pare, Pradeep Kumar, Mallikarjuna Ragher
DOI:10.4103/jpbs.JPBS_90_20  
Aim: The sealing ability of the retrograde material is greatly affected by the technique used for root end preparation. Advances in retrograde preparation techniques such as lasers has shown to provide an efficient outcome. The study was to evaluate and compare the effect of various techniques of retrograde cavity preparation on apical microleakage. Materials and Methods: Forty-five single rooted teeth were decoronated. Biomechanical preparation was carried out up to size F2 ProTaper system and obturated. Glass–ionomer cement was used as an access restorative material. The apical root resection was done at 3 mm from the apex at angulation of 90° to the long axis of the root. The allocation of the samples was done into three groups of 15 each. Group A: Retrograde cavities prepared using conventional round bur; Group B: Retrograde cavities prepared using ultrasonic retro preparation diamond tip; and Group C: Retrograde cavities prepared using “Erbium, chromium: yttrium, scandium, gallium, garnet” (Er,Cr:YSGG). The retrograde cavities hence prepared were filled with MTA Plus. Nail varnish was used to coat the samples except at the apical end. Samples were immersed in methylene blue for 24h. Stereomicroscope was used for examination of the sectioned teeth. The data were analyzed using one-way analysis of variance (ANOVA) and post hoc Tukey test. Results: Results showed very highly significant difference between laser and bur (P value = 0.001). Conclusion: Retrograde preparation with Er,Cr:YSGG showed significantly less microleakage when compared to the use of ultrasonic retrotip and burs.
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Teledentistry: is it the future of rural dental practice? A cross-sectional study p. 304
Abirami Mathivanan, Janani Rajeshwari Gopalakrishnan, Aparnna Dhayanithi, Mudiarasu Narmatha, Khaniya Bharathan, KKN Saranya
DOI:10.4103/jpbs.JPBS_91_20  
Aim: To bridge the gap between urban and rural population, a vast number of researches are being carried out. Teledentistry is one of the technological advances in dentistry. It is defined by Cook in 1997 as “the practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance.” This study aimed to assess the knowledge, attitude, and practice of teledentistry among general dentists in and around Coimbatore district, Tamil Nadu, India. Materials and Methods: A self-administered closed-ended questionnaire was designed. The questions were divided into three sections based on knowledge, attitude, and practice. Data collected from the questionnaire were entered in Microsoft Excel. Level of significance (P < 0.05) was set at 95% confidence interval and P < 0.01 at 99% confidence interval was maintained, and the data were statistically analyzed. Results: The majority of the dentists had less knowledge about teledentistry. About 73% of the dentists believe that teledentistry can provide access of specialists to the rural population. Conclusion: Of the dentists, 90% agree that teledentistry would be the major advancement in the future; however, there needs to be a specific module of operation and promotion of the module in future.
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Assessment of salivary flow rate in patients with chronic periodontitis p. 308
Chitra G Vallabhan, Sujith Sivarajan, Ashwin Devanarayanan Shivkumar, Vandana Narayanan, Steffi Vijayakumar, RS Indhuja
DOI:10.4103/jpbs.JPBS_92_20  
Background: Chronic periodontitis (CP) is an infectious disease, primarily affecting the attachment apparatus of the dentition, and is categorized into mild, moderate, and severe periodontitis on the basis of its severity. It is a well-established and proven fact that an adequate level of saliva is essential for maintaining the integrity of oral tissues including the periodontium. Although various factors, such as stimulation, circadian rhythm, diet, age, and drugs, can affect the salivary flow rate, many recent studies have provided evidence that it can be altered by pathological inflammatory conditions such as periodontal diseases. Therefore, this study has been undertaken to assess the unstimulated and stimulated salivary flow rate in the different clinical stages of chronic periodontitis. Materials and Methods: This study comprised 60 study participants, who were divided into four groups depending on clinical attachment level (CAL). In all, both unstimulated and stimulated saliva were collected, and the flow rate was expressed in milliliter per minute. Results: Statistical analysis was accomplished with Statistical Package for the Social Sciences (SPSS) software. One-way analysis of variance (ANOVA) was used to analyze differences in salivary flow rate among the groups. Statistical significance was set at P < 0.05. The amount of unstimulated saliva in healthy subjects, in mild, moderate, and severe periodontitis was 0.766, 0.400, 0.270, and 0.146 mL/min, respectively. Likewise, the amount of stimulated saliva in healthy subjects, in mild, moderate, and severe periodontitis was 1.017, 0.494, 0.347, and 0.236 mL/min, respectively. Conclusion: The study identified a significant decrease in both unstimulated and stimulated salivary flow rate with the severity of progression of chronic periodontitis.
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Effect of nonsurgical periodontal therapy on serum levels of interleukin-1β and interleukin-8 in smokers and nonsmokers with chronic periodontitis p. 313
Steffi Vijayakumar, Elizabeth Koshi, Arun Sadasivan, RS Indhuja, Chitra G Vallabhan
DOI:10.4103/jpbs.JPBS_93_20  
Aim: The aim of this study was to evaluate the effect of nonsurgical periodontal therapy on serum levels of interleukin-1β (IL-1β) and interleukin-8 (IL-8) in smokers and nonsmokers with chronic periodontitis before and after scaling and root planing (SRP). Materials and Methods: This was a comparative interventional study including a total of 52 (26 smokers and 26 nonsmokers with chronic periodontitis) subjects. Clinical parameters (gingival index [GI], plaque index [PI], recession, probing pocket depth [PPD], and clinical attachment level [CAL]) were recorded at baseline and 4 weeks after initial periodontal therapy. Initial periodontal therapy included oral hygiene instructions and full mouth SRP. Venous blood sample of 5 mL was collected from each subject at baseline and 4 weeks after initial periodontal therapy to evaluate serum IL-1β and IL-8. These biochemical parameters were assayed using enzyme-linked immunosorbent assay (ELISA) method. Results: The periodontal parameters such as PI, GI, recession, PPD, and CAL were reduced after nonsurgical periodontal therapy. Smokers with chronic periodontitis showed statistically significant lower GI and higher PI, gingival recession, PPD, and CAL as compared to nonsmokers with chronic periodontitis. Statistically significant reduction in periodontal parameters was seen in both groups after periodontal therapy. IL-1β and IL-8 were increased in both groups at baseline; after SRP both groups showed statistically significant reduction in IL-1β and smokers with chronic periodontitis showed statistically significant increase in IL-8 after SRP. Conclusion: Smokers with chronic periodontitis showed more periodontal destruction and systemic inflammatory markers compared to nonsmokers with chronic periodontitis. After periodontal therapy both groups showed statistically significant improvement in clinical parameters and biochemical parameters excluding IL-8.
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Spectrophotometric evaluation of shade selection with digital and visual methods p. 319
S Preethi Suganya, P Manimaran, D Saisadan, C Dhinesh Kumar, D Abirami, V Monnica
DOI:10.4103/jpbs.JPBS_95_20  
Aim: The main purpose of the study was to learn the possible shade differences between human eye and the digital method with spectrophotometric methods. Materials and Methods: Fifty dental students of age groups 18–25 with maxillary right central incisor after undergoing oral prophylaxis were included in this study. Before undergoing shade selection, standardization protocol was followed. The shade of the right maxillary central incisor was determined by using the following methods: visual, spectrophotometer, and digital photography. The shades obtained by both spectrophotometer and visual methods are compared and similarly L*, a*, and b* values obtained by both spectrophotometer and digital methods are compared. Finally these comparisons are subjected to statistical analysis. Results: Z and P values of digital and spectrophotometric methods were found to be statistically significant. Tooth shade selected between spectrophotometric and visual method was analyzed by using chi-square test, which shows highly significant value. Conclusion: It was concluded that the digital photography can be used as one of the reliable methods for shade selection in a clinical setup.
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A case-control study comparing and correlating iNOS expression among various clinicopathological variants of oral leukoplakia and oral squamous cell carcinoma: A Immunohistochemistry study p. 324
Deepak N Singh, Kumar Chandan Srivastava, Aparna D Potsangbam, Deepti Shrivastava, Doddabasavaiah Basavapur Nandini, Wahengbam T Singh, Koijam S Singh
DOI:10.4103/jpbs.JPBS_96_20  
Background and Objective: The role of inducible nitric oxide synthase (iNOS) has been implicated in various pathological processes including oral carcinoma. Oral premalignancy being its precursor lesion is also expected to show similar pattern. This study attempts to appraise the iNOS expression in various clinicopathological stages and grades of oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC). Materials and Methods: A case-control study design was adopted for this study with a total sample of 90 subjects, distributed equally into the three study groups, namely controls, OL, and OSCC. Clinical staging and histopathological grading for both the case groups were performed. Representative tissue samples from all groups were obtained and studied for iNOS expression using immunohistochemistry (IHC). Data were presented in mean and percentages accordingly. Inferential analysis was performed using Kruskal–Wallis test, Mann–Whitney test, and Spearman rank correlation test. Results: Significant (P < 0.001) difference was observed among the groups, where 83.3% of OSCC and 73.3% of OL epithelial cells showed iNOS expression. The normal cells did not show up any expression. The expression was found to rise with the progressing clinical stages of OL (P < 0.05) and OSCC (P < 0.01). Similar pattern was observed with respect to advancing dysplasia in OL (P < 0.01) and cell differentiation in OSCC (P < 0.01). Significant positive correlation was found in clinicopathological categories of OL and OSCC. Considering the risk assessment, iNOS staining was found to be significantly raised in advanced cases of OSCC (P < 0.01) and high-risk cases of OL (P < 0.01). Conclusion: Increased expression of iNOS can be an early diagnostic marker in OL and as prognostic marker in OSCC.
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Relation between apical seal and apical preparation diameter: An in vitro study p. 332
Priyanka Saluja, Shugufta Mir, Shashit S Bavabeedu, Suraj Arora, Anshad M Abdulla, Suheel M Baba
DOI:10.4103/jpbs.JPBS_97_20  
Background: The current recommendations for the apical preparation diameter, one of the most important mechanical imperatives in the apical third preparation, are to preserve the apical foramen in its original position along with its narrowest diameter to avoid any complication such as tearing, zipping, or transport of the foramen. The aim of our study was to see the correlation between apical seal and apical preparation diameter. Materials and Methods: In total, 90 extracted maxillary incisors were randomly allocated into three groups of 30 teeth each according to the apical preparation size: Group 1: finishing file F1 corresponding to size 20 reached the working length, Group 2: prepared up to size 30 corresponding to finishing file F3, and Group 3: prepared up to size 50 corresponding to finishing file F5. After the filling of the root canals, the teeth were isolated and immersed in a dye solution, then cut longitudinally, photographed, and the dye penetration were calculated using a computer software. Results: Comparison of the three different apical preparation sizes showed no statistically significant differences regarding the apical microleakage. Conclusion: The most important value of the dye penetration was observed in the group with the largest apical diameter.
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Perceived status and care practices among complete denture wearers p. 336
Neeraj Sharma, Jyotsna Shukla, Dheeraj Sharma, Divya Mehta, Lalita Kakde, Krati Bais
DOI:10.4103/jpbs.JPBS_99_20  
Background: Oral health is neglected even today. This can be evidently seen in the low utilization rates and poor oral health status. Conventional dentures are the most common treatment option in the restoration of lost teeth. Without appropriate denture care practices, there is an elevated risk of developing a multitude of problems. The aim of this study was to assess the perceived status and care practices among complete denture wearers in Modern Dental College and Research Centre, Indore, Madhya Pradesh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Prosthodontics at the Modern Dental College and Research Centre, Indore, Madhya Pradesh, India. Patients with self-care optimum overall health who were using either single or full complete dentures for more than 1 year from the commencement of the study were requested to participate in the study. A total of 1000 study participants were given a self-administered questionnaire on their denture care practices followed by clinical examination of the denture status. Data were statistically analyzed using the Statistical Package for the Social Sciences software for Windows, version 20.0. Results: Maximum denture wearers informed that they cleaned their dentures once a day, with brush and water, and had the habit of removing the dentures before sleeping at night. Almost 90% of the participants reported their denture status to be good or fair. Clinical examination revealed that slightly more than half of the participants had poor denture status. Conclusion: This study signifies the importance for improvement in patient oral health education and counseling with respect to the maintenance of dentures and upkeep of denture hygiene. It also emphasizes the need for educating patients on how to evaluate the status of their dentures.
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Perception, knowledge, and attitude of problem-based learning among dental college students in India: A closed-ended questionnaire study p. 340
Sabarinathan Jaganathan, Maya Ramesh, Ramesh Krishnan
DOI:10.4103/jpbs.JPBS_376_19  
Context: Problem-based learning (PBL) is mostly a student-centered learning method, and it is a new method used in medical and dental education all over the world. In India, PBL is a part of the learning process sparingly followed. Contrary to other institutions, PBL has been introduced in dental curriculum along with the traditional curriculum very recently. Aim: The aim of this study was to evaluate the newly introduced PBL curriculum among the dental students using a closed-ended questionnaire on a five-point scale. Materials and Methods: The questionnaire on PBL was prepared in Google Forms, comprising 22 closed-ended questions on a five-point Likert scale, ranging from strongly disagree (1) to strongly agree (5). We carried out a pilot study in 10% of the target population to check validity and feasibility. Final study was conducted in the targeted population of 185 dental students who had undergone PBL sessions. Results: The responses for the questionnaire thus received from the students were compiled and analyzed using Google Forms software. Overall rating of PBL by the respondents was as follows. The majority of the student’s responses were agreed with 54.6% and a significant number of students strongly agreed with PBL at 33%. Conclusions: This study shows the responses of the students on aspects of group learning, imparting content knowledge, improvement of group skills, improvement of communication skills, and carrying out self-directed learning within the Indian context of dental health education.
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Microbiological and Clinical evaluation of Neem gel and Chlorhexidine gel on dental plaque and gingivitis in 20-30 years old adults: A Randomized Parallel-Armed, Double-blinded Controlled Trial p. 345
Gargi Nimbulkar, Vikram Garacha, Vittaldas Shetty, Ketaki Bhor, Kumar Chandan Srivastava, Deepti Shrivastava, Mohammed G Sghaireen
DOI:10.4103/jpbs.JPBS_101_20  
Background: The etiological relationship between the plaque and the gingival inflammation has been long established. The long-term use of chemical antiplaque agents may lead to side effects such as teeth staining and alteration of taste. Therefore, natural plant extracts with potential antibacterial and anti-inflammatory activity have been explored, which are equally effective and safe for long-term use. Objective: The aim of this study was to compare and evaluate effect of neem gel and chlorhexidine (CHX) gel on dental plaque, gingivitis, and bacterial count of Streptococcus mutans and Lactobacilli among 20–30-year-old school teachers in a city of western Maharashtra, over 90 days’ usage. Materials and Methods: A double-blind, parallel armed, controlled, randomized clinical study was conducted among 60 school teachers of 20–30 years’ age group for 90 days. The two study groups were as follows: Group A––2.5% neem gel (n = 30) and Group B––0.2% CHX gel (n = 30). The plaque scores were recorded by Plaque Index (Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38:610-6) and gingival scores by Gingival Index (Löe H, Silness J. Periodontal disease in pregnancy. Acta Odontol Scand 1963;21:533-51). Streptococcus mutans and Lactobacilli species count by conventional culture method was carried out at baseline, 30th day and 90thday. Considering P value <0.05 as statistically significant, intergroup comparison was performed using unpaired t test. One-way analysis of variance (ANOVA) test was used followed by Tukey’s post hoc test for intragroup comparison. Results: The mean plaque, gingival scores, and microbial count of S. mutans and Lactobacilli showed significant reduction at 30th and 90th day in neem gel group as well as CHX gel group (P < 0.05). None of the parameter showed any significant change at 30th and 90th day (P > 0.05) on intergroup comparison. Conclusion: The neem gel showed significant decrease in dental plaque, gingival inflammation, and microbial counts, which was comparable to CHX gel proving to be a good herbal alternative. No side effects were reported for use of neem gel over considered period of time.
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Evaluation of antimicrobial efficacy of calcium hydroxide along with proton pump inhibitor against Enterococcus faecalis p. 352
Namitha Divakar, Sunil Paramel Mohan, Manoj Kumar Pulyodan, Arun Tom, Deepthi Karukayil, Maya Somasundaram
DOI:10.4103/jpbs.JPBS_104_20  
Aim: The aim of this study was to evaluate in vitro the efficacy of pantoprazole, a proton pump inhibitor, alone, and in combination with calcium hydroxide against Enterococcus faecalis, a star survivor in endodontic pathology. Materials and Methods: Teeth were inoculated with E. faecalis strains MTCC 439 and were divided into groups. Group 1 used saline as the negative control, Group 2 used calcium hydroxide, Group 3 used pantoprazole alone, and Group 4 used calcium hydroxide along with pantoprazole. They were incubated and dentine harvesting was performed. Colonies were counted using a digital counting machine. Data were statistically analyzed. Results: Group 4 was found to be the most effective against the pathogen. Discussion: This study indicates that the association of calcium hydroxide with the proton pump inhibitor pantoprazole can be successfully used as an intracanal medicament against E. faecalis.
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Evaluation of long-term stability of bilateral sagittal split osteotomy in individuals with different growth patterns p. 355
Tojan Chacko, Jose Jacob, Midhun Raghav, Supriya Gopalakrishnan, Anuradha Parayancode, Vineetha V Menon
DOI:10.4103/jpbs.JPBS_105_20  
Objective: Bilateral sagittal split osteotomy (BSSO) is a routinely used surgical step for the correction of a class III with mandibular prognathism. Many factors influence the stability of the surgical correction achieved. This study was designed to access the role of growth pattern in the surgical stability after a BSSO correction. Materials and Methods: A total of 18 individuals (6 vertical growers, 6 horizontal growers, and 6 normal growing individuals) were considered for the study. Five parameters, horizontal plane (HP)–pogonion (POG) angle, HP-occlusal plane angle, POG height, POG depth, and Point B depth, were measured and compared postsurgically and in the follow-up phase. Result: Vertical growing individuals showed greater tendency for relapse and clockwise rotation of mandible postsurgically. No major difference was observed in the normal and horizontal growing individuals. When planning BSSO on vertical growing patient, utmost care should be taken to prevent posttreatment relapse to ensure better surgical stability.
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Comparison of marginal accuracy of interim restoration fabricated from self-cure composite and autopolymerizing acrylic resin: An in vitro study p. 361
Sankar Madhavan, Suja M Jude, Sylvana Achammada, Sujana Ullattuthodi, Tessa Kuriachan, Jose Jacob
DOI:10.4103/jpbs.JPBS_106_20  
Background and Objectives: One of the important steps toward achieving a successful fixed partial denture treatment is the fabrication of interim restorations with good marginal adaptation. Poor marginal adaptation of the interim restorations will allow ingress of fluids and microorganisms between the restorations and may lead to caries and pulpitis. The objective of this study was to evaluate and compare the marginal accuracy of interim restorations made from two polymethyl methacrylate (PMMA) and two bis-acryl materials. Materials and Methods: An in vitro method was used to replicate a clinical procedure in which the interim crown was made using a direct technique. A maxillary first molar typodont tooth was prepared to receive a full cast crown restoration having 1 mm chamfer and a taper of 5°, and then the prepared artificial tooth was cast into a cobalt chromium metal die. Wax patterns were prepared on the metal die using type 2 inlay wax for full metal crowns. The impression of the die along with the wax pattern was made with a putty-type polyvinyl siloxane, and this impression was used as a mold for making interim restorations. Two PMMA and two bis-acryl provisional crown materials were distributed as follows: Group A: Unifast Trad (GC Dental), Group B: DPI self-cure tooth molding material, Group C: Structur 2 QM (VOCO), and Group D: Cool Temp Natural (Coltene/Whaledent). A total of 60 interim restorations from all the four materials were fabricated (15 interim restorations from each material). The marginal discrepancy of the interim restoration was determined by measuring the space between the margin of the interim restoration and the finish line of the metal die at four vertical reference lines previously marked at the midpoint of the metal die finish line at the buccal, palatal, mesial, and distal surfaces of the die. The marginal gaps were visualized at ×45 magnification using a stereomicroscope and interpreted using ProgRes image capture software. Results: The mean marginal discrepancy calculated in PMMA materials was 269 µm for DPI and 205 µm for Unifast Trad, and the mean marginal gap for the bis-acryl material was 171 µm for Cool Temp and 140 µm for Structur 2 QM. Interpretation and Conclusion: Comparison of marginal accuracy showed that bis-acryl provisional crown material showed better marginal accuracy than PMMA provisional crown material. Among the materials tested, Structur 2 QM showed the best marginal accuracy, and the least marginal accuracy was shown by DPI.
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Reliability of cone beam computed tomography in comparison with panoramic radiography to predict the anatomical relationship of inferior alveolar nerve with mandibular third molar: A radiological and clinical study p. 367
Ashford L George, Prasanth Panicker, Joseph Johny, Manoj Bhaskar, Basil M Jacob, H H Hasli Zulthana
DOI:10.4103/jpbs.JPBS_107_20  
Objectives: The purpose of the study was to assess the precision of cone beam computed tomography (CBCT) in comparison with panoramic radiography in determining the anatomical relationship of inferior alveolar nerve (IAN) with the impacted mandibular third molar. Materials and Methods: Twenty patients diagnosed with the following panoramic radiographic markers: darkening of the root, interruption of white line of mandibular canal, diversion of mandibular canal, and narrowing of the roots suggesting a close relationship of roots with the mandibular canal were selected and underwent an additional CBCT to assess the proximity of IAN to mandibular third molar roots. All patients were assessed for loss of sensation or neurosensory deficit in the chin and lower lip during postoperative period by objective and subjective methods. Results: Twenty patients with an average age of 25.4 years (21–39 years) with 21 impacted mandibular third molars were included in this sample. It was found that after the removal of impacted third molars, IAN was not visible in any of the cases and postoperative objective and subjective neurosensory tests showed no signs of neurosensory disturbances. Conclusion: The study found that CBCT had limited usefulness in neurovascular bundle exposure prediction, prior to surgical removal of impacted mandibular third molars. The accuracy of radiographic markers in conventional panoramic radiography to predict neurovascular exposure was also limited.
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Comparative evaluation of fracture resistance of incisor fragments using simple, bevel, internal groove preparation designs and reattached with nanocomposites: An in vitro study p. 373
Roshni Chandran, Sreeram Rayar, Arjun B Ravi, Kaushik Haridas
DOI:10.4103/jpbs.JPBS_110_20  
Aim: The aim of this in vitro study was to evaluate the fracture resistance of anterior crown fragments using three different preparation designs and reattached using two different nanocomposites. Materials and Methods: A total of 120 sound human permanent incisors were selected and divided into six groups. The teeth were sectioned and reattached using different preparatory designs and nanocomposites. Group A (simple reattachment with G-aenial Universal Flo), Group A2 (bevel preparation reattached with G-aenial Universal Flo), Group A3 (internal groove preparation reattached with G-aenial Universal Flo), Group B1 (simple reattachment with Polofil NHT Flow), Group B2 (bevel preparation reattached with Polofil NHT Flow), and Group B3 (internal groove preparation reattached with Polofil NHT Flow). The teeth were sectioned and reattached using different preparatory designs and nanocomposites. These teeth were then subjected to thermocycling, and fracture resistance of the reattached fragments was recorded using Instron machine. Results: Group A3 showed the highest fracture resistance. The least fracture resistance was seen in Group B1. Conclusion: The fracture resistance of reattached incisor fragments depends mainly on the preparation design incorporated and also the material used to restore. Fragments where internal groove preparatory design was done and reattached with G-aenial Universal Flo, showed greater fracture resistance. Simple reattachment preparatory design showed the least fracture resistance, and hence must be avoided.
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Evaluation of efficacy of pilocarpine and bethanechol in xerostomic denture wearers p. 378
Revati Singh, Rohit Singh, Supriya Singh, Rani Indira Sinha, Ganesh Kulkarni, Harshvardhan Shridhar Jois
DOI:10.4103/jpbs.JPBS_111_20  
Aim: The aim of this study was to evaluate effectiveness of bethanechol and pilocarpine among xerostomic denture wearers. Materials and Methods: This in vitro study was conducted in 60 complete denture wearers of both genders. For assessment of salivary flow, resting saliva and stimulated saliva were collected. Patients were split into two groups consisting of 30 patients each. Pilocarpine was given to patients in group I and patients in group II received bethanechol. Salivary flow was measured at baseline, after 2 weeks, and after 4 weeks. Results: The mean whole resting saliva in patients of group I was 0.61 mg/mL and in that of group II was 0.65 mg/mL. The mean whole stimulated saliva in patients of group I was 1.35 mg/mL and in group II it was 1.51 mg/mL. The mean whole resting saliva after 2 weeks in patients of group I was 0.83 mg/mL and in group II was 0.92 mg/mL. Whole stimulated saliva in patients of group I was 1.67 mg/mL, and in patients of group II it was 1.86 mg/mL. The difference noted was significant (P < 0.05). The mean whole resting saliva after 4 weeks in patients of group I was 1.23 mg/mL and in that of group II was 1.43 mg/mL. Whole stimulated saliva in patients of group I was 1.98 mg/mL and in patients of group II it was 2.04 mg/mL. Conclusion: Authors found that both agents were effective in increasing salivary secretions. However, pilocarpine is a more effective sialagogue as compared to bethanechol in completely edentulous patients with xerostomia.
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Expression of survivin in oral potentially malignant disorders: An immunohistochemical study p. 382
Venkatraman R Rajanna, Murali C Raveendranath, Shanmugam Kathiresan, Soundarya Srinivasan, Janani Ilango
DOI:10.4103/jpbs.JPBS_114_20  
Aim: The aim of this study was to compare the immunohistochemical expression of survivin in oral potentially malignant disorders (OPMDs) and evaluate its prognostic significance among oral leukoplakia (OL), oral submucous fibrosis (OSMF), and oral lichen planus (OLP). Materials and Methods: The study material consisted of 60 formalin-fixed paraffin-embedded tissue samples: 15 cases each of OL, OSMF, OLP, and normal oral mucosal epithelium as control. Survivin expression was analyzed immunohistochemically, and data analysis was accomplished using Statistical Package for Social Sciences, version 22.0 (SPSS Inc., Chicago, IL). Fisher’s chi-square test was opted to compare the study groups. Results: Survivin was expressed in all the OPMDs including OL, OSMF, and OLP, but was absent in normal oral tissue samples. Higher immunoreactivity and survivin staining was observed in OLP compared to OL and OSMF whereas OL showed a significant difference in the distribution of survivin immunoexpression against OLP. An increased nuclear expression of survivin along with distribution in the basal and parabasal layers was evident in all OPMDs. Conclusion: Survivin was expressed more in OLP in comparison to OSMF and OLP, indicating unfavorable prognosis. OL showed increased expression in comparison to OSMF, showing unfavorable prognosis. On the basis of this study, it was concluded that survivin may be used as an important diagnostic and prognostic marker for OPMDs.
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A case–control study to evaluate candidal parameters in the oral cavity of patients with type 2 diabetes mellitus p. 389
Lakshmanan Vijayalakshmi, Joseph Babhu Susai Raj, Jayavel Kavitha, Selvaraj Krishnaraj, Balagangadharan Manovijay, Dhanasekaran Manikandan
DOI:10.4103/jpbs.JPBS_115_20  
Aim: The aim of this study was to evaluate candidal parameters in the oral cavity of patients with type 2 diabetes mellitus (DM). Materials and Methods: The samples included in the study were divided into two groups: group A, comprises 50 patients with type 2 DM, and group B, comprises 30 subjects who were nondiabetic. A nonrandom consecutive sampling technique was used to enroll the subjects for the study. The χ2 test was used to examine the characteristics of the samples. Results: The results found that there is a significant difference in saliva and swab for Candida growth between patients with type 2 DM and normal healthy individuals. Swab had shown slightly more Candida growth than saliva in group A (type 2 DM). No significant variation in Candida growth was found. Candida krusei was seen in normal healthy individuals alone. In antifungal susceptibility pattern to various antifungal agents, Candida tropicalis has shown a significant result for various antifungal agents whereas Candida albicans and Candida dubliniensis did not show any significant result for various antifungal agents used in group A (patients with type 2 DM). Conclusion: Diabetic individuals who are prone to a hyperglycemic state favors the growth and establishment of Candida species. Although a smaller percentage of multidrug-resistant Candida species has been observed in the saliva of patients with type 2 DM.
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Reconstruction of craniofacial bone defects with autologous human bone marrow stem cells and autogenous bone grafts: A case report with review of literature p. 394
Prasanth P Panicker, Sunil Paramel Mohan, Jaisanghar Nallusamy, Suman J Lakshmi, Joseph Johny, Manoj K Bhaskaran
DOI:10.4103/jpbs.JPBS_116_20  
Reconstruction of craniofacial bony defects has always been a challenging task for the surgeons over the years. The science of reconstructing such defects is of at most importance to craniofacial and plastic surgeons due to its relevance in facial aesthetics function as well as prerequisite procedure for continuing other surgical procedures. The main goal of the reconstruction of the craniofacial defects is to reduce the morbidity by restoring the facial form and aesthetics, as well as a good function of the facial structures by achieving a reasonable occlusion and articulation. Although significant improvements have occurred during the last few decades, challenges still exist as to what type of reconstruction to be carried out with regard to techniques and the type and quality of materials of choice to be used. As decades progressed, the advancement in surgical techniques and the variety of reconstruction methods have definitely improved the quality of life. This article reviews the method of bony reconstruction of craniofacial defects using autologous human bone marrow stem cells and autologous bone grafts and its modification, which includes much recent tissue engineering techniques and regenerative medicine, thereby replacing older techniques by biological substitutes, which can restore improve and maintain orofacial function and aesthetics.
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Comparison of flexural strength of Kevlar, glass, and nylon fibers reinforced denture base resins with heat polymerized denture base resins p. 399
Karthik Kannaiyan, M Biradar Sharashchandra, Swetha Kattimani, Malati Devi, Boinapelli Vengal Rao, Sudarshan Kumar Chinna
DOI:10.4103/jpbs.JPBS_117_20  
Introduction: Polymethyl methacrylate (PMMA) has been widely accepted and used in dentistry owing to its working characteristics, aesthetics and stability in the oral environment, ease in manipulation, and inexpensive processing methods and equipment. Aim and Objectives: The aim of this study was to evaluate the flexural strength of a high-impact PMMA denture base resin material and flexural strength of a commonly available heat cure PMMA denture base material with Kevlar, glass, and nylon fibers. Materials and Methods: The test samples were studied under two groups. The Group I (control group) comprised pre-reinforced PMMA (Lucitone 199; Dentsply Sirona Prosthetics, York, Pennsylvania, USA) consisting of 12 samples and second group comprised regular PMMA (DPI, Mumbai, India) reinforced with different fibers. The second test group was further divided into three subgroups as Group 2, Group 3, and Group 4 comprising 12 samples each designated by the letters a–l. All the samples were marked on both ends. A total of 48 samples were tested. Results were analyzed and any P value ≤0.05 was considered as statistically significant (t test). Results: All the 48 specimens were subjected to a 3-point bending test on a universal testing machine (MultiTest 10-i, Sterling, VA, USA) at a cross-head rate of 2 mm/min. A load was applied on each specimen by a centrally located rod until fracture occurred; span length taken was 50 mm. Flexural strength was then calculated. Conclusion: Reinforcement of conventional denture base resin with nylon and glass fibers showed statistical significance in the flexural strength values when compared to unreinforced high impact of denture base resin.
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Effect of green tea extract mouthrinse and probiotic mouthrinse on salivary pH in a group of schoolchildren: An in vivo study p. 404
Saranya Manikandan, Subasish Behera, Radhakrishnan Karthikeyan, Arumugasamy Niranjana, Rajendran Bharathan, Omar Farooq Burhanuddin Mohammed
DOI:10.4103/jpbs.JPBS_119_20  
Aim and Objective: The aim of the study was to assess the efficacy of probiotic and green tea mouthrinse on salivary pH. Materials and Methods: This study was conducted over a period of 1 month among 40 healthy schoolchildren aged between 6 and 8 years. The subjects who fulfilled inclusion criteria were selected and randomly divided into two groups, namely probiotic and green tea groups. Salivary pH was recorded at baseline (0 day) and at the end of the specified time using GC pH strips. Statistical analysis was done using paired t test. P < 0.05 was considered statistically significant. Result: The comparison of mean pH scores for green tea showed that the pH of saliva was increased in the children after rinsing with green tea (6.00–7.60) and was statistically significant (P < 0.001). Similarly, when pre- and post-mean pH was compared in the probiotic group, the pH was found to be higher in the probiotic rinse group (5.60–7.20). The results were statistically significant. Conclusion: The study conducted shows the beneficial effects of green tea in providing a alkaline environment, which is conducive to the oral health of children.
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Efficiency of an integrated apex locator in determining working length in various irrigating solutions: An in vivo study p. 410
Rakesh Reddy Chukka, Malati Devi Bellam, Narender Reddy Marukala, Sainath Dinapadu, Naresh Kumar Konda, Jithender Nagilla
DOI:10.4103/jpbs.JPBS_122_20  
Objective(s): The objective of this in vivo study was to compare and evaluate the accuracy of VDW Gold (VDW, Munich, Germany) integrated apex locator (IAL) and Root ZX Mini (J. Morita Corp., Kyoto, Japan) in two different irrigating solutions. Materials and Methods: Forty patients who required extraction were included in the study. Following local anesthesia, access opening was performed under rubber dam isolation. Initial negotiation of canal was performed using size 10 K-Files (M-Access, Dentsply Maillefer, Ballaigues, Switzerland). Cervical preparation was carried out using Rotary ProTaper SX files (Dentsply Maillefer, Ballaigues, Switzerland) under copious irrigation with 3% sodium hypochlorite. Patients were divided into two groups of 20 each: Group I (NaOCl) and Group II (CHX). The working length (WL) was determined in triplicates for each tooth using Root ZX apex locator and with S1 ProTaper rotary file in continuous motion in case of VDW Gold IAL in the presence of 3% sodium hypochlorite and 2% chlorhexidine. Therapeutic extraction was performed and WL was determined using size 15 K-Files under 20× magnification. Results: The paired sample independent t test showed that there was no significant difference between the Root ZX and VDW apex locator in determining the minor foramen in NaOCl group (P = 0.234, 0.453 respectively) and CHX group (P = 0.085, 0.087) when compared with actual working length. Conclusion: Both the apex locators were equally effective in determining WL at 0.5 mm from the apex in presence of irrigating solutions, that is, NaOCl and chlorhexidine.
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Alternative approach to prevent inferior alveolar nerve injury in lower third molar surgery: A pilot study on coronectomy p. 415
Prabakaran Sureshkannan, Kuriadom Sam Thomas, Vannala Venkataramana, Annamalai Thangavelu, Sambandham Thiruneelakandan
DOI:10.4103/jpbs.JPBS_123_20  
Context: Injury to inferior alveolar nerve (IAN) in lower third molar (L3M) surgery may lead to unpleasant sensation or anesthesia of lower lip. Considering the quality of life of the patient and the litigations faced by the dentist, alternative treatment approaches to odontectomy have been studied by various researchers. Coronectomy is one such option to prevent the nerve injury. Aims: The aim of this study was to assess the efficacy of coronectomy to reduce nerve injury during L3M surgery in high-risk cases as per radiological signs. Settings and Design: A pilot study was conducted in the oral surgery department of Rajah Muthiah Dental College, Annamalai Nagar, Chidambaram, India to evaluate coronectomy and its usefulness. Materials and Methods: Sixty-five patients who satisfied the inclusion and exclusion criteria for coronectomy were included in the study. The patients were followed up to 1-year period. Statistical Analysis Used: Descriptive statistics was used. Results: None of the patients in the study group had IAN impairment. Conclusions: Coronectomy is a safe alternative for complete odontectomy in high-risk L3M surgery cases. Root migration, infection, and need for second surgery are potential complication. Further studies with more samples and variables need to be performed.
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Comparative evaluation of xerostomia among diabetic and nondiabetic subjects wearing complete denture p. 419
Manikandan Sundaram, Saranya Manikandan, Balakrishnan Satheesh, Deenadayalan Srinivasan, Dinakaran Jayapal, Dhivya Kumar
DOI:10.4103/jpbs.JPBS_124_20  
Background: Diabetes mellitus represents a group of metabolic diseases that are characterised by hyperglycaemia due to a total or relative lack of insulin secretion and insulin resistance or both. Diabetes mellitus patients present with a higher susceptibility to infections due to a deficiency in polymorphonuclear leukocytes, as a result of vascular alterations and neuropathies. An increased risk of infections has been observed in complete denture wearing subjects with xerostomia. The objective of this study was to compare diabetic and non-diabetic subjects wearing complete dentures regarding xerostomia of different age group. Materials and Methods: A cross-sectional study was conducted among 50 subjects, 25 with and 25 without a diagnosis of diabetes, were matched for gender, race, and age. Results: In this study we intended to compare diabetic and non-diabetic subjects wearing complete dentures regarding xerostomia and we found that xerostomia was more associated with diabetic denture wearer group in comparison with the non-diabetic denture wearers with a significant P value of <0.05. Conclusion: These results indicate that xerostomia should be diagnosed and effectively managed before any complete denture therapy is initiated in diabetic denture wearing patients to improve the quality of life.
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Can herbal extracts serve as antibacterial root canal irrigating solutions? Antimicrobial efficacy of Tylophora indica, Curcumin longa, Phyllanthus amarus, and sodium hypochlorite on Enterococcus faecalis biofilms formed on tooth substrate: In vitro study p. 423
Shan Sainudeen, Veena S Nair, Mohammad Zarbah, Anshad Mohamed Abdulla, Chawre Mustufa Najeeb, Sivadas Ganapathy
DOI:10.4103/jpbs.JPBS_127_20  
Aim: The purpose of this study was to evaluate the antimicrobial efficacy of Tylophora indica, Curcumin longa, and Phyllanthus amarus on Enterococcus faecalis biofilms formed on the tooth substrate. Sodium hypochlorite was used as a positive control. DMSO (dimethyl sulfoxide), the vehicle for the herbal extracts, was used as the negative control. Materials and Methods: Extracted human teeth were biomechanically prepared, vertically sectioned, placed in the tissue culture wells exposing the root canal surface to E. faecalis to form a biofilm. At the end of the third week, all groups were treated for 15 min with the test solutions and the control. The results were analyzed both quantitatively and qualitatively. Results: Statistical analysis was performed by using one-way analysis of variance and compared by the Mann–Whitney test using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. The qualitative assay with the 3-week biofilm on the canal portion showed complete inhibition of bacterial growth for NaOCl, whereas samples treated with herbal solutions showed significant reduction of bacterial growth compared to control group, which showed 139.9 × 109 CFU/mL among the experimental herbal solutions groups. P. amarus has shown maximum bacterial count followed by C. longa and T. indica. Conclusion: NaOCl 5% showed maximum antibacterial activity against 3-week biofilm on tooth substrate. T. indica, P. amarus, and C. longa showed statistically significant antibacterial activity against 3-week biofilm. The use of herbal alternatives might prove to be advantageous considering the several undesirable characteristics of NaOCl.
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Detection of salivary alkaline phosphatase levels in smokers, diabetic patients, potentially malignant diseases and oral malignant tumours p. 430
Adi Ravi Prakash, Prashant Nahar, Madhusudhan Ashtekar, Srikant Natarajan, Rohit Singh, Ganesh Kulkarni
DOI:10.4103/jpbs.JPBS_129_20  
Aim: Alkaline phosphatase (ALP) is present in human and plays a key role in intracellular destructive processes and cellular damage. It has bicarbonate and phosphate ions, which help in buffering against acids. ALP activity is affected by smoking, which changes pH in oral environment and has harmful effects. Thus, the evaluation of ALP activity of smokers and healthy nonsmoker along with patients who were diabetic, potentially malignant, and malignant was carried out in this study. Materials and Methods: The study took place between 2016 and 2017. A total of 150 smokers, non-smokers, and patients who were diabetic, potentially malignant, and malignant were included. Collection of unstimulated whole saliva was done from each participant, and salivary ALP levels were measured by spectrophotometric assay. Results: Mean salivary ALP levels were significantly higher in smokers compared to those in nonsmokers. Mean ALP levels were also increased in patients who were diabetic, potentially malignant, and malignant compared to those in controls. Conclusion: ALP levels were significantly higher among smokers when compared to a healthy control group. Oral tissue function and side effects among smokers can be evaluated by these salivary enzyme alterations, which can serve as biomarkers for the diagnosis of any disease process. These salivary alterations could potentially be used as biochemical markers for the evaluation and early diagnosis. The higher levels were also found in patients who were diabetic, potentially malignant, and malignant, and ALP levels may also be used as biomarkers for the evaluation of the disease process.
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To compare mineral trioxide aggregate, platelet-rich fibrin, and calcium hydroxide in teeth with irreversible pulpitis: A clinical study p. 436
Revati Singh, Rohit Singh, Kumari Kavita, Apoorva Kommula, Ganesh Kulkarni, Harshvardhan Shridhar Jois
DOI:10.4103/jpbs.JPBS_130_20  
Aim: Numerous pulp-capping agents such as mineral trioxide aggregate (MTA), calcium hydroxide (Ca(OH)2), platelet-rich fibrin (PRF), and biodentine have been suggested. This clinical study was conducted to compare MTA, PRF, and Ca(OH)2 in teeth with irreversible pulpitis. Materials and Methods: The 60 mandibular molar teeth with irreversible pulpitis were used in this study, which were restored with Ca(OH)2, MTA, and PRF. Assessments of the treatment were carried out at 6 months and 1 year by clinical examination and also radiographically. Results: A nonsignificant difference was observed in pain intensity recorded at numerical rating scale at baseline, 24h, 1 week, 1 month, 3 months, 6 months, and 1 year. A nonsignificant (P > 0.05) difference was reported in clinical and radiographic success rate recorded at 6 months and 1 year in all groups. Conclusion: Pulp-capping agents such as Ca(OH)2, MTA, and PRF yielded similar success rate when used in teeth with irreversible pulpitis.
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Assessment of aluminum chloride retraction cords, expasyl, and tetrahydrozoline-soaked retraction systems in gingival retraction p. 440
Kumari Kavita, Rani Indira Sinha, Revati Singh, Rohit Singh, K R Parameshwar Reddy, Ganesh Kulkarni
DOI:10.4103/jpbs.JPBS_131_20  
Aim: The aim of this study was to assess different gingival displacement systems such as aluminum chloride retraction cords, expasyl, and tetrahydrozoline-soaked retraction cord to record intracrevicular margins of tooth preparations. Materials and Methods: This study included 60 patients. Patients were divided into four groups of 15 each. In group I, aluminum chloride retraction cords, in group II expasyl, in group III tetrahydrozoline-soaked retraction cord, and in group IV no retraction cord were used. Results: The mean gingival displacement (μm) in group I was 825.6, in group II was 482.1, in group III was 742.3, and in group IV was 214.8. Significant difference was seen in between groups by one-way analysis of variance as P < 0.05. Post hoc Tukey analysis showed significant difference during multiple comparison between groups. Conclusion: Authors found that maximum gingival retraction was achieved with aluminum chloride retraction cords followed by tetrahydrozoline and expasyl.
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Assessment of efficacy of 5% topical amlexanox and 0.1% topical triamcinolone acetonide in management of recurrent aphthous stomatitis p. 444
Kumari Kavita, Rohit Singh, Revati Singh, Sudhir Gonuguntla, Alexander Maniangat Luke, Harshvardhan Shridhar Jois
DOI:10.4103/jpbs.JPBS_133_20  
Aim: The aim of this study was to assess the efficacy of 5% topical amlexanox and 0.1% topical triamcinolone acetonide in recurrent aphthous stomatitis (RAS) management. Materials and Methods: Sixty adult patients of RAS of both genders were divided into two groups with each group having 30 patients. In group I, 0.1% topical triamcinolone acetonide was prescribed. In group II, 5% topical amlexanox was prescribed. Patients were recalled regularly and size of ulcer, erythema, and pain score was recorded on days 1, 3, and 5. Results: The mean ulcer size (mm) on day 1 in group I was 4.3 and in group II it was 4.1, on day 3 it was 3.5 in group I and in group II it was 3.6, on day 5 in group I it was 1.3 and in group II it was 1.7. The result was not statistically significant (P > 0.05). The mean pain score recorded on visual analog scale was in descending grade day by day on first, third, and fifth days. In group I, healing was seen in 29 (96.6%) patients and in 28 (93.3%) patients in group II. Partially healing was seen in 1 (3.3%) patient in each group, whereas in group II nonhealing was observed in 1 (3.3%) patient. The statistical significance was not achieved as P > 0.05. Conclusion: Authors found that above drugs were effective in reducing pain, size of ulcer, erythema, and improving healing in patients with recurrent aphthous stomatitis. There were better results with triamcinolone acetonide as comparison of amlexanox.
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Comparison of antibacterial effect of calcium hydroxide combined with chlorhexidine and povidone-iodine against Enterococcus faecalis in dentinal tubules of human incisors: An in vitro comparative study p. 448
Sameer Punathil, Shabna Moyin, Sham S Bhat, Sundeep Hedge, Archana Pai, Jeswin James
DOI:10.4103/jpbs.JPBS_134_20  
Background and Objectives: It has been found that the microorganism behind the failure of root-filled teeth is Enterococcus faecalis, which shows resistance to most of the intra-canal medicaments. Therefore, the purpose of this study was to evaluate the antibacterial efficacy of three intra-canal medications—calcium hydroxide with saline, combinations of calcium hydroxide with 2% chlorhexidine (CHX), and calcium hydroxide with 5% povidone-iodine—against E. faecalis in dentinal tubules of human incisors. Materials and Methods: Forty permanent maxillary central incisors were made into standardized segments and infected with E. faecalis. They were treated with a paste made of calcium hydroxide and 2% CHX, calcium hydroxide and 5% povidone-iodine, and calcium hydroxide and saline for 1 week. Dentinal shavings collected from the canal were suspended in thioglycollate broth solution and spread on brain heart infusion agar. Colony-forming units (CFUs) were enumerated and the CFU per milligram of dentin was calculated. The pH of the medicaments used was measured with the help of pH meter. Results: The results showed that the paste made from calcium hydroxide and 2% CHX was significantly more effective than that made from calcium hydroxide and povidone-iodine, and calcium hydroxide and saline. The addition of CHX or povidone-iodine did not affect the alkalinity of calcium hydroxide. Conclusion: This study concludes that Ca(OH)2 + 2% CHX are effective against E. faecalis. Combinations of calcium hydroxide and 5% povidone-iodine showed better antibacterial effect than calcium hydroxide and saline. Ca(OH)2 + saline was ineffective against E. faecalis.
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Histocompatibility of novel cycloaliphatic comonomer in heat-cured denture base acrylic resin: Histomorphometric analysis in rats p. 453
Ranganathan Ajay, Karthigeyan Suma, Sengottaiyan Arulkumar, Ravichandran Mahadevan, Elumalai Ambedkar, Katturkaran Antonisamy Biju
DOI:10.4103/jpbs.JPBS_139_20  
Background: Prosthodontics is impossible without denture base resins. Allergic reactions to these resins are not uncommon, albeit favorable properties. Monomeric modifications are being done to improve the properties of the material. Tricyclodecane dimethanol diacrylate (TCDDMDA) monomer has been recently identified and experimented as a comonomer with methyl methacrylate (MMA). Aim: This study aimed to investigate the histocompatibility of TCDDMDA comonomer in polymerized resin at 10% and 20% (vol/vol) concentrations in rats by histomorphometric analysis. Materials and Methods: Twenty-four male Wistar rats were randomly divided into the following four groups: NP group (control; n = 6), with no palatal appliance, Groups P0, P10, and P20 were fixed with palatal appliances fabricated of 100% MMA, 10% TCDDMDA + 90% MMA, and 20% TCDDMDA + 80% MMA, respectively. Weights of the animals were recorded just before the appliance placement and after 14 days. The animals were sacrificed, and the palatal tissues were processed for histopathological analysis. Histomorphometric parameters assessed were total epithelial (ET), connective tissue (CT), and keratin layer (KT) thicknesses. Results: No significant difference was observed regarding body weight. Group P0 showed increased ET, CT, and KT when compared to other groups. Bonferroni multiple comparison tests showed a statistically significant difference between all the groups except between P10 and P20 for all the three morphometric parameters. Conclusion: Palatal appliances with TCDDMDA comonomer showed good histocompatibility in rats up to 20% (vol/vol) concentration.
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Prevalence and pattern of impacted mandibular third molar: An institution-based retrospective study p. 462
Sundarrajan KalaiSelvan, Sappaniapillai Kathiresan Nithya Ganesh, Pughalaendhi Natesh, Murugesan Senthil Moorthy, Thanvir Mohamed Niazi, Sitharaju Santhosh Babu
DOI:10.4103/jpbs.JPBS_140_20  
Introduction: The third molar is the most frequently impacted tooth with a frequency of occurrence generally reported to be from 18 to 32%. It is considered impacted when its eruption into normal functional occlusion has been interfered with by other teeth, overlying bone or soft tissue and when it is not fully erupted by its expected age of around 20 years. Racial differences affect the pattern of impaction. There is a lacunae of literature on the pattern of mandibular third molar impaction in Tamil population. Aim: To investigate the prevalence of pattern of third molar impaction among the population in Madurai. Materials and Methods: A retrospective cohort study was conducted. The first 1000 OPGs (Orthopantamograms) were taken at the Department of Oral Medicine and Radiology, CSI College of Dental Sciences and Research from August to December 2018 of Madurai population aged between 20 and 40 years old. Data include angle, level and position of impaction, proximity to inferior alveolar nerve and dental caries in second molar and/or third molar. Results: The average age of subject with mandibular third molar impaction is 30.5 years. The most common occurring mandibular impaction is mesioanglar (60%), Level A (71%), Class II (50%) without involving the inferior alveolar nerve (33%) and dental caries in 20% of second and/ or third molar. Conclusion: Mandibular third molar impactions are one of the common developmental condition in this modern civilization. Assessing the third molar and prognosis of its eruption is mandatory for better patient management because of numerous complications associated with unerupted third molar.
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Retrospective analysis of oral and maxillofacial biopsies: An institutional study p. 468
Gurunathan Ulaganathan, Sitharaju Santhosh Babu, Murugesan Senthilmoorthy, Varun Prasad, Sundarrajan Kalaiselvan, Ramasamy Subramanian Asok Kumar
DOI:10.4103/jpbs.JPBS_141_20  
Aim: To determine the preponderance and the distribution of pathological lesions in oral and maxillofacial region reported in and around the Madurai city. Study Design: Retrospective study on the oral and maxillofacial biopsies taken during 11 years period from 2007 to 2018 in a CSI Dental College, Madurai, Tamilnadu. A total of 1000 cases were analyzed and 904 were selected. The parameters recorded were age, sex, area, and the histopathological report obtained. Descriptive statistics was used for analysis. Result: The most common soft tissue lesion was traumatic fibroma (16.1%) and the prevalent hard tissue lesion was periapical cyst (12.7%). The more common oral malignant tumour observed was squamous cell carcinoma (7.3%) and benign tumor was ameloblastoma (5.3%). The frequently affected sites were mandible (36.1%) and buccal mucosa (19.8%). There was more predilection among male than females. The frequency of lesion is common in age group of 31-60 years. A considerable similarity was observed between age, type of lesion and its location. Conclusions: This study evaluated chronic periapical lesions were the most common hard tissue lesions and fibromas in soft tissue category. The idea of this histopathological study concludes on the requirement for biopsy to rule out type of the lesion and its severity to start up the earlier management.
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Prevalence and pattern of adult maxillofacial injuries: An institution-based retrospective study p. 472
Thanvir Mohamed Niazi, Asok Kumar Ramasamy Subramanian, Cathrine Diana, Natesh Pughalaendhi, Ulaganathan Gurunathan, Nithya Ganesh Sappaniapillai Kathiresan
DOI:10.4103/jpbs.JPBS_142_20  
Introduction: Maxillofacial injuries are more prevalent in road traffic accidents (RTAs). The incidence of RTAs tends to vary with geographical location, socioeconomic status, religion etc. Aim: The main aim of this study is to determine the pattern and prevalence of maxillofacial injuries reported to our institution. Materials and Methods: Data were obtained from medical records of the patients from January 2007 to December 2017 reported in CSI College of Dental Sciences and Research, Madurai, Tamil Nadu were retrieved and analyzed. Data include age, gender, etiology, site of injury, anatomical site associated injuries and their management were recorded and analyzed with STATA software version 14 (StataCorp LLC, College Station, TX, USA). Results: Maxillofacial injuries occur more commonly in 2nd and 3rd decade (40.44%) with mean age of 32.58 ± 11.15 years. RTA (77.21%) and alcohol influence (51%) were considered as the most common cause of maxillofacial injuries and was statistically significant. Mandible (44.85%) was most commonly involved and 62.5% required a surgical intervention. Conclusion: RTA with mandibular fracture is predominant in men between the age group of 20-30 years. Expansion in road network, increase in motorization, alcohol consumption and urbanization in developing countries had accompanied with rise in RTAs. Thus the use of safety devices and educating people by conducting preventive camps about traffic rules will reduce the number of RTA.
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Influence of aerated drink, mouthwash, and simulated gastric acid on the surface roughness of dental ceramics: A comparative In Vitro study p. 480
Tehseen Zakir, Savita Dandekeri, Karkala S Suhaim, Naresh H G Shetty, Mallikarjuna Ragher, Sanath K Shetty
DOI:10.4103/jpbs.JPBS_143_20  
Background: Dental ceramics are known for their natural appearance and their durable chemical and optical properties, and their uses mainly reflect their excellent aesthetic properties, biocompatibility and resistance to wear. In addition, dental ceramics are considered to be chemically inert restorative material with large differences in the chemical compositions and microstructures. Although ceramics exhibit excellent physical properties and biocompatibility, the oral environment presents a series of external factors that affect its physical and mechanical properties in its long term function. Aims and Objectives: The aim of this study is to compare and evaluate the surface roughness of 2 dental ceramics (Noritake® & IPS Emax ceram) before and after exposure to an aerated drink, a mouthwash and simulated vomit solution with distilled water. Materials and Methods: 128 ceramic discs were made, 16 for each of the 4 groups of 2 ceramics to be tested. It was fabricated in the form of discs of diameter 10 mm × 2 mm thickness. The test specimens were calibrated by grinding, using a medium grit diamond bur. Both the above specimens were divided into 4 groups of 16 each. They were then subjected to test solutions. Each specimen in a group was immersed in the following solutions: Coca-Cola, chlorhexidine mouthwash, simulated vomit solution and distilled water. Results: The results analyzed statistically using one way ANOVA (analysis of variance), paired t test and independent t test. Conclusion: Within the limitations of this study, it was concluded that the surface roughness of the evaluated ceramics increased upon exposure to Coca-Cola, chlorhexidine mouthwash and simulated vomit solution. Simulated vomit solution caused the maximum change in surface roughness followed by coca cola and then chlorhexidine mouthwash. No changes were observed after immersion in distilled water. Noritake® showed slightly more resistance to change in surface profile when compared to IPS e.max.
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Hearing assessment of dental personnel: A cross-sectional exploratory study p. 488
Rajesh Shetty, Shifa Shoukath, Sanath K Shetty, Savita Dandekeri, Naresh H G Shetty, Mallikarjuna Ragher
DOI:10.4103/jpbs.JPBS_145_20  
Aim: Dental professionals are prone to have hearing impairment due to prolonged exposure of noise in dental college. The aim of the study was to assess the hearing ability of dental personnel working in Yenepoya Deemed to be University, Mangaluru, Karnataka, India. Materials and Methods: A cross-sectional exploratory study was conducted on 60 subjects (30 male and 30 female). Audiometric analysis was carried out using pure-tone audiometry (PTA) and otoacoustic emission test (OAE). Statistical Analysis: Data were calculated and analyzed using two-way analysis of variance and Tukey’s honestly significant difference test. Results: No statistically significant difference was observed between hearing loss and its association with age, gender, working experience, mean daily working time, and specialization. PTA results showed a statistically significant hearing loss in the left ear, showing a dip at frequency of 4000 Hz among working experience group of 11–15 years and at 6000 Hz for 21–25 years. Also, a statistically significant hearing loss was observed in the left ear at 6000 and 8000 Hz for the age-group of 51–55 years. OAE results were consistent with PTA findings. Conclusion: Dentists and dental personnel are at a higher risk of noise-induced hearing loss. As the working experience increases, the threshold shift is seen to shift from 4000 to 6000 Hz, which is indicative of sensorineural hearing loss due to noise-induced dental environment.
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A novel design modification to improve flexural strength of zirconia framework: A comparative experimental in vitro study p. 495
Rajesh Shetty, Shifa Shoukath, Naresh H G Shetty, Sanath K Shetty, Savita Dandekeri, Mallikarjuna Ragher
DOI:10.4103/jpbs.JPBS_146_20  
Aim: Zirconia-based restoration is successfully replacing metal ceramic restorations in posterior areas. Although higher mechanical properties of zirconia, their use in compromised situation is questionable. Hence, there is a need to modify the design which to strengthen the framework. The aim of this in vitro study was to evaluate the influence of lingual collar design on the flexural strength of CAD/CAM-fabricated posterior three-unit zirconia framework. Materials and Methods: A mandibular metallic stainless steel master mold is designed for a three-unit fixed partial denture framework. All CAD-milled 20 samples are divided into two groups based on the design. Group A––with collar (10 samples) and Group B––without collar (10 samples), tested using universal testing machine to calculate the mean fracture load and flexural strength. Statistical Analysis Used: Descriptive statistics and independent sample t test were used to find the difference between the groups, and simple linear regression was used to find the relationship between load and displacement between the groups. Results: The result of the mean flexural strength for Group A was 11328.06 ± 3770MPa and for Group B was 7633.95 ± 3196 MPa; the mean fracture strength observed for Group A was 1274.04 ± 424 MPa and for Group B was 858.80 ± 359 MPa. A statistically significant difference was observed in flexural strength between Groups A and B (P < 0.05). Conclusion: Zirconia framework with connector dimension of 7 mm2 with lingual collar design can be successfully incorporated in compromised situation where an ideal connector dimension of 9 mm2 cannot be placed.
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Comparison of the bond strength of composite resin to zirconia and composite resin to polyether ether ketone: An in vitro study p. 504
Hasan Sarfaraz, Mohammed N Rasheed, Sanath K Shetty, Uma M Prabhu, Kevin Fernandes, Smrithi Mohandas
DOI:10.4103/jpbs.JPBS_147_20  
Aim: The aim of the study was to compare the shear bond strength of composite resin bonded to polyether ether ketone (PEEK) and zirconia, and also to evaluate the effect of thermocycling on the shear bond strength. Materials and Methods: A total of 22 zirconia (Group 1) and 22 PEEK (Group 2) specimens (disks of 10 mm in diameter and 10 mm in thickness) were machine milled using computer-aided design (CAD)/computer-aided manufacturing (CAM) from commercially available zirconia and PEEK. These specimens were air abraded with 110-μm aluminum oxide. Following which these two groups were subdivided into four groups, that is, Group 1A: 11 zirconia specimens before thermocycling, Group 1B: 11 zirconia specimens after thermocycling, Group 2A: 11 PEEK specimens before thermocycling, and Group 2B: 11 PEEK specimens after thermocycling. These four groups of specimens were embedded in an acrylic block, and bonding agent was applied over the upper surfaces of the disks of each of these specimens. Composite resin was then cured, and then Group 1B and group 2B were thermocycled under a standard temperature. The bond strength of the specimen was tested using universal testing machine. Result: The result showed that there was no significant difference in shear bond strength between the groups, although higher shear bond strength was observed in the PEEK group. Conclusion: Shear bond strength of PEEK is similar to zirconia. The results suggest that the pretreatment method and primers used were effective in improving the bonding of resin cements to zirconia ceramic and the bonding properties of the veneering resin to the PEEK surface.
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A study to assess the bond strength of acrylic teeth with different retentive features p. 510
Savita Dandekeri, Smrithi Mohandas, Sanath K Shetty, Mallikarjuna Ragher, Mohammed Rasheed, Nikhil Raj
DOI:10.4103/jpbs.JPBS_148_20  
Background and Aim: Flexible denture base has been gaining attention as a denture base material because of its toxicological safety, comfort, and enhanced aesthetics. Debonding of acrylic teeth from the flexible denture base material has posed a great problem to the clinician and patient. This study aimed at comparing the bond strength between flexible denture base with acrylic teeth having different mechanical modifications. Materials and Methods: Forty mandibular molar teeth (Combination Acry Rock, Badia Polesine (Ro), Italy) were used in four groups for mechanical modifications on the ridge lap area. The groups were group 1 (no mechanical modifications), group 2 (round groove 2 mm in diameter and 2 mm deep on the ridge lap surface), group 3 (horizontal slot 2 mm deep, 2 mm wide, and 4 mm long prepared on the ridge lap surface of the teeth), and group 4 (T-shaped groove 2 mm deep, 2 mm wide, and length of 4 mm mesiodistally and 2 mm buccolingually prepared with a straight fissure bur). The acrylic teeth were attached to a wax block of dimension 1.2cm × 1.2cm × 2.5cm. These were flasked and dewaxed, followed by injection molding with Valplast flexible denture base material. The bond strength was assessed by attaching the specimens to universal testing machine tested under a tensile load at a cross-head speed of 1 mm/min till it fractured. Data obtained were statistically evaluated by one-way analysis of variance and post hoc test. Results: There was significant increase in mean bond strength after various mechanical modifications. Group with T-shaped diatoric hole showed greatest bond strength value compared to other groups. Conclusion: Incorporating mechanical retentive features with increased surface area and undercut can improve the bonding of acrylic teeth to flexible denture base.
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Influence of different zirconia coping designs on the fracture resistance of all-ceramic crowns: An in vitro study p. 517
Sanath K Shetty, Tharammal Fayaz, Mohammed Zahid, Karkala S Suhaim, Mallikarjun Ragher, Mohammed S Hasan
DOI:10.4103/jpbs.JPBS_149_20  
Background and Aim: Increased demand for metal-free restorations in posterior areas has increased the focus on zirconia restorations because of its advantages in excellent mechanical properties, patient comfort, and acceptance. Although all-ceramic crowns have better biocompatibility and esthetic properties, there are some clinical reasons for the fracture of the veneer or the core materials in the posterior region. This study aims at comparing the influence of zirconia coping designs on the fracture resistance of all-ceramic crowns. Materials and Methods: A total of 32 zirconia copings (n = 8 for each group) were designed and fabricated based on the marginal collar height of zirconia coping. The groups were the following: Group 1: 0.0 mm zirconia coping; Group 2: 0.5 mm collar; Group 3: 1.0 mm collar; and Group 4: 1.5 mm collar. All these zirconia copings were veneered with porcelain. Master die with cemented ceramic-layered zirconia copings was tested using Universal testing machine. Data obtained were statistically evaluated by one-way analysis of variance and post hoc test. Results: There was statistically significant difference between the groups with P < 0.001. Group 4 has the highest strength (3318.89 ± 395.67) followed by Group 3 (2910.0 ± 219.22), then Group 1 (2320.02 ± 547.36) that is the control group and the least strength with Group 2 (2286.59 ± 496.66). Conclusion: On the basis of the results obtained from this study, it can be concluded that, the more the height of the zirconia collar, the higher the fracture strength of the all-ceramic crowns. Thus ceramic-layered zirconia coping design with 1.5 mm marginal collar height is recommended for functional long life, at least in the posterior higher load-bearing areas with lesser esthetic demands.
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Evaluation of fracture resistance and color stability of crowns obtained by layering composite over zirconia and polyetheretherketone copings before and after thermocycling to simulate oral environment: An in vitro study p. 523
Sanath K Shetty, Mohammed Shabbir Hasan, Mohammed Zahid, Karkala S Suhaim, Fahad Mohammad, T Fayaz
DOI:10.4103/jpbs.JPBS_150_20  
Background: Most common material used for the fabrication of an implant restoration is full-ceramic crown or an all-ceramic crown. Frequent chipping of the ceramic under occlusal load has posed a great problem to the clinician and the patient. Composites have been layered over zirconia successfully in the recent past to overcome this problem. This study, thus, aimed to evaluate and compare the fracture resistance and color stability of crowns obtained by layering composite over zirconia and polyetheretherketone (PEEK) copings before and after thermocycling to simulate oral environment. Materials and Methods: A total of 40 crowns (20 per group) were obtained by layering composite of A3 shade over computer-aided design/computer-aided milling milled zirconia and PEEK copings. Thermocycling of the 10 out of the 20 crowns was performed in a thermocycler (5000 cycles, in water temperature of 5°C and 55°C with dwell time of 30s), and then they were kept in hot and cold beverages for 24h each, to simulate oral environmental conditions. After thermocycling, the crowns were divided into four groups of 10 samples each: Group Z, ZT, P, and PT. Shade evaluation of all the crowns was performed using digital shade guide (VITA Easyshade® Advance; VITA Zahnfabrik, Bad Säckingen, Germany) and VITAPAN classical (VITA Zahnfabrik). Fracture strength was tested for all the crowns in a universal testing machine. Fracture strength in megapascal and the applied occlusal load in kilograms were recorded. Data obtained were statistically evaluated by one-way analysis of variance and post hoc test. Results: The final shade of the crowns obtained by layering A3 shade composite in the groups Z was A3, ZT was B3, P was C3, and PT was D2. The value of mean fracture strength of crowns of groups Z was 1142.3 MPa, ZT was 1034.57 MPa, P was 2134.64 MPa, and PT was 1765.01 MPa. Conclusion: Thermocycling affected the shade of all the crowns. The mean fracture strength of the crowns having PEEK copings was significantly higher than that of zirconia copings. Thermocycling did not have a significant effect on the mean fracture strength.
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A comparative study of the effect of different disinfectant solutions on the compressive strength of type III gypsum p. 530
Anthony K Fernandes, Vidhya Bhat, Muraleedhara Bhat, Subramanya Shetty, Shakkira M Kutty, Abdul Malik
DOI:10.4103/jpbs.JPBS_151_20  
Aim: To investigate and compare the effect on compressive strength after incorporation of disinfecting solutions (sodium hypochlorite and povidone iodine) to commonly available type III dental stone. Materials and Methods: A total of 90 dental stone samples of 20 × 40 mm were made. The standardized samples were fabricated according to the ADA specification no. 25 using custommade silicon mould and divided into 3 groups. Group A, type III gypsum was incorporated into distilled water; Group B, sodium hypochlorite (3%) was incorporated into distilled water in the ratio of 1:10 concentration according to ADA specification; and Group C, povidone iodine (3%) was incorporated into distilled water. The mix was carefully vibrated into the silicone mould and allowed to set. The specimens were subjected to compressive load after 1 and 24 h from the time of mixing using an Universal Instron testing machine. The result obtained were tabulated and subjected to statistical analysis using twoway analysis of variance tests. Results: This study showed that incorporating the disinfecting solutions like sodium hypochlorite and povidone iodine decreases the compressive strength of type III dental stone. The effect of decreasing compressive strength on type III gypsum product is seen more in povidone iodine when compared to sodium hypochlorite disinfecting solution. Conclusion: Incorporation of sodium hypochlorite and povidone iodine disinfecting solutions is not an encouraging method as it reduces the compressive strength of type III gypsum product.
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The efficacy and adverse events of delafloxacin for treating acute bacterial skin and skin structure infections: A systematic review and meta-analysis p. 538
Syed Bilal Tanvir, Syed Saad Bin Qasim, Joe Latimer, Zeeshan Qamar, Fayez Hussain Niazi
DOI:10.4103/jpbs.JPBS_154_20  
Background: Acute bacterial skin and skin structure infections (ABSSSI) cause significant morbidity and mortality in hospitalized patients and outpatients as well. Newer fluoroquinolones such as delafloxacin might be a useful medication for treating infections of skin caused by gram-positive bacterial species that are resistant. Aims and Objectives: The aim of this study was to evaluate all the literature on delafloxacin in databases and make comparisons of its efficacy with antimicrobial drugs routinely used to treat skin infections. Materials and Methods: A detailed search on different databases was conducted using, Cochrane Central Register of Controlled Trials, PubMed, and Embase. Primary outcome was microbiological cure at the end of the follow-up period. Absence of the signs and symptoms at the termination of the follow-up period and clinical response to medications was regarded as the secondary outcome. Results: The pooled efficacy of delafloxacin was at 80% (95% confidence interval 1.01 [0.97, 1.06]; P = 0.51). No statistically significant difference was found between intravenous delafloxacin and comparator drugs. Conclusion: The effectiveness of delafloxacin was found to be non-inferior to tigecycline and linezolid. Efficacy and pooled cure rate of delafloxacin was also found to be superior to vancomycin.
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Prevalence of dental caries in adult south Indian population in association with dietary pattern: A comparative study p. 546
Druvan Kavitha, Anju Varghese, Singh Prabath, Rayar Sreeram, Joseph Asha, Arjun B Ravi
DOI:10.4103/jpbs.JPBS_155_20  
Background: Dental caries is considered to be one of the most prevalent dental diseases among humans. It involves cycles of demineralization and remineralization. The etiology and pathogenesis of dental caries are multifactorial. The role of diet plays an important aspect in occurrence and progression of dental caries. Indians have differing dietary habits due to various religious and personal reasons. A substantial number of Indians are vegetarian by choice. Aim: The aim of this study was to assess the effect of vegetarian and mixed diet over the prevalence of dental caries. Materials and Methods: This observational cross-sectional study was conducted among 104 individuals. Healthy subjects who were 20–40 years of age, with no systemic disease, and not on any medications were included in this study. A thorough dental examination was performed by a single investigator with the help of mouth mirror and probe. The examination of patients involved the sequential assessment of teeth starting from 1 to 32. All the exposed and accessible surfaces of the teeth were examined for dental caries, and the data were recorded. Statistical Analysis: The data obtained were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) software, version 11.0, and the results were tabulated. Univariate analysis was performed to find an association between caries and diet. Results: Distribution of the respondents according to dietary practices revealed 51% of the population consuming mixed diet and 49% consuming vegetarian diet. Oral hygiene was measured in terms of frequency of brushing tooth. Among the enrolled subjects, 57% brushed their teeth once a day and 42% brushed twice a day. No significant association was found between vegetarian and mixed dietary habits and dental caries. Two-sample independent t test was carried out to find the mean age. The mean age of caries group was 30.93 ± 12.27 and in without caries group, 27.83 ± 11.58, which is statistically not significant (P = 0.218). Conclusion: The study did not show any significant association between dietary habits and prevalence of dental caries.
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Validation of self-reported periodontal disease status among subjects seeking dental treatment in a dental school p. 550
Khalid Gufran, Mohammed Alasqah, Sultan Almalki, Yousef Alkhaibari, Yazeed Alghamdi, Tariq Z Aljulify
DOI:10.4103/jpbs.JPBS_157_20  
Introduction: Periodontal disease and its relation with quality of life have made it necessary to know in detail regarding the disease. Hence, the aim of this study was to check the validity of self-reported periodontal status with clinical findings among subjects attending a dental teaching institution. Materials and Methods: A cross-sectional study was conducted on subjects with periodontitis attending a dental teaching institution. A questionnaire was developed after reviewing the relevant literature and participants were asked to complete the questionnaire. Information about signs and symptoms of periodontal disease was included, and subjects were examined for periodontal disease. Data were recorded and analyzed for sensitivity and specificity. Result: A total of 103 subjects answered the study questionnaire and underwent clinical examination. The sensitivity of question varied from 16.6% with need of periodontal or gum treatment to 57.1% in case of gingival swelling. In many questions, more than 90% of specificity was found. There was a difference in self-assessed periodontal status with clinically examined periodontal status. Conclusion: Self-assessed questionnaires were of low value in evaluating oral periodontal disease status. Periodontal perception of subjects was higher but does not reflect with clinical findings; this calls for educational programs to be conducted to improve knowledge and awareness about periodontal diseases.
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Comparative study on fracture resistance of endodontically treated tooth in relation to variable ferrule heights using custom-made and prefabricated post and core: An in vitro study p. 554
Singaravelu Suresh Kumar, Mani Viswanathan, Krishnan Rajkumar, Chinnappan Marudhamani, V Shanmugam Rajaganeshan, K Antony Biju
DOI:10.4103/jpbs.JPBS_166_20  
Introduction: Endodontically treated teeth have significantly differentphysical properties compared to vital teeth. To ensure functional longevity,endodontically treated teeth must have at least 5 mm of tooth structure coronalto the crestal bone, 2 mm of coronal tooth structure incisal to the preparationfinish line are necessary to ensure functional integrity. Aim and Objectives: To evaluate fracture resistance of endodontically treated teeth restored withcustom cast post, custom cast post with variable ferrule height and teethwithout ferrule, prefabricated post with variable ferrule height and teethwithout ferrule. To compare fracture resistance of teeth restored with customcast post and prefabricated post with variable ferrule heights. Materials and Methods: Methodology includes selection of teeth, root canal preparation,post space preparation, grouping of samples, Group A�custom cast post andcore with sub groups of variable ferrule height, pattern fabrication, Group A- pattern fabrication for customized cast post. Group B�pattern fabricationfor prefabricated post and core, investing and casting, cementation, custommade acrylic jig preparation, testing of specimens. Results: The differencein the fracture load between the samples of Group A was highly significantat the 0.001 level. Subgroup A4 had highest fracture resistance while GroupA, possessed the least fracture resistance. Subgroups A2, A3 had fractureresistance value intermediate between A1, A4. Conclusion: Increasing theferrule height significantly increases (P < 0.001) the fracture resistance ofendodontically treated teeth restored with both custom made cast post andcore and prefabricated post with metal core. Comparatively the custom madecast post and core with variable ferrule height, especially 2 mm ferrule showedsignificant fracture resistance than prefabricated post with metal core. Thepresence of 2 mm ferrule height significantly increases (P < 0.001).
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Bone sparing effects of bisphosphonates in cyclosporine-induced alveolar bone loss: An animal study p. 560
Sneha R Bhat, Rajanna Shwetha, Vinita A Boloor, Shravan R Kini, Aravind R Kudva
DOI:10.4103/jpbs.JPBS_171_20  
Various pharmacological agents are known to create an imbalance in the normal physiology of bone remodeling. Cyclosporine-A (Cs-A) is one of the drugs that is widely used in transplantation and has its main side effect as gingival hyperplasia and alveolar bone loss by their action on the inflammatory mediators. Bisphosphonates are a new class of drugs that inhibit bone resorption by decreasing the osteoclast activity and number. The aim of this study was to evaluate the effect of concomitant administration of alendronate on Cs-A-induced alveolar bone loss in a rat model.
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A study to determine and compare dimorphic trait of mandibular canine between Gujarati and non-Gujarati populations p. 564
Himanshu Shrivastava, Nidhi M Shah, Rumiya Aysha, Mitul Shah, Nareen Chakravarthy, Santosh R Duliganti
DOI:10.4103/jpbs.JPBS_175_20  
Introduction: Among all teeth, mandibular canine shows greatest variation in dimensions between the sexes, a phenomenon known as sexual dimorphism. This can be immensely beneficial to the forensic investigator for the purposes of both investigation and identification, as it significantly narrows down the possibilities, as the probable perpetrators and/or victims are concerned. Sex identification is an absolute necessity in cases of suicide, homicide, mass, casualties (both manmade or natural), and a tooth, which shows obvious sexual dimorphism can be a useful means of personal identification, especially where there has been extensive decomposition or destruction of facial soft tissue features. Another facet of forensic investigation is identification of racial origin. So, any odontometric parameter showing significant racial divergence can be used as a means of identification. Aim and Objective: The aim of this study was to determine and compare cervico-incisal heights and mesiodistal widths of both mandibular canines of the Gujarati and non-Gujarati subjects under study. Materials and Methods: The study sample involved 100 participants, divided into four groups, each of the four groups included 25 participants, representing Gujarati males, Gujarati females, non-Gujarati males, and non-Gujarati females, respectively. Results: When we compared the mesiodistal and cervico-incisal dimensions of the mandibular canine, both right and left, Gujarati males were found to possess significantly larger sized teeth in comparison to their female counterparts, and the same results were replicated for non-Gujarati males vis-a-vis their female counterparts. Non-Gujarati males and non-Gujarati females were found to have significantly higher odontometric values in comparison with their Gujarati counterparts. Conclusion: Gujaratis have smaller sized mandibular canine in comparison with non-Gujaratis. However, studies comparing specific groups are required, as non-Gujaratis are a diverse racial group.
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Immunohistochemical detection of nerve growth factor (NGF) in follicular and plexiform ameloblastoma – A novel study p. 569
Thuckanickenpalayam Ragunathan Yoithapprabhunath, Seeni Renugadevi, Nalliappan Ganapathy, Janardhanam Dineshshankar, Andamuthu Yamunadevi, Ramadas Madhavan Nirmal
DOI:10.4103/jpbs.JPBS_185_20  
Background: Ameloblastoma is the second most common odontogenic tumor that holds a unique position among benign tumors due to its locally destructive and invasive nature. The differed tumor biology behind follicular and plexiform ameloblastoma is always an enigma. Nerve growth factor (NGF), a neurotrophin that plays a major role during odontogenesis, could also possibly play a role in the pathogenesis of odontogenic tumors such as ameloblastoma. With this background, the study was aimed to investigate the expression of NGF in follicular and plexiform ameloblastoma. Objectives: The objectives of this study were to analyze the immunohistochemical expression pattern of NGF in ameloblastoma and to compare the immunohistochemical expression pattern of NGF among the follicular and plexiform histological types of ameloblastoma. Materials and Methods: Forty histological sections of ameloblastomas (20 follicular and 20 plexiform) were stained immunohistochemically with anti-human NGF mouse IgG monoclonal antibody and the staining was analyzed statistically. Results: Almost all the 40 ameloblastoma samples (20 follicular and 20 plexiform) showed positive immunoreactivity to NGF. Both peripheral pre-ameloblast-like tall columnar cells and central stellate-reticulum-like cells showed positive reactivity. The pattern of staining was membranous in the immunoreactive cells. The χ2 value for the immunoexpression between follicular and plexiform ameloblastoma was statistically significant with a P value <0.002. A possible mechanism has been proposed after studying the results with the downstream pathways obtained from literature. Conclusion: The pattern of expression of NGF is seen in both follicular and plexiform ameloblastoma. But the intensity is more in plexiform than that of follicular ameloblastoma.
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A comparative evaluation of phytic acid as final rinse solution with other chelating agents for elimination of intraradicular smear: A scanning electron microscope study p. 576
Shrimanikandan Ayappa Gandhi, Preetha Chandrasekar, Jayaprakash Nachimuthu, Chris S Abraham, Karunakaran Jeyaraman Venkataraman
DOI:10.4103/jpbs.JPBS_186_20  
Aim: The aim of this study was to compare radicular smear layer removal ability of different solutions of phytic acid (PA) with other chelating agents when used in specific irrigant protocols. Materials and Methods: Seventy four maxillary central incisors were collected, standardized, and canals were prepared. A total of 5% sodium hypochlorite was used as the initial rinse solution (8 mL). Samples were divided into control (Group I—normal saline and II—7% ethylenediaminetetraacetic acid) and experimental groups (Group III, IV, V, VI, VII, and VIII) based on the type of final rinse solution used, that is, 5% PA, 10% PA, 17% PA, 5% citric acid (CA), 10% CA, and 17% CA (5 mL). Samples were coded, buccolingually divided into two halves, dehydrated, mounted, splutter coated, and examined under scanning electron microscope. Results: Group IV had the least smear and debris in coronal, middle, and apical thirds with mean scores of 1.06 and 1.3, respectively. When compared with Group II, no statistically significant difference was found (P > 0.05). Overall, the Group III had the lowest erosion scores at apical, middle, and coronal one-third with a mean of 1.68. Group VII had the highest amount of erosion with loss of peritubular and intertubular dentin at all levels. Conclusion: The role of PA as final rinse solution for the removal of radicular smear is promising and comparable to other chelating agents.
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Fracture resistance of titanium, chrome–cobalt, and gold alloy as post and core materials: A comparative evaluation p. 583
Karunakaran Jeyaraman Venkataraman, Sathya Thanapathi, Sathyanarayanan Balasubramanian, Shrimanikandan Ayappa Gandhi, Anagha Chandrasekharan Sarojinikutty
DOI:10.4103/jpbs.JPBS_205_20  
Aim: This study aimed to comparatively evaluate the fracture resistance of different metallic post and core materials. Materials and Methods: Twenty-four maxillary–central incisors were selected, standardized, and segregated into three groups (GP I–III) (n = 8) based on the type of alloy used for post and core preparation. GP I (gold alloy [Au]), GP II (chrome–cobalt alloy [Co–Cr]), and GP III (titanium alloy [Ti]) were comparatively evaluated for use as post and core materials. The teeth were endodontically treated and tooth preparation for post core was done.Metal post and cores were fabricated using indirect wax pattern and luted. Teeth were mounted on resin bases, fracture testing was done, and type of fractures were analyzed. Results: Mesiodistal type of fracture was the most common among experimental groups with a percentage incidence of 54.20%. The comminuted type of fracture was the next most common with a percentage incidence of 29.2%. The incidence of buccolingual, transverse, and other type of fracture was not common and had a percentage incidence of 29.2%, 4.2%, 8.3% and 4.2% respectively. Group II had the highest fracture resistance with a mean value of 742.89N. Group III and Group I had mean values of 482.33 and 361.1123N. Statistically significant difference between experimental groups (I and II) and (II and III) was observed in load values of root fracture (P < 0.05). Conclusion: On the basis of the protocols used and limitations of this study, among metallic post and core materials tested, GP II had the highest fracture resistance values. Further evaluation of these different post and core systems, new alloy formulations designed specifically for use as post and core materials, and assessment in a clinical setting is recommended.
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Efficacy of Psidium guajava and Allium sativum extracts as antimicrobial agents against periodontal pathogens p. 589
Sunaina Shetty, Raghavendra M Shetty, Betul Rahman, Venkataramana Vannala, Vijay Desai, Shishir R Shetty
DOI:10.4103/jpbs.JPBS_206_20  
Background: The accumulation and maturation of bacterial plaque at the gingival margin is widely recognized as the primary etiological factor in the development of chronic periodontitis. With the rise in bacterial resistance to antibiotics, there is considerable interest in the development of other classes of antimicrobials for the control of infection. Aim: The aim of this study was to evaluate the efficacy of Psidium guajava (guava) and Allium sativum (garlic) on Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.Materials and Methods: Aqueous guava extract (AGvE), ethanolic guava extract (EGvE), aqueous garlic extract (AGE), and ethanolic garlic extract (EGE) were prepared. The inhibitory effects of these extracts for the periodontal pathogens were tested by agar well diffusion method. Minimal inhibitory concentration (MIC) of the aqueous and ethanol extracts of guava and garlic was determined by macrobroth dilution method. Minimum bactericidal concentration (MBC) was done to observe the bactericidal effect of the guava and garlic extracts against the organisms. Results: Of the AGE, 25, 50, and 75 μL showed 16, 20, and 25 mm zone of inhibition, respectively, on P. gingivalis. The AGE showed greater bacteriostatic activity against the P. gingivalis with MIC determined at 16.6 μL/mL. MIC determined for AGvE and EGvE was at 75 μL/mL concentration for P. gingivalis, whereas EGvE showed the activity at 75 μL/mL on P. gingivalis. MIC determined for AGvE was at 50 μL/mL, whereas MIC determined for EGvE was at 3.12 μL/mL for A. actinomycetemcomitans.Conclusion: P. guajava and A. sativum displayed a significant antibacterial effect. A. sativum was found to be most effective against P. gingivalis, whereas P. guajava showed the highest efficacy on A. actinomycetemcomitans.
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Comparative evaluation of antimicrobial efficacy of toothpastes containing probiotic and neem as primary ingredient on salivary Streptococcus mutans in Melmaruvathur population: An in vivo study p. 595
Karthikeyan Selvaraj, Nagareddy Bharath, Raghunathan Natarajan, Sridhar Dinesh, Sabari Murugesan, Saravanan Selvaraj
DOI:10.4103/jpbs.JPBS_209_20  
Aim: This in vivo study was designed to compare the antimicrobial effect of toothpastes containing probiotics and neem on Streptococcus mutans in 18–30-year-old patients in Melmaruvathur population. Materials and Methods: The study consisted of 60 patients who were randomly divided into two groups of 30 each. Group I received probiotic-based toothpaste (PerioBiotic), whereas Group II received neem-based toothpaste (Babool) as a preventive measure protocols to control the incidence and prevalence of dental caries. Study Design Protocols: Participants were instructed to use the dentifrice selected for the study, two times a day for 60 days. Tests were performed on the saliva samples at the beginning of the study, 0 day, 15th day, 30th day, and 60th day following the use of toothpaste. The Statistical Package for the Social Sciences (SPSS-25) software, version, and Chi-square and one-way analysis of variance were used for data analysis. Results: The toothpastes containing neem and probiotics as primary ingredients were efficient in reducing the number of bacterial count when comparing the baseline data with the 60 days data in both the groups as a therapeutic regimen. Intragroup values showed reduction in the number of bacterial count in both the groups in a gradual manner, whereas the intergroup values between the toothpaste showed no statistically significant difference in the bacterial count, and both toothpastes were efficient in reducing the bacterial count. Conclusion: This study reveals the influence of probiotics and neem on salivary S. mutans levels. The results revealed that neem-based and probiotic-based toothpaste, which were tested in this study, showed comparable antibacterial activity against the S. mutans. The neem-based toothpaste showed promising and good antimicrobial activity and reduced the level of bacterial count, which can be attributed to the presence of secondary metabolites, such as flavonoids, alkaloids, lectins, and polyphenols, as its active components. The effect of each component against the S. mutans needs to be quantified in further studies, and within the limitation of this short study, it can be considered as a better choice than commercially available toothpaste, which predominantly has chemicals as active ingredients, which in turn can compromise the safety aspects in the patients when used for controlling the dental caries for a longer duration.
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Root form and morphology of human permanent maxillary first premolars of an Indo-Dravidian population based in southern India: An in vitro study p. 601
Jeyaraman Venkataraman Karunakaran, Anbarasi Kaliyaperumal, Ragavendran Nagappan, Senthil Kumar Swaminathan, Kaneesh Karthik Arthanari, Leo Sujith Samuel
DOI:10.4103/jpbs.JPBS_212_20  
Aim: The aim of this study was to analyze root form and morphology of human maxillary first permanent premolars of an Indo-Dravidian population from southern India. Materials and Methods: Eight hundred and twenty-two maxillary first permanent premolars were cleansed and stored appropriately. Morphology and root form analysed, segregated into Groups (Gps): Gp I, Gp II, and Gp III, and later divided into subgroups (SGs) based on specific criteria. Gp I was divided into two SGs: SG A (minimal or absence of grooving in the root) (n = 252) and SG B (clear and defined longitudinal groove in the root) (n = 104), and Gp II was divided into SG C (roots dividing in coronal one-third) (n = 154), SG D (roots dividing in the middle one-third) (n = 158), and SG E (roots dividing in the apical one third) (n = 138). Gp III consisted of only one SG F (teeth with three roots) (n = 16). The groups were analyzed separately, their external root form and morphology were recorded. Root form was analyzed, and results were tabulated. This study was compared with other studies and statistically analyzed. Results: Gp II was common with an incidence of 54.74%. Gp I was the next most common with an incidence of 43.3%. Gp III was the least common with an incidence of 1.94%. The number and distribution of roots was also computed. Six types of root form were identified (Type [Ty] A = 30.65%, Ty B = 12.65%, Ty C = 18.73%, Ty D = 19.22%, Ty E = 16.78%, and Ty F = 1.94%). Conclusion: Awareness and assessment of root form, number preoperatively with regard to specific populations before initiation will pave way for successful outcome of therapy.
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Assessment of quality of platelet-rich plasma produced with desktop centrifuge and comparison with standardized commercially available Platelet-rich plasma p. 607
V Ramesh Srinivasan, M Rekha, Effie Edsor, S Pradheep Raja, T Dinesh Kumar, S Kalaiselvan
DOI:10.4103/jpbs.JPBS_163_20  
Aims: The aim of this study was to assess the quality of platelet-rich plasma (PRP) produced by in-house desktop centrifuge method and compare it with that of standardized commercial PRP. Materials and Methods: REMI desktop centrifuge was used to prepare PRP and to compare with standardized commercial PRP by calculating the quantity of platelets using Beckman Coulter cell counter in 10 PRP samples and assessing the morphological quality of platelets using JEOL JEM transmission electron microscope (TEM). Statistical Analysis Used: The t test for platelet count in desktop PRP with the test value of therapeutic PRP was 12.618. The P value was <0.001, which was significant statistically. The data followed a normal distribution in normal Q-Q plot for platelet count in desktop centrifuge. So the test samples were not much deviated. Results: The platelet count was lesser than that of standardized commercial PRP. When viewed under JEOL JEM transmission electron microscope, the α granules in platelets were intact and the morphological quality of the PRP was good. Conclusions: With this study, we have determined that the morphological quality of PRP produced by the in-house desktop centrifuge method is comparable to that of standardized commercial PRP. Though the quantity of platelets was less than 1 million cells/μL, the clinical results were good with desired bone formation, thereby providing good avenue for further research.
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Influence of periodontal infection as a possible risk factor for preterm low birth weight p. 613
Rajesh K Thakur, Bipin K Yadav, Rafat Sultana, Shakeb K Afridi, Debasmita Das, Sheetal K Sahoo
DOI:10.4103/jpbs.JPBS_73_20  
Background: There is emerging interest and increasing amount of evidence that support the interrelationship between periodontitis and systemic conditions. Epidemiological and microbiological–immunological studies have lent credence to the concept that periodontal disease may be a separate risk factor for cardiovascular disease, cerebrovascular disease, and respiratory disease, as well as preterm delivery of low-birth-weight infants. Aim: The aim of this study was to evaluate the influence of periodontal infection as a possible risk factor for preterm low birth weight (LBW) based on age, literacy, and hemoglobin level of mother. Materials and Methods: The observational study was conducted on 200 subjects, which were selected from the free labor ward, District Hospital, Saifai, Etawah, UP, India. Periodontal examinations were performed using the World Health Organization criteria. The periodontal status of the mother was recorded using Community Periodontal Index. Results: For this study, chi-square test was performed to know the effect of variables and to find out the statistical significance of the study. Age of mother shows statistical insignificant association with periodontal disease, whereas literacy of mothers showed statistical significant association with periodontal disease, and periodontal status and hemoglobin levels of the mothers also showed a significant association. Conclusion: The prevalence of LBW infants was considerably less in mothers with a healthy periodontium and increased with progressive periodontal disease.
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Oral health–related quality of life in children and adolescents of Indian population p. 619
Neeta Sinha, Daya Shankar, Vikas Vaibhav, Tarun Vyas, Anju Singh, Anuj Singh Parihar
DOI:10.4103/jpbs.JPBS_113_20  
Background: Kids and teenagers are more prone to oral diseases. Poor oral health has a significant impact on oral well-being–associated quality of life. Thus, we performed an investigation to examine the outcome of oral health status on the quality of life of children and adolescents in Indian population, by using the Oral Health Impact Profile-14 (OHIP-14). Materials and Methods: A total of 100 children, ranging between 1 and 19 years of age who attended Indian hospitals from November 2016 to October 2019, were included in the study. The DMFT Index (Decayed, Missing, and Filled Teeth) and OHIP-14 were used as data collection tools. Association of the total OHIP-14 score and seven subscales associated with it was evaluated using Spearman’s correlations. Results: The results showed statistically noteworthy association between the toothbrushing regularity, number of dental appointments, history of oral trauma, smoking, and subdomains of OHIP-14 (P < 0.05)Conclusion: Dental and oral health of an individual has a great impact on their quality of life.
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Biofriendly substitutes for xylene in deparaffinization p. 623
Viswanathan Prema, Harikrishnan Prasad, Kenniyan Kumar Srichinthu, Singaravelu Suresh Kumar, Krishnan Rajkumar, Chinnannan Marudhamani
DOI:10.4103/jpbs.JPBS_164_20  
Background: Xylene is an aromatic hydrocarbon that is routinely used in histopathological laboratories. It is biohazardous and produces many toxic effects like carcinogenesis. A safer substitute for xylene is necessary to minimize its usage. Aim: The aim of this study was to evaluate the effectiveness of 1.7% dishwashing solution, 95% lemon water, and 100% coconut oil when compared to xylene as a deparaffinizing agent during hematoxylin and eosin (H&E) staining. Materials and Methods: Fifteen paraffin-embedded tissue blocks were selected. Four sections were made from each block. One section was stained with conventional H&E method using xylene (group A) as deparaffinizing agent and other three sections were stained with xylene-free H&E method using 1.7% dishwashing solution (group B), 95% lemon water (group C), and 100% coconut oil (group D), respectively. Slides were scored blindly by a single pathologist considering the parameters such as nuclear and cytoplasmic staining; uniformity, clarity, and crispness of staining; and presence or absence of wax retention. Results: Adequate nuclear staining was noted in 100% of sections of groups A, B, C, and D (P < 0.001), whereas adequate cytoplasmic staining was noted in 93.33% each in groups A, C, and D when compared with 100% in group B (P > 0.05). Uniform staining was present in 80% of groups A and B and in 73.33% of groups C and D (P > 0.05). Clarity of staining was present in 86.66% of groups A and B and in 80% of groups C and D (P > 0.05), whereas crispness of staining was seen in 73.33% of groups A and D, 86.66% of group B, and 80% of group C (P > 0.05). Wax retention was noted in 20% of groups A and B, and 26.66% of groups C and D (P > 0.05). Adequate staining for diagnosis was noted in 100% of group A sections followed by 93.33% in group B, 86.66% in group C, and 80% in group D as compared with 90% in group B (P > 0.05). Conclusion: Dishwashing solution, lemon water, and coconut oil can be used as safer and cost-effective substitutes to xylene for deparaffinization in H&E staining procedure.
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CASE REPORTS Top

Hemisection—A challenge for perio-endo lesions: A case report p. 631
Kokila Ganesan, Manovijay Balagangadharan, Tamilselvi Sengoden, Bharathi Santhi, Menaka Vasudevan, YogeshKumar Thoppe Dhamodharan
DOI:10.4103/jpbs.JPBS_196_20  
The perio-endo lesions confront the clinician as far as diagnosis and prognosis of the affected teeth is concerned. Hemisection is the treatment choice for perio-endo lesions to preserve the remaining part of the molar having sound periodontium. It is a resection of periodontally involved root along with the associated crown portion. Prognosis and treatment of perio-endo lesions depend on the severity of bone loss, root trunk length, degree of root separation, curvature of root, ability to eradicate the osseous defect, and restorative and oral hygiene procedures. In this case report, root canal treatment and hemisection were successfully performed to treat advanced perio-endo lesions. By this way, natural tooth and surrounding structures were preserved and thereby cost was lesser than the other treatment alternatives.
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Multidisciplinary approach for the management of mandibular canines with rare configuration p. 635
Suraj Arora, Gurdeep Singh Gill, Anshad M Abdulla, Priyanka Saluja, Suheel M Baba, Shafait Ullah Khateeb, Sivadas Ganapathy
DOI:10.4103/jpbs.JPBS_82_20  
It is very rare (2%–6% cases) for a mandibular canine to have two root canals and the incidence of finding two roots with two root canals in a mandibular canine that too bilaterally is almost negligible. This case report discusses the presence and multidisciplinary management of such rarest configuration in both mandibular canines of a female patient. This case shows the importance of recognition of anatomical variations in successful accomplishment of root canal treatment.
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Osteoblastoma of mandible in child: A case report p. 640
Sudhir Gonuguntla, Ravikiran Nama, CN Vanajakshi, Sharan Reddy Mandadi, Jhansi Reddy Madireddy
DOI:10.4103/jpbs.JPBS_100_20  
Osteoblastoma is considered as a bone tumor, which is benign and arises from non-odontogenic epithelium. This condition is quite rare in children and very few cases of osteoblastoma are reported. The case report describes osteoblastoma affecting mandible in an 8-year-old boy. It was noticed that the lesion began to show gradual enlargement and was painful. An excisional biopsy was carried out. Histopathological examination revealed eosinophilic bony trabeculae, lined by osteoblasts, with osteocytes within lacunae. Intertwining connective tissue showed delicate collagen fibers, numerous vascular channels, and extravasated RBCs. It was finally diagnosed as osteoblastoma based on the features of clinical, histological, and radiographic appearance.
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Customized template for occlusal correction in full mouth rehabilitation: A case report p. 644
Tamizhesai Balavadivel, Venkateshwaran Rajendran, Karthik Ramakrishnan, Jeffin Jacob, Marion Sarah Philip, Nithiyarajan Nambirajan
DOI:10.4103/jpbs.JPBS_125_20  
Reestablishing the occlusal plane involves multidisciplinary approach with extensive restorative procedure to accomplish “equilibration.” Broadrick occlusal plane analyzer (BOPA) provides an easy and practical method to commensurate for curve of Spee and establishing the occlusal plane. Transferring the new occlusal plane from the diagnostic model to patients mouth needs to be precise. To achieve controlled conservative reduction, customized acrylic template was a vital tool used in this case to transfer the exact plane correction achieved by the BOPA.
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Gingival fenestration management: A rarefied case entity and literature review p. 648
Prem B Rajula M, Kalaivani Varatharajan, Rekha Mani, Shobana Krishnakumar
DOI:10.4103/jpbs.JPBS_77_20  
Dehiscence and fenestration are commonly confronted alveolar defects. But the combined mucosal and alveolar fenestration is uncommonly reported in the literature as they less often cause pain, and in majority of the cases, only aesthetic complaint is present. This article highlights the case report of a 28-year-old female patient who presented with aesthetic concern about gingival/mucosal fenestration in her right lower central incisor. She had a history of surgical endodontic treatment in the same tooth. In this case, mucosal fenestration was treated with regenerative therapy using bioactive glass with platelet-rich fibrin and free connective tissue graft. The treatment resulted in excellent aesthetic outcome and satisfactory bone healing.
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Root as a novel post and core material for primary teeth: A case report p. 652
Ramakrishna Ravi, Ragulakollu Rajesh, Ravikiran Nama, Gangasani Alankrutha, Rashmika Reddy Nallabolu, Rohit Singh
DOI:10.4103/jpbs.JPBS_128_20  
Early childhood caries is an aggressive type of caries leading to early loss of crown structure. Retention of post and core is important in restoring teeth where there is compromised coronal structure. This case report describes the use of root stumps of primary teeth as a post and core for primary teeth.
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