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   Table of Contents - Current issue
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April 2015
Volume 7 | Issue 5 (Supplement)
Page Nos. 1-318

Online since Thursday, April 30, 2015

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EDITORIAL  

JPBS editorial dental supplement 2015 Indian Academy of Dental Specialists India p. 1
K. M. K. Masthan
DOI:10.4103/0975-7406.155756  
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MEDICAL SCIENCE - RESEARCH ARTICLES Top

A clinical study of retinoblastoma p. 2
L Subha, Arun Subhash Reddy, Ramyaa
DOI:10.4103/0975-7406.155761  
Aim: The aim was to analyze general incidence, age incidence, laterality, common mode of presentation, staging of the tumor, radiological evidence, histopathological confirmation, management and follow-up of cases, which were diagnosed as retinoblastoma. Design: Interventional case series study from April 1997 to March 2000. Materials and Methods: Detailed history regarding the symptoms such as white reflex, watering, pain, redness, protrusion of eyeball, squint, hyphema, and defective vision were obtained. Family history regarding consanguinity between parents, health of the siblings and other relatives were recorded. Ocular examination included vision, pupillary reaction, detailed fundus examination, ocular tension, and corneal diameter. Investigations included X-ray orbit and skull, computed tomography scan orbit and brain, B-scan orbit, serum and aqueous lactate dehydrogenase; enucleated eyes were subjected to holoprosencephaly (HPE). Enucleation, radiotherapy, cryotherapy and chemotherapy were modalities of treatment. The empty socket and the other apparently normal eye were examined carefully at each visit. Results: The incidence of retinoblastoma is less when compared to other diseases of the eye. There was no sex predilection. Most of the cases diagnosed were sporadic and unilateral. Age of onset is earlier for bilateral cases than unilateral cases. Consanguinity bears close relationship with bilateral involvement. Predominant clinical sign is white reflex in the pupillary area. Majority of cases presented in the second stage of the disease. Enucleation plays a greater role in the management of retinoblastoma. HPE should include several sections of the optic nerve to find out skip lesions.
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Serum uric acid in new and recent onset primary hypertension p. 4
NN Anand, V Padma, Arun Prasad, Krishna Chaitanya Alam, M. S. A. Syed Mohammed Javid
DOI:10.4103/0975-7406.155763  
Introduction: Hyperuricemia is common among adults with prehypertension, especially when the microalbuminuria is present. Hyperuricemia precedes the development of hypertension. Aim: (1) To find the association of hyperuricemia in new-onset hypertensive patients. (2) To find the association of hyperuricemia in hypertensive patients with regard to gender and risk factors such as smoking and central obesity. Material and Methods: A total of 50 adults aged between 20 and 50 years who had mild early hypertension were selected for the study. Fifty controls without hypertension were enrolled and investigated. Results: The association between uric acid (UA) and hypertension was analyzed using Student's t-test and statistical difference were assessed using Pearson coefficient. The study showed a significant difference in UA between the hypertensive subjects and the normotensive controls. There was not a significant difference between waist abnormality, smoking and UA in cases. Males have a higher degree of hyperuricemia than females in hypertensive patients. Conclusion: Serum UA is strongly associated with blood pressure (BP) in new and recent onset primary hypertension. The remarkable association of UA with BP in adults is consistent with recent animal model data and the hypothesis that the UA might have a pathogenic role in the development of hypertension.
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Health problems and stress in Information Technology and Business Process Outsourcing employees p. 9
V Padma, NN Anand, S. M. G. Swaminatha Gurukul, S. M. A. Syed Mohammed Javid, Arun Prasad, S Arun
DOI:10.4103/0975-7406.155764  
Stress is high in software profession because of their nature of work, target, achievements, night shift, over work load. 1. To study the demographic profile of the employees. 2. To access the level of job stress and quality of life of the respondents. 3. To study in detail the health problems of the employees. All employees working in IT and BPO industry for more than two years were included into the study. A detailed questionnaire of around 1000 IT and BPO employees including their personal details, stress score by Holmes and Rahe to assess the level of stress and master health checkup profile were taken and the results were analysed. Around 56% had musculoskeletal symptoms. 22% had newly diagnosed hypertension,10% had diabetes, 36% had dyslipidemia, 54% had depression, anxiety and insomnia, 40% had obesity. The stress score was higher in employees who developed diabetes, hypertension and depression. Early diagnosis of stress induced health problems can be made out by stress scores, intense lifestyle modification, diet advice along with psychological counselling would reduce the incidence of health problems in IT sector and improve the quality of work force.
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Significance of corneal arcus p. 14
K Mohan Raj, P Arun Subhash Reddy, Vikram Chella Kumar
DOI:10.4103/0975-7406.155765  
The corneal arcus consists of cholesterol, phospholipids and triglycerides. As serum triglyceride is one of the accurate of lipid metabolic state, greater importance was given, and it was found to be elevated in 72% of patients and a positive correlation with increasing age. This suggests a strong correlation between impairment of lipid metabolism and incidence of corneal arcus.
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Antioxidant status in neonatal jaundice before and after phototherapy p. 16
S Ayyappan, Sachu Philip, N Bharathy, V Ramesh, C Naveen Kumar, S Swathi, A Arun Kumar
DOI:10.4103/0975-7406.155766  
Background: Neonatal jaundice refers to yellow coloration of the skin and the sclera (whites of the eyes) of newborn babies that result from the accumulation of bilirubin in the skin and mucous membranes. Because bilirubin is potentially toxic to the central nervous system. Genetic disorders of bilirubin conjugation, particularly the common Gilbert's syndrome, can also contribute to neonatal hyperbilirubinemia. Objective: The aim of this study was to evaluate the lipid per-oxidation and antioxidant enzyme activities in patients with neonatal jaundice before and after phototherapy. Materials and Methods: The study includes 50 neonatal jaundice patients with average age 2-15 days. All patients of neonatal jaundice receiving phototherapy except feeding, cleaning. Subjects selected were from the patients attending Pediatrics Department. Plasma malondialdehyde (MDA), erythrocyte glutathione peroxidase (GPX), superoxide dismutase and catalase (CAT) to monitor the bilirubin level. Results: The results show increased levels of bilirubin compared with controls (P < 0.001) shows the level of plasma MDA in control, before and after phototherapy. Represents the level of GPX was significantly increased in after the phototherapy group when compared with before phototherapy and control SPSS soft ware: (P < 0.001). Shows the reduced glutathione (GSH) level in plasma was significantly decreased in the after phototherapy group when compared with before phototherapy and control (P < 0.001). And finally with ascorbic acid and CAT. Conclusion: It is evident from the study that increased oxidative stress in neonatal jaundice babies leads to decrease in the levels of antioxidants like GSH and ascorbic acid and disturb their metabolism, that weaken their ability to fight the growing stress. Intense oxidative stress and decreased antioxidants may contribute to neural cell death and alter the erythrocytomembrane structure processing in neonatal jaundice.
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A comparative study on serum lipoprotein (a) and lipid profile between rheumatoid arthritis patients and normal subjects p. 22
KP Shiva Govindan, Saleem Basha, V Ramesh, C Naveen Kumar, S Swathi
DOI:10.4103/0975-7406.155767  
Background: Rheumatoid arthritis is a chronic and systemic inflammatory disorder, in which Lipoprotein (a) [Lp (a)] increases plaque formation and thus promotes atherosclerosis. Coronary artery disease is one of the co-morbidity in rheumatoid arthritis patients. Aim: The aim of this study is to evaluate Lp (a) as a cardiovascular risk factor in patients with rheumatoid arthritis. This was a comparative study in which Lp (a) and lipid profile were compared in rheumatoid arthritis patients and controls. Materials and Methods: The study included 30 sero-positive rheumatoid arthritis patients and 30 normal healthy subjects with an age and sex matched group of 25-80 years. Statistical analysis was performed using SPSS version 17. Results: Serum Lp (a) concentration was significantly increased (P < 0.001) in rheumatoid arthritis patients compared with controls. Serum high-density lipoprotein-cholesterol was significantly lowered (P < 0.05) in patients as compared to controls. There was no significant difference in serum total cholesterol, triglycerides, and very low density lipoprotein-cholesterol between patients and controls. Conclusion: The findings indicate that the patients with rheumatoid arthritis are at high risk of developing cardiovascular disease in future due to the increased level of Lp (a). In addition to conventional lipid profile, estimation of Lp (a) can prove to be a valuable tool in risk assessment of population in general and management of disease in particular.
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Macrolide resistance in Streptococcus species p. 26
A Ilakkiya, Shabana Parveen, C Naveen Kumar, S Swathi
DOI:10.4103/0975-7406.155784  
Background: The Streptococci are Gram-positive spherical bacteria (cocci) that characteristically form pairs and chains during growth. Some macrolide-resistant bacteria lack the proper receptor on the ribosome (through methylation of the rRNA). This may be under plasmid or chromosomal control. Aim and Objectives: The aim was to study the prevalence of macrolide resistance among the isolate and evaluate the degree of resistance by minimum inhibitory concentration (MIC) method. And also to detect the phenotypic pattern of macrolide resistance. Materials and Methods: All age group attending general medicine OPD and pediatric OPD with symptoms of respiratory and pyogenic infections are included in the study. Various samples are collected with detailed case history and processed for macrolide resistance among beta hemolytic Streptococci MIC method and D-test. Results: According to our studies resistance pattern in Group A Streptococci by D-test, cMLS was 27.85%, iMLS was 13.92%, M-type was 55.69%, in GCS, cMLS was 17.6%, M-type was 82.35% In GGS, cMLS was 31.58%, iMLS was 10.53% and M-type was 57.89%. Conclusions: Therefore by this study, we would like to highlight the necessity to do antibiotic sensitivity testing for all isolates, and limit the usage of antibiotics, whenever necessary and select the appropriate antibiotics for resistant strains.
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Serum fructosamine a better indicator than glycated hemoglobin for monitoring gestational diabetes mellitus p. 32
S Ayyappan, Sachu Philips, C Kishore Kumar, V Vaithiyanandane, C Sasikala
DOI:10.4103/0975-7406.155786  
Gestational Diabetes mellitus is the condition of glucose intolerance that begins during pregnancy which is associated with both fetal and maternal complications. The measurement of serum fructosamine and glycated hemoglobin in normal and diabetic pregnancy used to investigate the influence of maternal and gestational age on concentrations of glycated proteins in serum and used to evaluate the patient's treatment. This study was done to measure the level of serum fructosamine and Glycated hemoglobin (HbA1c) in Gestational Diabetes mellitus (GDM) patients and to compare with pregnant women without diabetes and healthy non-pregnant adults, to determine the pattern of change in serum fructosamine, influence of serum fructosamine and HbA1c values and to evaluate the efficacy of patient's treatment. In this study the level of fructosamine was positively correlated to HbA1c during 2 nd trimesters of gestational period, implying that the level of fructosamine can be used to screen Gestational diabetes mellitus. Correlation of glycated hemoglobin values with serum fructosamine measurements in the accurate determination of glycaemic control provides confirmation of the utility of fructosamine measurement.
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Pulmonary function test in formalin exposed and nonexposed subjects: A comparative study p. 35
P Uthiravelu, A Saravanan, C Kishor Kumar, V Vaithiyanandane
DOI:10.4103/0975-7406.155787  
Background: The main function of the lung is gas exchange, which can be assessed in several ways. A spirometer measures the flow and the volumes of the inspired and expired air. The thoracic and abdominal muscle strength plays an important role in pulmonary function and diffusing lung capacity. Aims and Objectives: The aim of this study was to assess the effects of formalin exposure on the pulmonary function to compare with healthy individuals. To assess the chronic effects of formalin exposure on Pulmonary function tests (PFTs) in the faculties, lab technicians and attender of the Department of Anatomy and Pathology of SRM Medical Hospital and Research Centre, Kattankulathur. Materials and Methods: This prospective study was carried out in 50 healthy formalin exposed subjects (at least 5 years exposure) from Department of Anatomy and Pathology of SRM Medical College Hospital and Research Centre, Kattankulathur and 50 healthy controls of same age group of this study were included after obtaining ethical clearance and consent 'Easy One Pro Spirometer (Ndd Medical Technologies, Cheshire SK 101LT, United Kingdom) was used to find out the PFT. Results: Student's t-test was applied to compare the PFT parameters between formalin exposed and formalin nonexposed group. There was a significant difference in mean and standard deviation of pulmonary parameters with the P < 0.005 in formalin exposed, which shows that they have lesser ventilatory drive. Conclusion: The formalin exposed subjects in our study presented with a mixed disorder of both obstructive and restrictive type. We also found that there was a negative correlation of pulmonary function with that of the degree and duration of exposure to formalin.
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Antioxidant activity of ethanolic extract of Tinospora cordifolia on N-nitrosodiethylamine (diethylnitrosamine) induced liver cancer in male Wister albino rats p. 40
R Jayaprakash, V Ramesh, MP Sridhar, C Sasikala
DOI:10.4103/0975-7406.155791  
Background: Cancer is a disease that evokes wide spread fear among people and is one of the leading causes of deaths in the world. Diethylnitrosamine (DEN) is a known carcinogen in rodent liver. DENs reported to undergo metabolic activation by cytochrome P450 enzymes to form reactive electrophiles that cause oxidative stress leading to cytotoxicity, mutagenicity and carcinogenicity. Objective: The present study was carried out to evaluate the antioxidant activity of ethanolic extract of Tinospora cordifolia (EETC) in N-nitrosodiethylamine (DEN) induced liver cancer in male Wister albino rats. Materials and Methods: The antioxidant activity was assessed by the levels of lipid peroxidation (LPO), enzymic and nonenzymic antioxidants. Result: A significant levels of LPO was increased as the enzymic and nonenzymic antioxidants values were decreased in liver cancer bearing animals. Conclusions: The administration of EETC to cancer bearing animals reverted the LPO levels, enzymic and nonenzymic antioxidants to near normal
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MEDICAL SCIENCE - REVIEW ARTICLES Top

Anatomy research under the knife of medical ethics p. 46
W. M. S. Johnson, R Archana, KM Prathibha, Priscilla Johnson
DOI:10.4103/0975-7406.155792  
There is increased awareness and anxiety in conducting research for publication and at the same time ignorance about getting Ethical Committee clearance at least in Anatomy Departments among Basic Medical Sciences. While people are actively presenting papers, collect data, Indian Council for Medical Research guidelines does not cover aspects pertaining to Anatomy oriented research activities. This review article is an eye opener for fraternity in the medical field, especially in anatomy.
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Things you don't learn in medical school: Caduceus p. 49
M Prakash, J Carlton Johnny
DOI:10.4103/0975-7406.155794  
It is a known fact that every symbol has a unique meaning. In that case what does this unique symbol, Caduceus, which is used, in various forms and modifications, by many medical organizations mean? Is it just a custom or does it have a deeper meaning? The story of this medical symbol started way back in 1400 BC, travelled through time, has undergone many changes, misconceptions and has finally reached the present state. Here we have tried to give you a glimpse of how it has evolved over time, what it actually means, what have we interpreted and what can we learn from it.
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Intra cranial complications of tuberculous otitis media p. 51
M Prakash, J Carlton Johnny
DOI:10.4103/0975-7406.155795  
Tuberculosis is one of the most common infections in the world. It is seen that tuberculous otitis media (TOM) is almost secondary to pulmonary tuberculosis. In this review we have tried to deal with all the aspects of the intra cranial complications of TOM such as tuberculoma, otitic hydrocephalus, brain abscess and tuberculous meningitis. The aspects covered in this review are the pathology, clinical features, and investigations of the intra cranial manifestations.
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Whats special in a child's larynx? p. 55
Manoharan Prakash, J Carlton Johnny
DOI:10.4103/0975-7406.155797  
What's special in a child's larynx? Many of us know only a few specialties of the pediatric larynx, but there are much more features, which are unique and often not highlighted. To understand the pediatric larynx, we have reviewed the development, the functions in-utero and new born period and peculiarities.
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Rhinosporidiosis and the pond p. 59
M Prakash, J Carlton Johnny
DOI:10.4103/0975-7406.155804  
Rhinosporidiosis is a fungal disease caused by the organism Rhinosporidum seeberi. The life cycle and mode of infection are vague, and there are many hypothesis on it. Its prevalence in the world is unique as it is only limited to certain regions like India, Pakistan and Sri Lanka. We have tried to correlate the various factors, which will probably be associated with this pattern of prevalence of the disease. We have included factors like community practices, climatic conditions, rain fall pattern, water physiochemical properties, zoonotic and the aquatic organism composition in the specified regions. Thus, it serves as a wholesome idea of why the disease must only be prevalent in certain parts of the world.
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MEDICAL SCIENCE - CASE REPORTS Top

A case of mediastinitis secondary to retropharyngeal abscess p. 63
Aparajeet Kar, S Dharmic, V Suryanarayana, M Harish
DOI:10.4103/0975-7406.155805  
A 50 year old male patient who consumed chicken bone soup, 4 days back, presented with dysphagia, high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. Patient was toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 lit of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess and CT chest revealed Sub-cutaneous and mediastinal emphysema. The abscess was immediately drained and followed with parenteral anti-microbials and high flow oxygen theapy. Patient improved and was discharged after 12 days. This case was reported as, foreign body causing Retro-pharyngeal abscess is a very rare entity in this anti-biotic era especially leading to a very rare complication of mediastinitis and Pneumomediastinum is unusual.
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A rare case of typhoid presenting with fever, ascites, hyponatremia, thrombocytopenia, mesenteric lymphadenitis, and multi-drug resistance p. 65
A Priya Margaret, P John Solomon, Harita Lohith
DOI:10.4103/0975-7406.155806  
A rare case of typhoid presenting with thrombocytopenia, hyponatremia, ascites mesenteric adenitis, and multi-drug resistance is being presented in this article. An 8-year-old girl was admitted with a history of fever, vomiting, abdominal pain and loose stools. Clinical examination revealed fever and hepatosplenomegaly. Investigations showed leucopenia, thrombocytopenia and hyponatremia. Blood Widal was positive, and blood culture grew Salmonella typhi. Ultrasound abdomen revealed ascites, hepatosplenomegaly, mesenteric lymphadenopathy and thickening of the gall bladder. She was treated with ciprofloxacin intravenously for 6 days and when the fever persisted injection ceftriaxone was added. Ciprofloxacin was given intravenously for a total of 15 days and injection ceftriaxone was given for 12 days. Even then, the fever persisted and hence oral azithromycin was added. Fever subsided completely in 3 days with azithromycin and she became asymptomatic without fever, loose stools, abdominal pain or anything on follow-up after 3 months.
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An unusual cause of fungal pneumonia p. 67
S Dharmic, Shraddha Nair, M Harish
DOI:10.4103/0975-7406.155808  
A 65 year old female, known asthmatic on steroids intermittently, with no other co-morbidity presented with fever, breathlessness and cough with mucoid expectoration of ten days duration with bilateral crepts, went for Type II respiratory failure and was intubated followed by tracheostomy in view of prolonged ventilator support. In spite of high end antibiotics as per sputum culture sensitivity, weaning off the ventilator was not possible. Blood investigations revealed leucocytosis with neutrophilic predominance and I g E levels were within normal limits. CT chest showed multiple patchy consolidations of the right upper, middle and lower lobes with ground glass appearance and enlarged mediastinal lymph nodes. Work up for retrovirus, tuberculosis and Sputum for KOH mount was negative. No evidence of sputum and blood eosinophilia. BAL sample grew Curvularia species. Fluconazole 150mg OD was added. Serial imaging of the chest showed resolution of the consolidation and was weaned off the ventilator and was comfortable on room air. Pneumonia caused by Curvularia, in an immune competent patient is very rare. Even in broncho pulmonary involvement these fungi usually occur in allergic conditions as in ABPA than appearing as a solitary cause for lung infection. But if diagnosed and treated early, will respond well to triazoles. This case report highlights a unilateral fungal pneumonia with dramatic clinical improvement post treatment once the rare causative organism was identified.
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Bilateral angle closure glaucoma following general anaesthesia p. 70
K Mohan Raj, P Arun Subhash Reddy, Vikram Chella Kumar
DOI:10.4103/0975-7406.155809  
Angle closure glaucoma is one of the ophthalmic emergencies and treatment has to be given at the earliest. It is a rare complication of general anesthesia. A female patient underwent Hysterectomy under general anesthesia. Following this, patient developed bilateral angle closure glaucoma. This patient was treated with antiglaucoma medications followed by YAG laser iridotomy and patient regained vision.
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Nasal rhinosporidiosis with an atypical presentation p. 72
Manoharan Prakash, Johnny J Carlton
DOI:10.4103/0975-7406.155810  
Rhinosporidiosis is a unique disease, which is seen to be endemic in certain places in India such as Tamil Nadu and Sri Lanka. The disease is caused by Rhinosporidium seebri and it is transmitted by bathing in ponds contaminated by cattle feces containing spores of the organism. The disease usually presents as multiple granulomatous bleeding polyps. The case described here is a unique presentation where it occurs only in a single site and that too in an uncommon location where the suspicion of rhinosporidiosis is a last possibility.
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Erythema ab igne: Usual site, unusual cause p. 74
D Manoharan
DOI:10.4103/0975-7406.155811  
Erythema ab igne is reticular erythematous pigmented dermatoses seen in patients exposed to prolonged or repeated sub-threshold Infrared radiation inadequate to cause burns. Here, we report a case of erythema ab igne in a 40-year-old male patient seen over the abdomen due to prolonged laptop use.
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Hypothyroidism with scholastic excellence p. 76
S Salini, Shanthi Ramesh, Jagdeep Ramesh, D Vijayasekaran
DOI:10.4103/0975-7406.155812  
A 9-year-old boy had presented with not gaining adequate height with complaints of constipation from 5 years, lethargy and loss of appetite from past 6 months. He was diagnosed to have hypothyroidism with high thyroid antibody levels. Though he was stunted his neurocognition and scholastic performance was excellent as evidenced by his school rank cards. His physical symptoms had improved after thyroxin supplement
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Innovative management of nasal septal hematoma in an infant p. 78
R Sumitha, Ajay Kumar Anandan, Aberna Govarthanaraj
DOI:10.4103/0975-7406.155813  
Nasal septal hematoma is a collection of blood between the cartilage or bone and mucoperichondrium or mucoperiosteum of the nose. This condition requires immediate surgical drainage to prevent complications. All patients need nasal packing postoperatively to prevent recurrence. This causes a lot of discomforts due to mouth breathing more in infants who are obligatory nose breathers. They can go for cyanosis in the postoperative period. Here, we discuss the case report of an infant who had tubular nasal pack with endotracheal tube postoperatively to maintain the patency of nose.
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An unusual case of pseudochylothorax p. 80
M Padma Priya, S Dharmic, Aparajeet Kar, V Suryanarayana
DOI:10.4103/0975-7406.155814  
A 25-year-old male patient presented with right-sided pleuritic chest pain and pain in the ankle. Radiological investigations revealed a right sided pleural effusion, lytic lesion in spine D10 with paravertebral abscess. Pleural fluid analysis showed elevated lactate dehydrogenase, adenosine deaminase, increased triglycerides, cholesterol, and no chylomicrons. Hence, a diagnosis of pseudochylothorax secondary to tuberculosis was made. Pleural fluid was drained by tube thoracostomy, decortication was done to improve the lung function and patient was started on anti-tuberculosis treatment (ATT). Patient improved with ATT. Pseudochylous effusion or chyliform effusions are uncommon. <200 cases has been reported in the international literature. The possibility of tuberculosis has to be considered in diagnosis and treatment of such cases. Here, we present a case of tuberculous pseudochylous effusion.
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Single umbilical artery p. 83
Shanthi Ramesh, Sangeetha Hariprasath, Gunasekaran Anandan, P John Solomon, V Vijayakumar
DOI:10.4103/0975-7406.155815  
The umbilical cord usually contains two arteries and one vein. The vein carries the oxygenated blood from the placenta to the fetus. The arteries carry the deoxygenated blood and the waste products from the fetus to the placenta. Occasionally, primary agenesis or secondary atrophy of one of the arteries occurs resulting in single umbilical artery.
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DENTAL SCIENCE - RESEARCH ARTICLES Top

Correlation between arch form and facial form: A cross sectional study p. 85
Sanjna Nayar, Aruna , Santhosh , Wasim Manzoor
DOI:10.4103/0975-7406.155816  
Arch form is a key determinant in teeth position. Teeth selection and placement must be based on the functional and esthetic needs of the patient. Keeping in mind, the biomechanics involved with the prosthesis. The aim of the study was to evaluate the correlation between arch form and facial form. About 40 individuals in the age group of 20-25 years were involved in the study. The arch form and facial form were analyzed statistically to check for any correlation. It was found that, 63.63% of leptoprosophic individuals had squarish arch form while, 54.6% of mesoprosophic faces had ovoid arch form.
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Comparative evaluation of the three different surface treatments - conventional, laser and Nano technology methods in enhancing the surface characteristics of commercially pure titanium discs and their effects on cell adhesion: An in vitro study p. 87
Vignesh , Sanjna Nayar, Bhuminathan , Mahadevan , S Santhosh
DOI:10.4103/0975-7406.155817  
The surface area of the titanium dental implant materials can be increased by surface treatments without altering their shape and form, thereby increasing the biologic properties of the biomaterial. A good biomaterial helps in early cell adhesion and cell signaling. In this study, the commercially pure titanium surfaces were prepared to enable machined surfaces to form a control material and to be compared with sandblasted and acid-etched surfaces, laser treated surfaces and titanium dioxide (20 nm) Nano-particle coated surfaces. The surface elements were characterized. The biocompatibility was evaluated by cell culture in vitro using L929 fibroblasts. The results suggested that the titanium dioxide Nano-particle coated surfaces had good osteoconductivity and can be used as a potential method for coating the biomaterial.
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Evaluation depth of the curve of Spee in class I, class II, and class III malocclusion: A cross sectional study p. 92
Sanjna Nayar, V Dinakarsamy, S Santhosh
DOI:10.4103/0975-7406.155821  
Occlusal plane is an essential consideration when multiple long-span posterior restorations are designed. When restorations are added to an existing tooth arrangement characterized by rotated, tipped, or extruded teeth, excursive interferences may be incorporated, resulting in detrimental squeal. The curve of Spee, which exists in the ideal natural dentition, allows harmony to exist between the anterior tooth and condylar guidance. This curve exists in the sagittal plane and is the best viewed from a lateral aspect. It permits total posterior disclusion on mandibular protrusion, given proper anterior tooth guidance. It is unclear that whether the curve of Spee is a description of the occlusal surface of each arch separately or in maximal intercuspation. The purpose of this study was to examine the differences in the depth of curve of Spee between the class I, class II, class III and to investigate the relationship of depth of curve of Spee with over jet, over-bite.
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Relationship between occlusal plane and ala-tragus line in dentate individuals: A Clinical pilot study p. 95
Sanjna Nayar, S Bhuminathan, Wasim Manzoor Bhat, R Mahadevan
DOI:10.4103/0975-7406.155822  
Many methods have been used to establish the occlusal plane in complete denture prosthodontics. However, no single method seems to be fully accepted. Anteriorly, esthetic considerations help define the occlusal plane, and posteriorly the tongue, retromolar pad, and Stenson's duct are considered. Some dentists bisect the space between the residual ridges. The technique of using the ala-tragus line (Camper's line) to establish the occlusal plane is well documented. However, definitions of the ala-tragus line cause confusion, because the exact points of reference do not agree. For example, the glossary of prosthodontic terms states that the ala-tragus line runs from the inferior border of the ala of the nose to the superior border of the tragus of the ear while Spratley' describes it as running from the center of the ala to the center of the tragus. This article concerns us the exact relationship between the occlusal plane and ala-tragus line in dentate individuals.
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Self-perceived need for dental care p. 98
Ramyaa Dhanasekaran, Sanjna Nayar
DOI:10.4103/0975-7406.155825  
Aims: The aim of this study is to evaluate the self-perceived need for dental care among medical professionals and general public. Setting and Design: (1) To determine the perceived oral health status. (2) To evaluate the results in understanding the perception of oral health. (3) To determine the patients attitude toward dentist.Subjects and Methods: The study was carried out on 537 patients who came for their regular checkup and treatment. Statistical Analysis Used: The statistical analysis of this study was based on Chi-square test evaluation. The study was performed among in 537 participants. The participants included from age group of both <30 and >30. The study was made in the form of questionnaires enquiring how they would perceive their personal dental care and their attitude towards dentist. Results: Self-perceived questionnaires in evaluating general public in age group of <30 and >30 shows, that people in age group more than 30 has good oral hygiene maintenance, whereas attitude toward dentist and attending dental problems were more among group less than 30 of age. Conclusions: I conclude that there must be more awareness created by public health dentist among people about various dental problems, their complications and the treatment needs. Hence, that people be aware of their dental problem at the small stage and get cured. By conducting varies Public Health Programs and camp they became very free to contact their dentist for their varies dental problems and people attitude about dentist and toward dentist completely changes.
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Surgery preceding orthodontics in bimaxillary cases p. 101
B Saravana Kumar, Abu Dakir, Bala Krishnan, Vijay Ebenezer, Muthumani , Kishore Kumar, Waikhom Arvind
DOI:10.4103/0975-7406.155840  
Orthognathic surgery is performed to alter the shape of the jaws to increase the facial esthetic and improve the occlusions. Surgery prior orthodontics reduces the total length of the treatment of the patients, followed by orthodontics treatment. Advantages is positive outcome in short period of time. Surgical procedure includes Anterior Maxillary osteotomy and Anterior subapical mandibular osteotomy. Complication includes haemorrhage, paraesthesia, malunion of bone, etc.
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Palatal bone thickness measured by palatal index method using cone-beam computed tomography in nonorthodontic patients for placement of mini-implants p. 107
WS Manjula, RV Murali, S Kishore Kumar, Faizal Tajir, K Mahalakshmi
DOI:10.4103/0975-7406.155843  
Introduction: The purpose of this study was to compare the bone thickness of the palatal areas in different palatal index (PI) groups. Materials and Methods: Cone-beam computed tomography scans of 10 subjects were selected with a mean age group of 18 years. The measurements of palatal bone thickness were made at 36 sites using CareStream 3D Imaging software. The PI was measured using Korkhaus ratio (palatal height/palatal width). One-way analysis of variance was used to analyze intergroup differences, as well as the PI difference. Results: Bone thickness was higher in the anterior region than in the middle and posterior regions P<0.001. Furthermore, significant differences were found among the midline, medial, and lateral areas of the palate. Conclusions: These findings might be helpful for clinicians to enhance the successful use of temporary anchorage devices in the palate.
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Orthodontic instrument sterilization with microwave irradiation p. 111
Arif Yezdani, Krishnan Mahalakshmi, Kesavaram Padmavathy
DOI:10.4103/0975-7406.155847  
Objective: This study was designed to evaluate the efficiency of microwave sterilization of orthodontic instruments and molar bands immersed in plain distilled water with and without oral rinse, and to ascertain the minimum time of exposure required to sterilize. Materials and Methods: The orthodontic instruments (hinged and nonhinged), molar bands and mouth mirrors used in the patient's mouth were selected for the study. The instruments were divided into two groups - Group I with oral rinse-set A (0.01% chlorhexidine gluconate) and set B (0.025% betadine) and Group II (included sets C and D without oral rinse). The instruments of set A, B and C were microwaved at 2,450 MHz, 800 W for 5 min, whereas, set D was microwaved for 10 min at the same above mentioned specifications. The efficacy of sterilization was assessed by stab inoculation of the instruments onto trypticase soya agar plates. The plates were checked for bacterial growth following incubation at 37°C for 24 h. For sterility control, Geobacillus stearothermophilus (MTCC 1518) was included. Results: No growth was observed in the plates that were inoculated with the microwaved orthodontic instruments of sets A, B and D, whereas scanty bacterial growth was observed in the plates inoculated with the microwaved set C instruments. Conclusion: Effective sterilization was achieved when the orthodontic instruments and molar bands were immersed in distilled water without oral rinse and microwaved for 10 min as also for those that were immersed in distilled water with oral rinse and microwaved for 5 min.
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Comparison of frictional resistance of esthetic and semi-esthetic self-ligating brackets p. 116
MS Kannan, RV Murali, S Kishorekumar, K Gnanashanmugam, V Jayanth
DOI:10.4103/0975-7406.155852  
Aim: The frictional resistance encountered during sliding mechanics has been well established in the orthodontic literature, and it consists of complex interactions between the bracket, archwire, and method of ligation the claim of reduced friction with self-ligating brackets is often cited as a primary advantage over conventional brackets. This study was done to compare and evaluate the frictional forces generated between fully esthetic brackets and semi-aesthetic self-ligating brackets, which are of passive form and SEM (scanning electron microscope) study of the Brackets after Frictional evaluation. Materials and Methods: Two types of self-ligating esthetic brackets, Damon clear (Ormco) made of fully ceramic and Opal (Ultradent Products, USA) and, Two types of self-ligating semi-esthetic brackets, Clarity SL (3M Unitek) and Damon 3 (Ormco) both of which are made of ceramic with metal slot. Arch wires with different dimensions and quality 17 × 25, 19 × 25 Titanium Molybdenum Alloy (TMA) and 17 × 25, 19 × 25 stainless steel that came from plain strands of wire were used for frictional comparison test. The brackets used in this study had 0.022 × 0.028 inch slot. Results: The statistical tests showed significantly smaller amount of kinetic frictional forces is generated by Damon 3 (semi-esthetic self-ligating brackets). For each wire used, Damon 3 displayed significantly lower frictional forces (P ≤ 0.05) than any of the self-ligating system, followed by Opal (fully esthetic self-ligating brackets) which generated smaller amount of frictional forces but relatively on the higher side when compared with Damon 3. Damon clear (fully esthetic self-ligating brackets) generated the maximum amount of kinetic forces with all types of wire dimensions and properties when compared to the other three types of self-ligating system. Clarity SL (semi-esthetic self-ligating brackets) generated smaller amount of frictional forces when compared with Damon clear and relatively higher amount of frictional forces when compared to Opal and Damon 3
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Assessment of optimal condylar position with cone-beam computed tomography in south Indian female population p. 121
WS Manjula, Faizal Tajir, RV Murali, S Kishore Kumar, Mohammed Nizam
DOI:10.4103/0975-7406.155855  
Aim: The purpose of this study was to investigate, the condyle-fossa relationship, in clinically asymptomatic orthodontically untreated south Indian female volunteers, by cone-beam computed tomography (CBCT). Materials and Methods: The study population consisted of 13 clinically symptom-free and orthodontically untreated angle's Class I female subjects with the mean age of 18 years (ranges from 17 years to 20 years). The normal disc position of the 13 subjects was confirmed by history, clinical examination and magnetic resonance imaging scan. Then, the images of the temporomandibular joint (TMJ) of the subjects were taken using CBCT to evaluate the optimal condylar position. Posterior joint space (PS), superior joint space (SS) and anterior joint space (AS) were measured, and the values were subjected to statistical analysis. Mean PS, SS and AS of right and left side TMJ's were calculated. Paired samples t-test were used for each measurement to evaluate the average differences between the right and left side for each element of the sample. Results: The mean value of PS, SS and AS of right side TMJ's were 2.1385, 2.2769 and 1.7615, respectively. The mean value of PS, SS and AS of left side TMJ's were 2.1385, 2.5308 and 1.8538, respectively. Statistical analysis with the t-test indicated no significant differences in the AS, SS, or PS values between the right and left side. TMJ's mean PS, SS, and AS measurements were 2.1 mm (standard deviation [SD] ±0.65 mm), 2.4 mm (SD ± 0.58 mm), and 1.8 mm (SD ± 0.52 mm), respectively. The ratios of SS and PS to AS, with AS set to 1.0, were 1.3 and 1.2, respectively. Conclusion: These data from optimal joints might serve as norms for the clinical assessment of condylar position obtained by CBCT.
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A new approach for evaluation of canine dento alveolar distraction using cone-beam computed tomography p. 125
Chandrasekaran Deepak, MS Kannan, MR Sukumar, L Rajesekar, Utpal Datta
DOI:10.4103/0975-7406.155859  
Objective: The aim was to evaluate and plan the canine dento alveolar distractions (DADs) with the use of cone-beam computed tomography (CBCT). Materials and Methods: 5 patients are requiring 10 canine DADs were selected for the study. A custom-made DAD distractor was fabricated for the study. CBCT scans were taken prior to and post thedistraction. DAD parameters such as Canine retraction, canine and molar rotation, molar anchor loss and level of the osteotomy cut above the canine was evaluated. Results: Average canine retraction was 7.5 mm in 17 days, molar anchor loss was 0.5 mm, canine and molar rotations were 8° and 0.40° and the distance of the osteotomy cut to the canine was1.93 mm. Conclusion: The CBCT can be used to accurately evaluate the canine DAD technique.
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Elongated styloid process: A study p. 131
Jinu Merlin Koshy, Madhu Narayan, Sankar Narayanan, B Sathya Priya, G Sumathy
DOI:10.4103/0975-7406.155861  
The styloid process (SP) on the temporal bone is a highly variable formation. The normal length of the SP ranges from 20 to 30 mm. In spite of its being normally distributed in the population, SPs could be divided into two groups - short SPs with >20 mm and long SPs with <20 mm in length. The SP is often denoted as elongated when it is longer than 30 mm or 33 mm. These dimensions, based on early reports, do not respect the natural variation of the SP. The aim of this study is to investigate the natural variation of the length of the SP.
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Assessment of bleeding during minor oral surgical procedures and extraction in patients on anticoagulant therapy p. 134
S Jimson, Julius Amaldhas, Sudha Jimson, I Kannan, J Parthiban
DOI:10.4103/0975-7406.155862  
Introduction: The risk of postoperative hemorrhage from oral surgical procedures has been a concern in the treatment of patients who are receiving long-term anticoagulation therapy. A study undertaken in our institution to address questions about the amount and severity of bleeding associated with minor outpatient oral surgery procedures by assessing bleeding in patients who did not alter their anticoagulant regimen. Subjects and Methods: Eighty-three patients receiving long-term anticoagulant therapy visited Department of Oral and Maxillofacial Surgery from May 2010 to October 2011 for extractions and minor oral surgical procedures. Each patient was required to undergo preoperative assessment of prothrombin time (PT) and measurement of the international normalized ratio. Fifty-six patients with preoperative PT values within the therapeutic range 3-4 were included in the study. The patients' age ranged between 30 and 75 years. Application of surgispon was done following the procedure. Extraction of teeth performed with minimal trauma to the surrounding tissues, the socket margins sutured, and sutures removed after 5 days. Results: There was no significant incidence of prolonged or excessive hemorrhage and wound infection and the healing process was normal.
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DENTAL SCIENCE - REVIEW ARTICLES Top

Role of DNA profiling in forensic odontology p. 138
S Leena Sakari, Sudha Jimson, K. M. K. Masthan, Jenita Jacobina
DOI:10.4103/0975-7406.155863  
The recent advances in DNA profiling have made DNA evidence to be more widely accepted in courts. This has revolutionized the aspect of forensic odontology. DNA profiling/DNA fingerprinting has come a long way from the conventional fingerprints. DNA that is responsible for all the cell's activities, yields valuable information both in the healthy and diseased individuals. When other means of traditional identification become impossible following mass calamities or fire explosions, teeth provide a rich source of DNA as they have a high chemical as well as physical resistance. The recent evolution in the isolation of DNA and the ways of running a DNA fingerprint are highlighted in this literature review.
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Ghost cell lesions p. 142
E Rajesh, Sudha Jimson, K. M. K. Masthan, N Balachander
DOI:10.4103/0975-7406.155864  
Ghost cells have been a controversy for a long time. Ghost cell is a swollen/enlarged epithelial cell with eosnophilic cytoplasm, but without a nucleus. In routine H and E staining these cells give a shadowy appearance. Hence these cells are also called as shadow cells or translucent cells. The appearance of these cells varies from lesion to lesion involving odontogenic and nonodontogenic lesions. This article review about the origin, nature and significance of ghost cells in different neoplasms.
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Reticuloendothelial malignancy of head and neck: A comprehensive review p. 145
L Malathi, R Amsaveni, N Anitha, N Balachander
DOI:10.4103/0975-7406.155867  
The mononuclear phagocyte system consists of cells that have a common lineage whose primary function is phagocytosis. The specific immunity is achieved by the combined effects of macrophages and lymphocytes, and system has been called lymphoreticular system. Reticuloendothelial system means a special group of cells, scattered in different parts of the body, but all having some common characteristics. These cells are powerful phagocytes.
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Oral lichen planus: An overview p. 158
R Jayasri Krupaa, S Leena Sankari, K. M. K. Masthan, E Rajesh
DOI:10.4103/0975-7406.155873  
Lichen planus is an immunologically mediated mucocutaneous disease that is triggered by varied etiological agents. The oral lichenoid reaction is considered a variant of the disease that needs to be clearly diagnosed as a separate entity from oral lichen planus and treated. They follow a strict cause-effector relationship, protocols that suggest the differentiation. Lichen planus has varied clinical forms in the oral mucosa and cutaneously that has different prognosis. This condition also arises in association with various other systemic conditions such as hypertension, diabetes mellitus. There have been cases reported in the esophagus, larynx, scalp, nail, cutaneous areas, especially arms and wrists, trunk. There is reported malignant transformation that essentiates careful examination, treatment protocol and regular follow-up sessions. This article throws light on the disease condition of oral lichen planus and oral lichenoid reaction that is essential for the differentiation and treatment.
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Candida in potentially malignant oral disorders p. 162
S Leena Sankari, K Gayathri, N Balachander, L Malathi
DOI:10.4103/0975-7406.155886  
Oro-pharyngeal cancer is a significant component in the global burden of cancer. A considerable proportion of oral squamous carcinomas develop from preexsiting potentially malignant disorder of the oral cavity. The term potentially malignant oral disorders (PMD) were proposed for the precancerous lesions and conditions by World Health Organization in 2007. PMD are considered an in-between clinical state, which showed increased risk for cancer development. Etiology of PMD is multifactorial. Tobacco and alcohol are the major risk factors. In recent years, role of candidal infection is recognized as a significant factor in the development of PMD. There is an enduring discussion whether Candida infection can be a cause of PMD or a superimposed infection in a preexisting lesion. This article highlights the association between Candida and PMD.
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Leukoplakia: A short review on malignant potential p. 165
K. M. K. Masthan, N Aravindha Babu, S Leena Sankari, C Priyadharsini
DOI:10.4103/0975-7406.155890  
Oral leukoplakia is one of the most common potentially malignant disorders. Right diagnosis of potentially malignant disorders may help to prevent these lesions from malignant transformation. Proper understanding, recognizing, identification and differentiating these lesions from normal mucosa are necessary for proper treatment.
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Ameloblastoma p. 167
K. M. K. Masthan, N Anitha, Jayasri Krupaa, Sudha Manikkam
DOI:10.4103/0975-7406.155891  
Ameloblastoma is a benign odontogenic tumor generally present in the jaw bone. The tumor originates from the residual epithelium of the tooth germ, epithelium of odontogenic cysts stratified squamous epithelium and epithelium of the enamel organ. It represents approximately 1% of oral tumors. About 80% of ameloblastomas occur in the mandible mainly the third molar region and the remaining 20% in the upper jaw. Ameloblastoma clinically appears as an aggressive odontogenic tumor, often asymptomatic and slow-growing, with no evidence of swelling. This article deals with a complete review on ameloblastoma.
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Fibrous dysplasia-recent concepts p. 171
N Anitha, S Leena Sankari, L Malathi, R Karthick
DOI:10.4103/0975-7406.155892  
Fibrous dysplasia (FD) is a benign intramedullary fibro-osseous lesion. FD is a bone developmental anomaly characterized by replacement of normal bone and marrow bone by fibrous tissue. It involves any of the bones as single lesion (monostotic) or in multiple bone lesions (polyostotic) or all of the skeletal system (panostotic). Long bones are most commonly involved, which mostly identified incidentally and clinically appears asymptomatic. Clinical, radiographical and histopathological findings will help in confirming the lesion. There are many treatment option available, but still management of FD remains challenging.
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Circulating tumor cells in oral squamous cell carcinoma-an enigma or reality? p. 173
N Anitha, Sudha Jimson, K. M. K. Masthan, J Jenita Jacobina
DOI:10.4103/0975-7406.155893  
Oral squamous cell carcinoma (OSCC) is ranking 1 st among males and 4 th among females in India. In spite of major advances in diagnosis and treatment of OSCC, survival rates, have remained poor. Circulating tumor cells (CTCs) in the blood stream, play an important role in establishing metastases. It is important to identify patients suffering from nonlocalized tumor with "circulating" tumor cells to determine the tailor made, systemic therapy in addition to local resection and irradiation. Thus, detecting metastases at an early stage are needed for better prognosis and survival. CTCs as new prognostic marker to detect the metastatic potential will provide a novel insight into tumor burden and efficacy of therapy. The recent advances and its application in OSCC will be reviewed.
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Evolution of forensic odontology: An overview p. 176
N Balachander, N Aravindha Babu, Sudha Jimson, C Priyadharsini, K. M. K. Masthan
DOI:10.4103/0975-7406.155894  
Forensic dentistry or forensic odontology admits dentists' participation or identification of the victim and assisting legal and criminal issues. It refers to the proper handling, examination, identification and evaluation of dental evidence. This article summarizes the evolution of forensic odontology that started right from Garden of Eden to the modern scenario in identification of the gang rape case which happened in the state capital. Forensic dentistry plays a significant role in identifying the victims of crime, deceased individuals through the examination of anatomical structures, dental appliances and dental restorations.
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Naturally occurring products in cancer therapy p. 181
E Rajesh, Leena S Sankari, L Malathi, Jayasri R Krupaa
DOI:10.4103/0975-7406.155895  
Natural products have been used for the treatment of various diseases and are becoming an important research area for drug discovery. These products, especially phytochemicals have been extensively studies and have exhibited anti-carcinogenic activities by interfering with the initiation, development and progression of cancer through the modulation of various mechanisms including cellular proliferation, differentiation, apoptosis, angiogenesis, and metastasis. This concept is gaining attention because it is a cost-effective alternative to cancer treatment. In this article, we have discussed some of the naturally occurring products used in cancer treatment.
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Serum ferritin level and red blood cell parameters in healthy controls and chronic periodontitis patients p. 184
S Latha, S Thirugnanamsambandan, RT Arun, K. M. K. Masthan, L Malathi, E Rajesh
DOI:10.4103/0975-7406.155896  
Periodontitis, which is a chronic inflammatory disease causes reduction in the number of erythrocytes and hemoglobin. It is found to be caused by specific pathogenic subgingival plaque bacteria. Periodontitis is host mediated through release of pro inflammatory cytokines by local tissues and immune cells in response to bacterial flora and its products, especially lipopolysacharides. Periodontitis is found to have systemic effect and the cytokines produced inhibit proliferation and differentiation of erythrocytes leading to anaemia. This study evaluate level of hemoglobin erythrocytes, hematocrit and serum ferritin levels in healthy subjects and periodontitis patient.
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Myoepithelial cells in pathology p. 190
N Balachander, K. M. K. Masthan, N Aravindha babu, V Anbazhagan
DOI:10.4103/0975-7406.155898  
Myoepithelial cells are a normal constituent of the salivary acini and ducts and are found between the epithelial cells and the basement membrane. Microscopically myoepithelial cells are thin and spindle-shaped and ultrastructurally they possess a number of Cytoplasmic processes that extend between and over the acinar and ductal-lining cells, and they show features of both smooth muscle and epithelium. They play a vital role during expulsion of saliva and regulates the electrolytic exchange. They also perform as tumor suppressors and are considered to play a very important role in differentiation of various salivary gland tumors and help in the diagnosis of tumors. Neoplastic myoepithelial cells in both benign and malignant tumors can take numerous forms including epithelioid, plasmacytoid, spindle and clear cell variant, and this variability largely accounts for difficulties in histopathological diagnosis.
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Burning mouth syndrome p. 194
Sudha Jimson, E Rajesh, R Jayasri Krupaa, M Kasthuri
DOI:10.4103/0975-7406.155899  
Burning mouth syndrome (BMS) is a complex disorder that is characterized by warm or burning sensation in the oral mucosa without changes on physical examination. It occurs more commonly in middle-aged and elderly women and often affects the tip of the tongue, lateral borders, lips, hard and soft palate. This condition is probably of multi-factorial origin, often idiopathic, and its etiopathogensis is unknown. BMS can be classified into two clinical forms namely primary and secondary BMS. As a result, a multidisciplinary approach is required for better control of the symptoms. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.
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DNA adducts-chemical addons p. 197
TR Rajalakshmi, N AravindhaBabu, KT Shanmugam, K. M. K. Masthan
DOI:10.4103/0975-7406.155901  
DNA adduct is a piece of DNA covalently bond to a chemical (safrole, benzopyrenediol epoxide, acetaldehyde). This process could be the start of a cancerous cell. When a chemical binds to DNA, it gets damaged resulting in abnormal replication. This could be the start of a mutation and without proper DNA repair, this can lead to cancer. It is this chemical that binds with the DNA is our prime area of concern. Instead of performing the whole body analysis for diagnosing cancer, this test could be carried out for early detection of cancer. When scanning tunneling microscope is used, the DNA results can be obtained earlier. DNA adducts in scientific experiments are used as biomarkers.
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Apoptosis in immune-mediated diseases p. 200
S Leena Sankari, N Aravindha Babu, E Rajesh, M Kasthuri
DOI:10.4103/0975-7406.155902  
Apoptosis plays a significant role in both the physiological and pathological process. A dysfunctional apoptotic system can lead to either excessive removal or prolonged survival of cells. Therefore, dysregulation is involved in the pathogenesis of a variety of immunological diseases. The present review aims to provide an overview regarding role of apoptosis in immune-mediated disease.
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Genodermatoses p. 203
N Aravindha Babu, E Rajesh, Jayasri Krupaa, G Gnananandar
DOI:10.4103/0975-7406.155903  
Genodermatoses are an inherited disorder, present with multisystem involvement. Help us to identify regular mutations and appalling skin diseases with recessive inheritance. Genetic heterogeneity is very common, and molecular diagnosis requires a broad effort. Recurrent mutations in unrelated families were seen in families with xeroderma, Griscelli. It seems likely that eventually oligonucleotide arrays will replace most other methods for routine mutation scanning of the more common diseases and planned sequencing will be increasingly used for rarer diseases.
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Imprint cytology p. 207
V Kamatchi, N Aravindha Babu, S Leena Sankari, E Rajesh
DOI:10.4103/0975-7406.155905  
A valuable information on morphological details of the cell can be obtained through imprint cytology. Though it has some pitfalls, it is still considered to be one of the best methods as it provides an excellent cytological clarity in fresh surgical specimens. This article shares knowledge about the procedure, uses, advantages and disadvantages of imprint cytology.
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Immunologically mediated oral diseases p. 209
Sudha Jimson, N Balachader, N Anita, R Babu
DOI:10.4103/0975-7406.155909  
Immune mediated diseases of oral cavity are uncommon. The lesions may be self-limiting and undergo remission spontaneously. Among the immune mediated oral lesions the most important are lichen planus, pemphigus, erythema multiformi, epidermolysis bullosa, systemic lupus erythematosis. Cellular and humoral mediated immunity play a major role directed against epithelial and connective tissue in chronic and recurrent patterns. Confirmatory diagnosis can be made by biopsy, direct and indirect immunoflouresence, immune precipitation and immunoblotting. Therapeutic agents should be selected after thorough evaluation of immune status through a variety of tests and after determining any aggravating or provoking factors. Early and appropriate diagnosis is important for proper treatment planning contributing to better prognosis and better quality of life of patient.
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A Paradigm shift in the concept for making dental impressions p. 213
Sanjna Nayar, R Mahadevan
DOI:10.4103/0975-7406.155910  
Digital dental impression is a revolutionary technological advancement that so surpasses the accuracy and efficiency of former techniques for obtaining replicas of prepared teeth for the purpose of fabricating restorations that its adoption by dentists is rapidly eclipsing the use of elastomeric impression materials. The ultimate goals of dentists dedicated to quality restorative dentistry are to make their treatment of patients as accurate, stressless, and efficient as possible. By elimination of the everyday problems described above, there is no question that the significant advantages of digital impressions will make intraoral digital scanning standard procedure in most dental offices within the next several years. Furthermore, digital impressions have proven to reduce remakes and returns, as well as increase overall efficiency. The patient also benefits by being provided a far more positive experience. Finally, through the use of digital impression making, it has been determined that laboratory products become more consistent and require less chair time at insertion.
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Rapid prototyping and stereolithography in dentistry p. 216
Sanjna Nayar, S Bhuminathan, Wasim Manzoor Bhat
DOI:10.4103/0975-7406.155913  
The word rapid prototyping (RP) was first used in mechanical engineering field in the early 1980s to describe the act of producing a prototype, a unique product, the first product, or a reference model. In the past, prototypes were handmade by sculpting or casting, and their fabrication demanded a long time. Any and every prototype should undergo evaluation, correction of defects, and approval before the beginning of its mass or large scale production. Prototypes may also be used for specific or restricted purposes, in which case they are usually called a preseries model. With the development of information technology, three-dimensional models can be devised and built based on virtual prototypes. Computers can now be used to create accurately detailed projects that can be assessed from different perspectives in a process known as computer aided design (CAD). To materialize virtual objects using CAD, a computer aided manufacture (CAM) process has been developed. To transform a virtual file into a real object, CAM operates using a machine connected to a computer, similar to a printer or peripheral device. In 1987, Brix and Lambrecht used, for the first time, a prototype in health care. It was a three-dimensional model manufactured using a computer numerical control device, a type of machine that was the predecessor of RP. In 1991, human anatomy models produced with a technology called stereolithography were first used in a maxillofacial surgery clinic in Viena.
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Fiber reinforced composites in prosthodontics - A systematic review p. 220
Sanjna Nayar, R Ganesh, S Santhosh
DOI:10.4103/0975-7406.155914  
Fiber-reinforced composite (FRC), prostheses offer the potential advantages of optimized esthetics, low wear of the opposing dentition and the ability to bond the prosthesis to the abutment teeth, thereby compensating for less-than-optimal abutment tooth retention and resistance form. These prostheses are composed of two types of composite materials: Fiber-composites to build the substructure and hybrid or micro fill particulate composites to create the external veneer surface. This article reviews the various types of FRCs and its mechanical properties.
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Mandibular advancement device for obstructive sleep apnea: An overview p. 223
S Raghavendra Jayesh, Wasim Manzoor Bhat
DOI:10.4103/0975-7406.155915  
This paper presents an overview of mandibular advancement device (MAD). The primary purpose of MAD is to move the mandible forwards relative to maxilla in ordered to widen the airway to prevent to closure.
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Osseointegration p. 226
Raghavendra S Jayesh, V Dhinakarsamy
DOI:10.4103/0975-7406.155917  
Direct rigid fixation of the implant into jawbones has become an accepted and proven treatment for edentulism. This paper reviews the concept of osseointegration.
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Bupivacaine versus lignocaine as the choice of locall anesthetic agent for impacted third molar surgery a review p. 230
K Balakrishnan, Vijay Ebenezer, Abu Dakir, Saravana Kumar, D Prakash
DOI:10.4103/0975-7406.155921  
One of the most important goal in minor surgical procedures is to achieve proper and sufficient anesthesia and analgesia preoperatively, intraoperatively and in the immediate postoperative period. Several local anesthetic agents have been cited in the literature and studied. Bupivacaine is one of the most common long-acting anesthetic agents being used for surgical removal of impacted third molars. Lignocaine is one of the commonest short-acting anesthetic agents being used for the same procedure. In this review article, the analgesic and anesthetic abilities of the bupivacaine versus lignocaine have been reviewed while surgical removal of impacted third molars.
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Immediate placement of endosseous implants into the extraction sockets p. 234
Vijay Ebenezer, K Balakrishnan, R Vigil Dev Asir, Banu Sragunar
DOI:10.4103/0975-7406.155926  
Implant by definition "means any object or material, such as an alloplastic substance or other tissue, which is partial or completely inserted into the body for therapeutic, diagnostic, prosthetic, or experimental purpose." The placement of a dental implant in an extraction socket at the time of extraction or explantation is known as immediate implant placement whereas delayed placement of implant signifies the implant placement in edentulous areas where healing has completed with new bone formation after the loss of tooth/teeth. Recent idea goes by "why late when it can be done immediately." There are several advantages of immediate placement of implants, and lots of studies have been done. In this article, the advantages and disadvantages of immediate versus delayed placement of implants have been reviewed.
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One point fixation of zygomatic tripod fractures in the zygomatic buttress through Keen's intraoral approach: A review of 30 cases p. 238
Abu Dakir, T Muthumani, NP Prabu, Rakesh Mohan, Abhishek Maity
DOI:10.4103/0975-7406.155934  
For decades, facial beauty and esthetics have been one of the most important quests of the human race. The lateral prominence and convexity of the zygomatic bone makes it the most important bone for providing the aesthetic facial look and sets up the facial width but at the same time this prominence and convexity makes this bone more vulnerable to injury. Zygomatic complex fractures or tripod fractures are the second most common fractures after nasal fractures among facial injuries. Several studies have been undertaken regarding the reduction and fixation of zygomatic fractures with mini plates and screws. In 2002 Fujioka et al in vivo studies successfully proved that one point fixation at the zygomaticomaxillary complex gives three point alignment and sufficient rigidity when the fractures are not comminuted. In this article, 30 cases have been reviewed with one point fixation of zygomatic complex tripod fractures at the zygomatic buttress through Keen's intraoral approach along with advantages and disadvantages.
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Management of tripod fractures (zygomaticomaxillary complex) 1 point and 2 point fixations: A 5-year review p. 242
K Balakrishnan, Vijay Ebenezer, Abu Dakir, Saravana Kumar, D Prakash
DOI:10.4103/0975-7406.155937  
The zygomaticomaxillary complex (ZMC) plays a key role in the structure, function, and esthetic appearance of the facial skeleton. They can account for approximately 40% of mid-face fractures. They are the second most common facial bone fracture after nasal bone injuries. The fracture complex results from a direct blow to the malar eminence and results in three distinct fracture components that disrupt the anchoring of the zygoma. In addition, the fracture components may result in impingement of the temporalis muscle, trismus (difficulty with mastication) and may compromise the infraorbital foramen/nerve resulting in hypesthesia within its sensory distribution. A 4-year retrospective review of all patients treated with ZMC fractures at oral and maxillofacial surgery department, sree balaji dental college and hospital was performed. Computed tomography scans were reviewed. Demographics, treatment protocols, outcomes, complications, reoperations, and length of follow-up were identified. A total of 245 patients was identified by the Current Procedural Terminology codes for ZMC fractures. Closed or open reduction methods were performed with the goal of treatment being preservation of normal facial structure, sensory function, globe position, and mastication functionality. Unacceptably poor surgical outcomes are uncommon. Significant facial asymmetry requiring surgical revision occurs in 3-4% of patients. Postoperative infection rates are extremely low, and these infections nearly always resolve with oral antibiotics. In general, the long-term prognosis after repair of ZMC fractures is very good.
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Nitrousoxide as a conscious sedative in minor oral surgical procedure p. 248
Rakesh Mohan, Vigil Dev Asir, Shanmugapriyan , Vijay Ebenezr, Abu Dakir, Balakrishnan , Jeffin Jacob
DOI:10.4103/0975-7406.155939  
Nitrous oxide (N 2 O) is the most commonly used inhalation anesthetic in dentistry and is commonly used in emergency centers and ambulatory surgery centers as well. When used alone, it is incapable of producing general anesthesia reliably. However, as a single agent, it has an impressive safety and is excellent for providing minimal and moderate sedation for apprehensive minor oral surgical procedure. In this article, action of N 2 O in overcoming the anxiety and pain of the patient during the minor oral surgery and its advantages and disadvantages, have been reviewed.
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The incidence of cysts and tumors associated with impacted third molars p. 251
AT Vigneswaran, S Shilpa
DOI:10.4103/0975-7406.155940  
Incidence of cysts and tumors associated with lower impacted third molars are very low prevalence, which might be because of the fact that most pathologies go unnoticed as many practitioners discard the erupted tissue after surgical removal of the impacted teeth rather than sending the tissue for histopathological examination. Our aim was to evaluate the patients who came for third molar surgical removal with due therapeutic prophylacis and an incidental finding. A proper study protocol both inclusion and exclusion criteria was strictly followed for all the cases, which were included in the study. The period of study was 6 years and the total number of cases assessed were 2778 patients out of which 70 cases reported pathology associated with the impacted third molars. Among 70 cases 61.4% were reported as cyst and tumors and 38.6% of the cases had chronic inflammatory reaction, including two cases with normal dental follicle. High incidence rate of pathology associated with third molar occurred between age group of 20 and 30 years older age groups showed very low incidence. Most common site of impaction was found to be left side of mandible and positions were vertical and distoangular impactions. Thus was male predominance in the younger groups. The examination is necessary whether the third molars impacted cases were symptomatic or asymptomatic
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Benefits of Aloe vera in dentistry p. 255
SP Mangaiyarkarasi, T Manigandan, M Elumalai, Priyanka K Cholan, Roopam Pal Kaur
DOI:10.4103/0975-7406.155943  
Aloe vera (Aloe barbadensis) is a plant that belongs to Liliaceae family. The name Aloe derives from the Arabic word "Alloeh" meaning shining bitter substance while "vera" in Latin means true. It contains various minerals and vitamins. It has got various properties such as immunomodulatory, antiviral and antiinflammatory in nature. A. vera can play a significant role in dentistry in treatment of lichen planus, oral submucous fibrosis, recurrent aphthous stomatitis, alveolar osteitis, periodontitis, etc.
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Forensic radiology in dentistry p. 260
T Manigandan, C Sumathy, M Elumalai, S Sathasivasubramanian, A Kannan
DOI:10.4103/0975-7406.155944  
Radiography can play an important part in forensic odontology, mainly to establish identification. This may take the precise form of comparison between antemortem and postmortem radiographs. Radiographs may also be taken to determine the age of a minor victim and even help in the assessment of the sex and ethnic group. Comparable radiographs are an essential factor to confirm identification in a mass disaster.
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Bruxism: Conceptual discussion and review p. 265
RV Murali, Priyadarshni Rangarajan, Anjana Mounissamy
DOI:10.4103/0975-7406.155948  
Bruxism is commonly considered a detrimental motor activity, potentially causing overload of the stomatognathic structures. The etiology of bruxism is unclear, but the condition has been associated with stress, occlusal disorders, allergies and sleep positioning. Due to its nonspecific pathology, bruxism may be difficult to diagnose. Unfortunately, very little data exists on the subject of a cause-and-effect relationship of bruxism to the point that expert opinions and cautionary approaches are still considered the best available sources for suggesting good practice indicators. The present paper reviewed current concepts on bruxism, etiology, diagnosis and management, underlining its effects on dental structures in an attempt to provide clinically useful suggestions based on scientifically sound data.
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Smile: A review p. 271
WS Manjula, MR Sukumar, S Kishorekumar, K Gnanashanmugam, K Mahalakshmi
DOI:10.4103/0975-7406.155951  
"Beauty is in the mind of the beholder, each mind perceives a different beauty" famously said by writer Margeret Wolfe Hungerford. A beautiful smile is a gateway to the world. The aim of this article was to identify the criteria for designing the perfect smile. It was determined, smile design is a multifactorial process and various steps are involved in designing a radiant smile.
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DENTAL SCIENCE - CASE REPORTS Top

Aggressive granular cell ameloblastoma: Report of a rare case p. 276
N Aravindha Babu, S Leena Sankari, N Anitha, Gouse Mohideen
DOI:10.4103/0975-7406.155955  
Granular cell ameloblastoma is a slow growing odontogenic ectodermal tumor. The tumor shows typical ameloblastoma with the cells showing eosinophilic granularity. This variant of ameloblastoma is aggressive with high recurrence rates. We report a case of aggressive ameloblastoma of granular cell variant
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Loop connectors in dentogenic diastema p. 279
Sanjna Nayar, Raghevendra Jayesh, Venkateshwaran , V Dinakarsamy
DOI:10.4103/0975-7406.155956  
Patients with a missing tooth along with diastema have limited treatment options to restore the edentulous space. The use of a conventional fixed partial denture (FPD) to replace the missing tooth may result in too wide anterior teeth leading to poor esthetics. Loss of anterior teeth with existing diastema may result in excess space available for pontic. This condition presents great esthetic challenge for prosthodontist. If implant supported prosthesis is not possible because of inadequate bone support, FPD along with loop connector may be a treatment option to maintain the diastema and provide optimal esthetic restoration. Here, we report a clinical case where FPD along with loop connector was used to achieve esthetic rehabilitation in maxillary anterior region in which midline diastema has been maintained.
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Enhanced aesthetics with all ceramics restoration p. 282
Sanjna Nayar, U Aruna, Wasim Manzoor Bhat
DOI:10.4103/0975-7406.155957  
The demand for the dentist to achieve excellence in esthetics and function has driven modern advances in materials and restoration fabrication. The development of various casting alloys and precise casting systems has contributed to the successful use of metal-based restorations. However, patient requests for more aesthetic and biologically "safe" materials that have led to an increased demand for metal-free restorations. The following case presentation illustrates a successful aesthetic and functional application of this exciting computer-aided design/computer-aided manufacturing-digital zirconia-based system for a natural smile.
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Expanding digits of a maxillofacial prosthodontist p. 285
Sanjna Nayar, U Aruna, Santhosh
DOI:10.4103/0975-7406.155958  
Complete or partial loss of a finger is the most commonly encountered problem in prosthetic dentistry. The etiology of missing digit may either be congenital or acquired. Trauma is the most common cause for acquired defect of the digit. Loss of a digit results in functional and psychological impact on quality-of-life of the patient. This article portrays about the prosthetic management of a patient with an acquired defect of finger
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Combination restoration in full mouth rehabilitation p. 288
Sanjna Nayar, S Bhuminathan, R Mahadevan
DOI:10.4103/0975-7406.155959  
Successful restoration of the dentition requires plenty of contemporary and conventional treatment techniques and planning and attachment retained partial dentures are one such kind of treatment modality in prosthodontics. Satisfactory restoration in a patient with a partially edentulous situation can be challenging especially when unilateral or bilateral posterior segment of teeth is missing. One such treatment modality is attachment-retained cast partial dentures. The purpose of this article is to provide an overview of a case with maxillary complete denture and opposing cast partial denture with precision attachment.
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Treatment of calcifying epithelial odontogenic tumor/Pindborg tumor by a conservative surgical method p. 291
T Vigneswaran, R Naveena
DOI:10.4103/0975-7406.155961  
Calcifying epithelial odontogenic tumor (CEOT) also known as Pindborg tumor is a rare odontogenic epithelial neoplasm. So far nearly 200 cases have been reported in literature. We are reporting a case of CEOT in a 42-year-old male patient with painless bony swelling in the mandible. Approximately, 50% of the cases are associated with an unerupted tooth or odontome, but was not so with our case. Considering the intrabony mandibular location of the lesion and its limited size, we opted for a more conservative surgery. The clinical, radiographic and histopathologic features and the surgical treatment done are discussed with relevant references.
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Role of dietary habits and diet in caries occurrence and severity among urban adolescent school children p. 296
VC Punitha, A Amudhan, P Sivaprakasam, V Rathanaprabu
DOI:10.4103/0975-7406.155963  
To identify the role of dietary habits (type of diet, skipping meals, snacking in-between meals and frequency of visits to fast food restaurants) in caries occurrence and severity. To explore the correlation between frequency of intake of selected foods and dental caries. A cross-sectional study was carried out on adolescent children (n = 916) of age 13-19, following a two-stage random sampling technique. Data were collected using a pretested questionnaire. Questionnaire included demographic details, dietary habits of children and food frequency table that listed selected food items. The dependent variable-dental caries was measured using the decayed, missing, filled teeth (DMFT) index. The prevalence of dental caries in this study population was 36.7% (95% confidence interval: 33.58-39.82). The mean DMFT was 1.01 (±1.74). No statistically significant difference found between caries occurrence and type of diet (P = 0.07), skipping meals (P = 0.86), frequency of eating in fast food stalls (0.86) and snacking in between meals (0.08). Mean DMFT values were higher among nonvegetarians and among children who had the habit of snacking in between meals. Frequency of intake of selected food items showed that mean frequency intake of carbonated drinks and confectionery was higher among children who presented with caries when compared to caries-free children (P = 0.000). Significant correlation found between mean DMFT and mean frequency intake of carbonated drinks and confectionery. Odds ratios were calculated for the same for frequency ≥4 times/day for confectionery and ≥4/week for carbonated drinks and results discussed. Frequent intake of carbonated drinks and confectionery is harmful to oral health that eventually reflects on general health. Educating the adolescent children on healthy dietary habits should be put in the forefront.
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Transparent aligners: An invisible approach to correct mild skeletal class III malocclusion p. 301
A Arif Yezdani
DOI:10.4103/0975-7406.155965  
This case report highlights the treatment of a mild skeletal class III malocclusion with an invisible thermoplastic retainer. A 15-year-old female patient presented with a mild skeletal class III malocclusion with a retrognathic maxilla, orthognathic mandible, a low mandibular plane angle with Angle's class III malocclusion with maxillary lateral incisors in anterior cross-bite with crowding of maxillary anteriors, imbricated and rotated mandibular incisors and deep bite. Accurate upper and lower impressions and a bite registration were taken with polyvinyl siloxane rubber base impression material. This was then sent to the lab for the processing of a series of ClearPath aligners. The ClearPath virtual set-up sent from the lab provided the treatment plan and interproximal reduction estimation complete with posttreatment results. This enabled the clinician to actively participate in the treatment plan and provide the necessary suggestions. The ClearPath three-dimensional aligner was found to have effectively corrected the anterior cross-bite and crowding of the maxillary anteriors.
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Solitary median maxillary central incisor: A case report of a rare dental anomaly p. 307
Deepak Chandrasekaran, Arif Yezdani, Faizal Tajir, B Saravanan, L Rajasekar
DOI:10.4103/0975-7406.155968  
The solitary median maxillary central incisor (SMMCI) syndrome is a rare dental anomaly and has an incidence of 1:50,000 live births. In SMMCI, there is only one central incisor present, and it develops exactly at the midline. SMMCI occurrence has been described with growth hormone deficiency or other structural anomalies in the midline of the body. In this case, the 8-year-old female patient reported a single median maxillary central incisor with missing maxillary and mandibular frena, with apparently no other abnormalities. Early diagnosis and recognition of SMMCI are important for all practicing Orthodontists, as it may be a sign of other severe congenital or developmental abnormalities.
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A rare case of impacted supernumerary premolar causing resorption of mandibular first molar p. 309
RV Murali, K Gnanashanmugam, L Rajasekar, BS Kularashmi, B Saravanan
DOI:10.4103/0975-7406.155971  
The management of patients with pain in today's general practice has become a major concern and sometimes this pain is related to some rare causes. A male patient aged 26 years reported with pain in the lower left molar region (36) and then an intra-oral periapical radiograph (IOPA), and orthopantomograph was taken. IOPA revealed the presence of supernumerary premolar causing pressure and root resorption of 36. Also, there was missing 21 and proximal decay in 11. Eleven was treated endodontically, and then bridge was done in relation to 11, 21 and 22. Lower anterior crowding was also present. The treatment plan was to extract 36 followed by orthodontic extrusion of the supernumerary premolar and also the correction of lower anterior crowding. Hidden approach (lingual orthodontics) was used as the patient was insisting upon the braces not being seen outside during the course of the treatment. Later all ceramic bridge was done in relation to 11, 21 and 22. Orthodontic tooth extrusion techniques offer excellent treatment options for Partially Impacted tooth. It is a well-documented clinical method for extruding sound tooth material from within the alveolar socket by light forces. The use of lingual technique for forced eruption enhance acceptance of orthodontic treatment by adults. The treatment of a young adult patient illustrates the importance of treatment planning from one discipline to another, communication among team members and the benefits of working together in an interdisciplinary approach
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Gnathological splint therapy in temporomandibular joint disorder p. 314
K Gnanashanmugham, B Saravanan, MR Sukumar, T Faisal Tajir
DOI:10.4103/0975-7406.155972  
Temporomandibular joint (TMJ) forms an integral functional part of stomatognathic system. Position, shape, structure and function of teeth have an influence on the proper functioning and health of TMJ. But a problem associated with TMJ is often neglected, and treatment for it is mostly restricted to palliative therapy. A proper understanding of the underlying cause of temporomandibular joint disorder (TMD) is necessary to device a proper treatment plan. Etiology of TMDs varies from idiopathic reasons to systemic disorders. The option of Gnathological splint is a conservative, safe and an effective mode of therapy for TMDs caused by occlusal discrepancies (fulcrum/interferences). This article presents a case report of a patient with TMD caused by occlusal discrepancy
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