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   Table of Contents - Current issue
October 2016
Volume 8 | Issue 5 (Supplement)
Page Nos. 1-192

Online since Wednesday, October 12, 2016

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Medical ethics p. 1
Aji Markose, Ramesh Krishnan, Maya Ramesh
Mutual trust and relationship between doctors and patients is an important factor of treatment plan. Changing trends in medical field does affect this relationship. This article reviews the basic code of conduct for every medical practitioner.
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Quick, painless, and atraumatic gingival retraction: An overview of advanced materials p. 5
M Aarti Rajambigai, S Ramesh Raja, S I. Joephin Soundar, M Kandasamy
The success of any fixed prosthesis depends on the accuracy of impressions. Finish line exposure has to be adequate during impression making. The goal of gingival retraction is to atraumatically displace gingival tissues to allow access for impression material to record the finish line and provide sufficient thickness of gingival sulcus so that the impression does not tear off during removal. Numerous advanced materials are available for gingival retraction. This article describes the different advanced materials available.
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Overview of immunology of oral squamous cell carcinoma p. 8
Anisha Cynthia Sathiyasekar, Pavithra Chandrasekar, Arul Pakash, KU Goma Kumar, MS Jaishlal
Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy and is a major cause of cancer morbidity and mortality worldwide. Every year, approximately 500,000 new cases of oral and pharyngeal cancers are diagnosed worldwide, and a majority of these cases are seen in developing countries. OSCC arises as a result of multiple molecular events that develop from the combined influences of an individual's genetic predisposition and exposure to environmental carcinogens. Here, we discuss the course of immunological development involving OSCC. We have reviewed a literature available in Medline and Google databases. We draw attention to possible shortcomings and issues requiring clarification. Emphasis is given to precise immunology involving the OSCC. In this article, we try to approach the immunology of OSCC through a practical approach consideration of common difficulties and dilemmas faced by the oral pathologist, and where possible, we offer guidance and practical tips. The article concludes with a brief consideration of the prognostic value of immunology involving the OSCC.
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Adjunctive aids for the detection of oral premalignancy Highly accessed article p. 13
D Charanya, LP Raghupathy, Amjad Fazeela Farzana, R Murugan, R Krishnaraj, G Kalarani
Early detection of cancer greatly decreases the morbidity and mortality rates and thereby increases the 5-year survival rates. In developing countries like India where the disease is highly prevalent focus is mainly on decreasing the mortality rates which can be easily achieved by detection at an asymptomatic stage. Visual examination has been the standard screening method for screening oral cancer through several decades, and it is well known that conventional visual examination is limited to subjective interpretation and cannot be easily achieved in certain anatomical sites. As a solution to all these adjunctive techniques have emerged, and it has been widely used. An effort is made through this paper to review the most commonly used adjunctive aids for the detection of premalignancy and cancer.
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Implant-based overdenture: A review in patient perspective p. 20
R Krishnaraj, R Murugan, N Krishna Meera, P Laksmipathy, CS Krishnan, I Packiaraj
A review in affected person's attitude in abstract care of edentulous patients has to be a priority in elderly individuals. The development of complete dentures (CDs) has been the selection of remedy retaining in mind the socioeconomic popularity, age, and nutritional elements. However, most of the patients complain of loss of retention in mandibular implant-supported overdentures (ODs), which compensated the downside of the loss of retention in complete dentures (CDs). Moreover, implant supported over dentures (ISOVDs) supplied accurate exceptional of lifestyles, esthetics, progressed nutritional deficiencies, and provided good patient satisfaction. The place of dental implants and desire of retentive attachments for implant supported mandibular over dentures (ISOVD) are selected on clinician preference and professional opinion. This text offers a fundamental statistics regarding implant placement, mode of treatment to be selected, and patient care. Two implants provide extraordinary long-term achievement and survival with improved oral capabilities. Single midline implant OD is costly, powerful, and may be a promising alternative. In maxilla, 4–6 implants splinted with bar have located to give true results.
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Induced pluripotent stem cells in dentistry p. 23
Paramel Mohan Sunil
Induced pluripotent stem cells (iPSCs), a path-breaking invention, have revolutionized the regenerative medicine field. The biggest advantage of this technology is its patient-specific nature and so it is nonimmunogenic. It involves autologous tissues with limitless source of cells throughout life. The Nobel-winning concept involves the reprograming of terminally differentiated cells by external factors and has a tremendous role in the treatment of genetic disorders, regeneration of tissues, drug discovery, and disease modeling. This short review aims at the probable applications of iPSC technology in dentistry with respect to regeneration of oral and maxillofacial tissues and also its role in oral malignancies.
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Antibiotics in dental implants: A review of literature p. 28
Hemchand Surapaneni, Pallavi Samatha Yalamanchili, Md Hafeez Basha, Sushma Potluri, Nirupa Elisetti, MV Kiran Kumar
The routine use of antibiotics in oral implant treatment seems to be widespread. The pre- or post-operative use of antibiotics in conjunction with implant surgery and its correlation with failure and success rates are poorly documented in the literature. The debate regarding overprescription of antibiotics raises the need for a critical evaluation of proper antibiotic coverage in association with implant treatment. The benefits of prophylactic antibiotics are well-recognized in dentistry. However, their routine use in the placement of endosseous dental implants remains controversial. The purpose of this review is to know the efficacy of antibiotic prophylaxis in implant dentistry.
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Endodontic management of patients with systemic complications p. 32
Kalaiselvam Rajeswari, Deivanayagam Kandaswamy, Soundararajan Karthick
Successful endodontic practice requires complete knowledge about the various medical conditions and appropriateness in planning treatment as per the need with effective safety measures. This review focuses on a number of systemic complications encountered in endodontic practice and directions to be followed for avoiding potential complications. A detailed PubMed search was carried out using specific keywords, and 25 articles were referred for finalizing the content.
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Role of plasma-rich fibrin in oral surgery p. 36
K Retna Kumar, K Genmorgan, SM Abdul Rahman, M Alaguvel Rajan, T Arul Kumar, V Srinivas Prasad
Platelet-rich fibrin (PRF) is a fibrin meshwork, in which platelet cytokines, growth factors, and cells are entrapped and discharged after a period and can serve as a resorbable film. PRF is the next generation of platelet concentrates equipped to improve arrangement without biochemical blood handling; PRF is an evolution of the fibrin adhesive, which is widely used in the oral surgery. The guidelines of this innovation depend on concentrating platelets and growth factors in a plasma medium, and initiating them in a fibrin gel, keeping in mind the end goal to enhance the healing of wounds. Maxillary bone loss requires numerous regenerative techniques: as a supplement to the procedures of tissue regeneration, a platelet concentrate called PRF was tested for the 1st time in France by Dr. Choukroun. This article enriches the benefits and role of plasma-rich fibrin in oral surgery. Platelet-concentrate fibrin is an evolution of the fibrin glue, which is widely used in the oral surgery.
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Bone morphogenetic proteins: Signaling periodontal bone regeneration and repair p. 39
G Sai Anusuya, M Kandasamy, SA Jacob Raja, S Sabarinathan, P Ravishankar, Balu Kandhasamy
Bone morphogenetic proteins (BMPs) are a group of growth factors also known as cytokines and as metabologens. Originally discovered by their ability to induce the formation of bone and cartilage, BMPs are now considered to constitute a group of pivotal morphogenetic signals, orchestrating tissue architecture throughout the body. The important functioning of BMP signals in physiology is emphasized by the multitude of roles for dysregulated BMP signaling in pathological processes. A study done wherein it was found that protein extracts from bone implanted into the animals at nonbone sites induced the formation of new cartilage and bone tissue. This protein extract contained multiple factors that stimulated bone formation and was termed as “BMP.” There are at least 15 different BMPs identified to date and are a part of the transforming growth factor-β super family. The most widely studied BMPs are BMP-2, BMP-3 (osteogenin), BMP-4, and BMP-7 (osteogenic protein-1). Now, any recombination type of morphogenic proteins have been synthesized, for example - recombinant human BMPs.
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A comparison of the sealing ability of various temporary restorative materials to seal the access cavity: An in vitro study p. 42
Aji Markose, Ramesh Krishnan, Maya Ramesh, Shishir Singh
Introduction: In multiple-appointment root canal treatment, a temporary filling material is used to seal the access cavity between visits. The primary function of this material is to prevent the contamination of the root canal system by fluids, organic debris, and bacteria from the oral cavity. Material and Methods: A total of fifty extracted noncarious unrestored human maxillaryanterior teeth with intact crowns and roots were selected The canals were instrumented using stepback technique and sodium hypochlorite (3%) and hydrogen peroxide (3%) were used as irrigants for each specimen alternatively. The coronal two-thirds of each canal were flared using Gates-Glidden drills up to no. 3 size and obturated with Gutta-percha using zinc oxide-eugenol (ZnOE) as sealer. The teeth were then randomly selected and divided into six groups out of which four were experimental groups and two control groups. The teeth were then immersed in 2% methylene blue dye solution for 3 days. All sealing materials and Gutta-percha were gently removed from the walls of the canal, and the entire circumference of the canal wall examined for dye penetration. Results: The lowest mean leakage was in the Fermit-N group followed by Cavit-W, ZnOE, intermediate restorative materials (IRM), and positive control. Conclusion: Fermit-N showed better sealing ability compared to cavit, ZnOE and IRM.
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Evaluation of efficacy of probiotic (BIFILAC) on Porphyromonas gingivalis: In vitro study p. 45
Sugumari Elavarasu, Thangakumaran Suthanthiran, Arthiie Thangavelu, Shiva Shangkharii Kanagaraj, Lakshmi Mohandas, Santhosh Sekar
Background: Periodontitis is inflammation of the periodontium and causes destruction of the connective tissue attachment of the teeth and alveolar bone. Porphyromonas gingivalis is the primary pathogen for the destructive periodontal diseases. The aim of the study is to evaluate the efficacy of probiotic on P. gingivalis . Materials and Methods: An in vitro study was done to analyze the effectiveness of probiotic BIFILAC on P. gingivalis was determined using disc diffusion method. The minimum inhibitory concentration for BIFILAC lozenges was also determined using microdilution method. Results: In disc diffusion method, the antibacterial activity of BIFILAC was analyzed using various concentrations such as 2.5, 5, 10, and 20 μg/ml, of which 20 μg/ml was proved to have a maximum inhibitory zone of 22 mm. In microdilution method, concentration ranging from 7.25 to 100 μg/ml was used and 25 μg/ml was found to have the minimum inhibitory effect on P. gingivalis . Conclusion: The present in vitro study confirms that probiotic BIFILAC has an antimicrobial effect against P. gingivalis . Thus, proving that BIFILAC probiotic can be used as an adjunctive therapeutic modality in periodontitis.
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Evaluation of superoxide dismutase levels in local drug delivery system containing 0.2% curcumin strip as an adjunct to scaling and root planing in chronic periodontitis: A clinical and biochemical study p. 48
Sugumari Elavarasu, Thangakumaran Suthanthiran, Arthiie Thangavelu, Sanjay Alex, Vijaya Kumar Palanisamy, Tamil Selvan Kumar
Aim: Curcumin has proven properties such as anti-inflammatory, antioxidant, antimicrobial, and it also accelerates wound healing. The purpose of this study was to investigate the level of superoxide dismutase (SOD) enzyme, in gingival crevicular fluid (GCF), and the impact of nonsurgical treatment on the antioxidant profile using 0.2% curcumin strip as local drug delivery. Materials and Methods: A total of twenty subjects of age 35–55 years and 15 subjects with chronic periodontitis, each with bilateral 5–6 mm probing pocket depth, were selected for this study. Healthy group consists of 5 sites in which no bleeding on probing, no pocket depth. Group I – It consists of 15 sites with chronic periodontitis, in which scaling and root planing (SRP) was done (control group). Group II – It consists of 15 sites, in which SRP followed by the placement of curcumin strip inside the pocket (SRP + curcumin strip) (test group). GCF collection was done preoperatively and postoperatively after 21 days. The SOD activity was assessed using enzyme-linked immunosorbent assay. Results: In this study, all the clinical parameters were significantly reduced in test and control sites. Further, SOD levels were significantly improved in test sites when compared with control sites. Conclusion: Thus, the present study concluded that curcumin strip can be effectively used as an adjunct to SRP in treatment of chronic periodontitis and serves as antioxidant in subgingival environment.
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Attitude and awareness of general dental practitioners toward radiation hazards and safety p. 53
BS Aravind, E Tatu Joy, M Shashi Kiran, J Eugenia Sherubin, S Sajesh, P Redwin Dhas Manchil
Aim and Objective: The aim and objective is to evaluate the level of awareness and attitude about radiation hazards and safety practices among general dental practitioners in Trivandrum District, Kerala, India. Materials and Methods: A questionnaire-based cross-sectional study was conducted among 300 general dental practitioners in Trivandrum District, Kerala, India. Postanswering the questions, a handout regarding radiation safety and related preventive measures was distributed to encourage radiation understanding and protection. Statistical Analysis: Statistical analysis were done by assessing the results using Chi-square statistical test, t -test, and other software (Microsoft excel + SPSS 20.0 trail version). Results: Among 300 general practitioners (247 females and 53 males), 80.3% of the practitioners were found to have a separate section for radiographic examination in their clinics. Intraoral radiographic machines were found to be the most commonly (63.3%) used radiographic equipment while osteoprotegerin was the least (2%). Regarding the practitioner's safety measures, only 11.7% of them were following all the necessary steps while 6.7% clinicians were not using any safety measure in their clinic, and with respect to patient safety, only 9.7% of practitioners were following the protocol. Conclusion: The level of awareness of practitioners regarding radiation hazards and safety was found to be acceptable. However, implementation of their knowledge with respect to patient and personnel safety was found wanting. Insisting that they follow the protocols and take necessary safety measures by means of continuing medical education programs, pamphlets, articles, and workshops is strongly recommended.
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Management of gingival recession with acellular dermal matrix graft: A clinical study p. 59
VR Balaji, T Ramakrishnan, D Manikandan, R Lambodharan, B Karthikeyan, Thanvir Mohammed Niazi, G Ulaganathan
Aims and Objectives: Obtaining root coverage has become an important part of periodontal therapy. The aims of this studyare to evaluate the clinical efficacy of acellular dermal matrix graft in the coverage of denuded roots and also to examine the change in the width of keratinized gingiva. Materials and Methods: A total of 20 sites with more than or equal to 2 mm of recession depth were taken into the study, for treatment with acellular dermal matrix graft. The clinical parameters such as recession depth, recession width, width of keratinized gingiva, probing pocket depth (PD), and clinical attachment level (CAL) were measured at the baseline, 8th week, and at the end of the study (16th week). The defects were treated with a coronally positioned pedicle graft combined with acellular dermal matrix graft. Results: Out of 20 sites treated with acellular dermal matrix graft, seven sites showed complete root coverage (100%), and the mean root coverage obtained was 73.39%. There was a statistically significant reduction in recession depth, recession width, and probing PD. There was also a statistically significant increase in width of keratinized gingiva and also gain in CAL. The postoperative results were both clinically and statistically significant (P < 0.0001). Conclusion: The results of this study were esthetically acceptable to the patients and clinically acceptable in all cases. From this study, it may be concluded that acellular dermal matrix graft is an excellent substitute for autogenous graft in coverage of denuded roots.
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Bone density assessment for evaluation of gender differences in cervical vertebral maturation: A computed tomography study p. 65
K Usha, Balashanmugam Baskaranarayanan, D Nagarajan, R Selvarani, M Vijjaykanth
Introduction: The cervical vertebral maturation (CVM) method is a vital tool for assessing the biological maturation of the orthodontic patient to evaluate the amount of mandibular bone growth left. Aim: To assess and visualize the cervical vertebral morphology (bone density) of orthodontic patients of the age group 9,16,27 years. Material and Methods: Twenty four subjects with age group of 9,16,27 who were randomly selected and subjected to 3d tomographic study to estimate the biological age of the orthodontic patients by analyzing c1 c2 and c3 vertebrae. Result: The results showed that bone density of males is lesser than females in 9 and 16 years, whereas they have more bone density than females in 27 years. Conclusion: The study provides qualitative method of assessing the biological age of the patient by using images of cervical vertebrae by three dimensional approach. Hence it can be useful for orthodontic diagnosis and treatment plan.
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Comparison and ranking of superelasticity of different austenite active nickel-titanium orthodontic archwires using mechanical tensile testing and correlating with its electrical resistivity p. 71
D Nagarajan, Balashanmugam Baskaranarayanan, K Usha, MS Jayanthi, M Vijjaykanth
Introduction: The application of light and continuous forces for optimum physiological response and the least damage to the tooth supporting structures should be the primary aim of an orthodontist. Nickel-titanium (NiTi) alloys with their desirable properties are one of the natural choices of the clinicians. Aim: This study was aimed to compare and rank them based on its tensile strength and electrical resistivity. Materials and Methods: The sample consisted of eight groups of 0.017 inch × 0.025 inch rectangular archwires from eight different manufacturers, and five samples from each group for tensile testing and nine samples for electrical resistivity tests were used. Data for stress at 10% strain and the initial slope were statistically analyzed with an analysis of variance and Scheffe tests with P < 0.05. The stress/strain plots of each product were ranked for superelastic behavior. The rankings of the wires tested were based primarily on the unloading curve's slope which is indicative of the magnitude of the deactivation force and secondarily on the length of the horizontal segment which is indicative of continuous forces during deactivation. For calculating the electric resistivity, the change in resistance after inducing strain in the wires was taken into account for the calculation of degree of martensite transformation and for ranking. Results: In tensile testing Ortho Organizers wires ranked first and GAC Lowland NiTi wires ranked last. For resistivity tests Ormco A wires were found superior and Morelli remained last. Conclusion: these rankings should be correlated clinically and need further studies.
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Effect of anti-asthmatic drugs on dental health: A comparative study p. 77
P Chellaih, G Sivadas, S Chintu, VK Vaishnavi Vedam, Rajeev Arunachalam, M Sarsu
Aims: Bronchial asthma constitutes important problem worldwide. This chronic lung disease has detrimental effect in the oral cavity like reduction of salivary secretion, change in salivary composition and pH. Materials and Methods: This study was conducted to compare the prevalence of dental caries in asthmatic children and healthy children, and also to evaluate the correlation between the Streptococcus mutans , Lactobacillus and dental caries in both the groups. Results: In this study, the mean decayed, missing, filled teeth score of children in the study group was (4.53 ± 3.38) higher than the control group (1.51 ± 1.58) (P < 0.01). The S. mutans count of the study group was (59574.47 ± 28510.67) higher than the control group (19777.78 ± 17899.83) P < 0.01. The Lactobacillus count in study group was (43553.19 ± 58776.96) higher than the control group (8843.84 ± 7982.72) P < 0.01. Subjects using inhaled corticosteroids were more prone to develop dental caries than the control group with odds ratio = 6.26 and 95% confidence interval. Conclusions: The dental caries prevalence increases with the usage of β2agonist and corticosteroid inhalers for the treatment of asthma. Thus in asthmatic children, increase in caries prevalence might be due to the drug treatment and not due to the disease by itself. It can be concluded that asthmatic children have a higher prevalence of dental caries than healthy children. Hence, special oral health care is needed for asthmatic children.
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A comparative evaluation of microleakage of restorations using silorane-based dental composite and methacrylate-based dental composites in Class II cavities: An in vitro study p. 81
Jambai Sampath Kumar Sivakumar, AS Prasad, Saravanapriyan Soundappan, N Ragavendran, R Ajay, Krishnamoorthy Santham
Aim: The aim of this in vitro study was to evaluate and compare the microleakage of restorations using low shrinkage silorane-based dental composite and methacrylate-based dental composites in Class II cavity at the occlusal and gingival margins. Materials and Methods: Sixty mandibular molars were collected and divided into three experimental groups and one negative control group. Class II slot cavity was prepared on the mesial surface. Experimental groups were restored with Group I: silorane-based microhybrid composite, Group II: methacrylate-based nanohybrid composite, and Group III: Methacrylate-based microhybrid composite, respectively. Group IV: negative control. The samples were thermocycled, root apices were sealed with sticky wax and coated with nail varnish except 1 mm around the restoration. This was followed by immersion in 2% Rhodamine-B dye solution under vacuum at room temperature for 24 h. Then, the samples were sectioned longitudinally in the mesiodistal direction and evaluated under stereomicroscope ×40 magnification. Scoring was done according to the depth of dye penetration in to the cavity. Statistical analysis of the data was done. Results: The results were that no statistically significant difference in the microleakage at the occlusal margin for all the restorative materials, whereas at the gingival margin, silorane-based microhybrid composite showed less microleakage than the methacrylate-based nano- and micro-hybrid composites. Conclusion: In general, silorane-based microhybrid composite had less microleakage among the other materials used in this in vitro study.
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A randomized triple-blind clinical trial to compare the effectiveness of topical triamcinolone acetonate (0.1%), clobetasol propionate (0.05%), and tacrolimus orabase (0.03%) in the management of oral lichen planus p. 86
Shivakumar Sivaraman, Krishnamoorthy Santham, Aruldoss Nelson, Bijaykumar Laliytha, Pandian Azhalvel, John Hearty Deepak
Background: Oral lichen planus (OLP) is believed to result from an abnormal T-cell mediated immune response. The most useful agent in the treatment is corticosteroids. The present study will be aimed at evaluation of therapeutic efficiency of two corticosteroids triamcinolone acetonate (0.1%) and clobetasol propionate with tacrolimus orabase (0.03%), an immunomodulator in the management of OLP. Aim: To compare the effectiveness of topical triamcinolone acetonate (0.1%), clobetasol propionate (0.05%), and tacrolimus orabase (0.03%) in the management of OLP and also to compare which has less recurrence. Study Design: The study comprises 30 patients, all were diagnosed with OLP clinically and histopathologically. They are randomly divided into three groups: Group A - triamcinolone acetonate (0.1%), Group B - clobetasol propionate (0.05%), and Group C - tacrolimus (0.03%). A formal informed consent was obtained from all of them who participated in the study. Results and Conclusion: Subjects in the Group A (triamcinolone 0.1%) and Group B (clobetasol 0.05%) show a significant reduction in lesion size than that of Group C (tacrolimus 0.03%). Group B (clobetasol 0.05%) shows a better significant reduction in lesion size than that of Group A (triamcinolone 0.1%). The overall treatment response was significant better in the Group B (clobetasol 0.05%). No recurrence was observed in any of the three groups at the end of 3 months. It is concluded that clobetasol propionate 0.05% ointment has higher efficacy when compared to triamcinolone acetonide 0.1% ointment and tacrolimus ointment 0.03% in the management of OLP. It was also inferred that triamcinolone 0.1% has better effects than tacrolimus 0.03%.
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Configuration of frontal sinuses: A forensic perspective p. 90
Jhansi Lakshmi Suman, Nallusamy Jaisanghar, Somasundaram Elangovan, Nazargi Mahaboob, Balasubramaniyan Senthilkumar, Thukanayakanpalayam Ragunathan Yoithapprabhunath, Kenniyan Kumar Srichinthu
Background: Identification of an individual whether living or deceased is of paramount importance in maintaining the integrity of the society. A simple, reliable, and efficacious method always finds a way for easier acceptance and inclusion in any discipline. Likewise, identification of an individual using the radiographic frontal sinus patterns is a simple technique which emphasized to conduct the study with a proven result. Objective: The objective of the study is to evaluate the radiographic configurations of frontal sinuses for their uniqueness based on different parameters. Study Group and Methods: Study group consisted of thirty individuals (15 males and 15 females) of age between 20 and 30. Individuals with the history of sinusitis, surgery, or any trauma were not included in the study. Paranasal sinus views were taken using standard exposure parameters, and the radiographs were assessed for their uniqueness. Results: The radiographs were assessed for area size, area asymmetry, superiority of the upper border, outline of the upper border, presence or absence of partial septa and supraorbital cells, and based on these results, a unique code number was assigned to each individual to prove the uniqueness. Conclusion: A frontal sinus comparison is particularly useful when no other means of an individual identification are available. Caution must be taken regarding the physiological and pathological changes (trauma, infection, old age, surgery, etc.) and postmortem changes and about the technical issues while taking a radiograph (distance, angle, orientation of the skull). In spite of all these issues, the configuration of frontal sinus is an excellent individualizing feature.
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Corrosion resistance of stainless steel, nickel-titanium, titanium molybdenum alloy, and ion-implanted titanium molybdenum alloy archwires in acidic fluoride-containing artificial saliva: An in vitro study p. 96
Venith Jojee Pulikkottil, S Chidambaram, PU Bejoy, PK Femin, Parson Paul, Mohamed Rishad
Objective: (1) To evaluate the corrosion resistance of four different orthodontic archwires and to determine the effect of 0.5% NaF (simulating high fluoride-containing toothpaste of about 2250 ppm) on corrosion resistance of these archwires. (2) To assess whether surface roughness (Ra) is the primary factor influencing the corrosion resistance of these archwires. Materials and Methods: Four different archwires (stainless steel [SS], nickel-titanium [NiTi], titanium molybdenum alloy [TMA], and ion-implanted TMA) were considered for this study. Surface characteristics were analyzed using scanning electron microscopy, atomic force microscopy (AFM), and energy dispersive spectroscopy. Linear polarization test, a fast electrochemical technique, was used to evaluate the corrosion resistance, in terms of polarization resistance of four different archwires in artificial saliva with NaF concentrations of 0% and 0.5%. Statistical analysis was performed by one-way analysis of variance. Results: The potentiostatic study reveals that the corrosion resistance of low-friction TMA (L-TMA) > TMA > NiTi > SS. AFM analysis showed the surface Ra of TMA > NiTi > L-TMA > SS. This indicates that the chemical composition of the wire is the primary influential factor to have high corrosion resistance and surface Ra is only secondary. The corrosion resistance of all wires had reduced significantly in 0.5% acidic fluoride-containing artificial saliva due to formation of fluoride complex compound. Conclusion: The presence of 0.5% NaF in artificial saliva was detrimental to the corrosion resistance of the orthodontic archwires. Therefore, complete removal of residual high-fluorinated toothpastes from the crevice between archwire and bracket during tooth brushing is mandatory.
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Cumulative effect of microwave sterilization on the physical properties of microwave polymerized and conventional heat-polymerized acrylic resin p. 100
S Mohammed Shafeeq, S Karthikeyan, Subash M Reddy, Suma Karthigeyan, R Manikandan, Arthiie Thangavelu
Aims: To evaluate and compare the flexural strength and impact strength of conventional and microwave cured denture base resins before and after repeated sterilization using microwave energy to consider microwave curing as an alternative to the conventional method of sterilization. Materials and Methods: The conventional heat cure acrylic resin (DPI heat cure material) Group A and microwave-polymerized acrylic resin (Vipi Wave Acrylic resin) Group B were used to fabricate 100 acrylic resins samples using a standard metal die of (86 mm × 11 mm × 3 mm) dimensions. The criterion was flexural strength and impact strength testing which had Group A and Group B samples; 50 samples for flexural strength and 50 samples for impact strength measurement. For each criterion, five control samples were taken for Group A and Group B. The samples were stored in water before experimenting. The test samples were subject to four cycles of microwave sterilization; followed by flexural strength testing with a 3-point flexural test in universal testing machine (UNITEK 94100) and impact strength testing with impact testing machine (ENKAY Pr09/E1/16). Results: The physical properties had significant changes for conventionally cured denture base resins, whereas no changes found for microwave-cured resins after repeated sterilization cycles.
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In vitro comparative evaluation of mechanical properties of temporary restorative materials used in fixed partial denture p. 105
D Saisadan, P Manimaran, PK Meenapriya
Introduction: Materials used to fabricate provisional restorations can be classified as acrylics or resin composites. Provisional crows can be either prefabricated or custom made. Acrylics: These materials have been used to fabricate provisional restorations since the 1930s and usually available as powder and liquid. They are the most commonly used materials today for both single-unit and multiple-unit restorations. In general, their popularity is due to their low cost, acceptable esthetics, and versatility. Composites: Composite provisional materials use bis-acryl resin, a hydrophobic material that is similar to bis-GMA. Composites are available as auto-polymerized, dualpolymerized and visible light polymerized. Preformed Crowns: Preformed provisional crowns or matrices usually consist of tooth-shaped shells of plastic, cellulose acetate or metal. They are commercially available in various tooth sizes and are usually selected for a particular tooth anatomy. They are commonly relined with acrylic resin to provide a more custom fit before cementation, but the plastic and metal crown shells can also be cemented directly onto prepared teeth. Aims and Objectives: The aim of this study is to choose a material to serve as a better interim prosthesis and to compare three different properties – flexural strength, compressive strength, and color stability. Materials and Methods: The samples were made with three different provisional materials (Revotek LC, Protemp 4, TemSpan). Result: It was inferred from the study that no one material was superior in all three tested parameters.
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An in vitro study to evaluate the difference in shade between commercially available shade guides and glazed porcelain p. 110
P Manimaran, D Sai Sadan
Introduction: Smile is one of the most important interactive communication skills of a person. A smile is the key factor for an aesthetic appearance. Hence aesthetics is one of the motivating factor for the patients to seek dental care. Correction of unaesthetic appearance gives a positive effect to the self esteem of the patient. Aim: The aim of this study was to compare the difference in the shade between the commercially available shade guides namely Vita Classical And Ivoclar Chromascop and the fired porcelain samples fabricated using Vita Zahnfabrik VMK 95 and Ivoclar Classic Materials respectively. Objectives: The objective of this study was to obtain a matching brand of material that has a particular shade tab among the brands used. Conclusion: To conclude, Ivoclar material matched the chromascop shade guide better than the vita material matched the vita classic shade guide.
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Faulty radiographs: A cross-sectional analysis among dental college students in Namakkal District, Tamil Nadu, India p. 116
S Elangovan, M Nazargi Mahabob, Suman Jaishankar, B Senthil Kumar, Deepika Rajendran
Aim: The aim of this study was to assess the ability of taking and processing of intraoral periapical radiographs (IOPA) by the dental college undergraduate students and also to evaluate the impact of teaching on their skills. Materials and Methods: This study was conducted in the OMRD department. Final year students (52) and interns (41) of 2014 were included in this study. In this 1 year study, 13104 IOPAs were taken and manually processed by these students. These radiographs were evaluated by two senior faculties of the department separately. To check variability between two examiners, ANOVA test was performed and all data were analyzed using WINDOW'S SPSS version 12 (Microsoft, USA). Results: Of 13104 IOPAs, 3538 were considered as faulty radiographs, of this 26.1% cone cut which occupies the first position and was followed by improper vertical angulation (25.2%), film position error (23.2%), improper horizontal angulation (13.1%), processing errors (9.5%), and miscellaneous such as reversed film, film bending (2.9%). Conclusion: Considering the statistical analysis by increasing experience, students make fewer numbers of errors.
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Evaluation of oral and periodontal status of leprosy patients in Dindigul district p. 119
SA Jacob Raja, J Johnson Raja, R Vijayashree, B Meena Priya, G Sai Anusuya, P Ravishankar
Aim: After the introduction of the multidrug therapy, the incidence of leprosy is decreasing every year. However, periodontal complaints are commonly seen in these patients due to compromised immunity and impaired oral hygiene. The aim of the present study is to assess the oral and periodontal status of the leprosy patients in Dindigul district. Materials and Methods: The study was conducted on 62 patients treated in a leprosy center at Dindigul district. Among these, 22 (35.5%) were female patients and 40 were male patients (64.5%). Age ranges between 40 and 70 with the mean age being 52. Facial changes, periodontal status, dental caries, attrition, tooth loss, plaque index (Silness and Loe), and calculus component of oral hygiene index-simplified were assessed. Results: Majority of the patients presented with loss of eyebrows and eyelashes, saddle nose, ocular involvement, and leonine facies. Gingival recession (54.8%) was a predominant finding followed by tooth loss (69.5%), mobility (60.86%), attrition (56%), chronic pulpitis (34.7%), and dental caries (26%). Most of the patients had severe periodontitis. Conclusions: Compromised immunity and altered autonomy pave way for many dental complaints such as periodontitis and deposits in tooth with poor oral hygiene. Awareness about the oral health problems and reinforcement of oral hygiene should be insisted to the leprosy patients to prevent further morbidity.
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”Evaluation of safety margin” in ameloblastoma of the mandible by surgical, radiological, and histopathological methods: An evidence-based study p. 122
S Kalaiselvan, AV Dharmesh Kumar Raja, B Saravanan, A Srivel Vigneswari, Ramesh Srinivasan
Objective: The purpose of this study is to elicit the amount of safety margin necessary around the ameloblastic lesion in view of preventing further recurrence. Materials and Methods: The study consisted of 25 cases of mandibular ameloblastoma. Diagnosis was based on clinical and radiological analysis and confirmed by histopathological report. An incisional biopsy was done preoperatively to confirm the diagnosis. Segmental resection was planned for all the cases. After the resection, postoperative panoramic radiograph of the specimen was taken followed by histopathological examination of its margin to detect tumor cell infiltration. Results and Conclusion: In all our cases, the ameloblastoma was infiltrating in nature. A follow-up period of 10 years showed neither recurrence nor implant failure. In our study, we conclude our safe margin for infiltrating variant of ameloblastoma based on histopathological report of the resected specimen.
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Comparative evaluation of serum and salivary immunoglobulin G and A levels with total serum protein in oral submucous fibrosis patients: A case control study p. 126
M Kandasamy, N Jaisanghar, Ravi David Austin, Kumar Chandan Srivastava, G Sai Anusuya, N Anisa
Aim and Objective: The objective of this study is to estimate and compare the serum and salivary immunoglobulin G and A (IgG, IgA) levels in various stages of oral submucous fibrosis (OSMF) patients and relate it to total serum protein (TSP) and hemoglobin (Hb) levels. Materials and Methods: The sample for the present study comprised a total of 20 healthy controls, 20 OSMF patients. About 5 ml of blood and 2 ml of saliva were collected. Quantitative analysis of serum and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hb were estimated by Biuret and cyanmethemoglobin methods, respectively. Results: Serum and salivary IgA and IgG levels were statistically significantly increased (P < 0.001) in OSMF patients when compared to controls. Also serum and salivary IgG and IgA levels showed significantly increased (P < 0.01) in all the three staging of OSMF when compared to control group. Hb levels and TSP levels were significantly decreased (P < 0.001) in OSMF patients when compared to controls. One-way ANOVA, Pearson's correlation, and unpaired t -test were used for statistical analysis. Conclusion: The elevated levels of IgG and IgA are also in favor of polygammapathy, which are nonspecific and nondiagnostic objective reflections of an underlying disease. Decreased TSP is a result of host response and Hb, acts as an indicator of nutritional status plays an important role. It is also observed from the present study that the severity of OSMF was directly proportional to the estimated elevated levels of the major IgG and IgA. A need is also felt for the knowledge of immunoprofile estimation in etiology and pathogenesis that would prove a great asset in the proper assessment of this condition.
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Chlorhexidine varnish implemented treatment strategy for chronic periodontitis: A clinical and microbial study p. 133
D Manikandan, VR Balaji, Tanvir Mohamad Niazi, G Rohini, B Karthikeyan, P Jesudoss
Aim: The aim of the present study was to evaluate the short-term clinical and microbiological effect of chlorhexidine varnish when used as an adjuvant to scaling and root planing in the treatment of chronic periodontitis. Materials and Methods: A split-mouth design was conducted in 11 patients suffering from chronic periodontitis. The control site underwent scaling and root planing, and the experimental site was additionally treated with chlorhexidine varnish application. Clinical parameters, namely, gingival index (GI), plaque index (PI), bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level were recorded at baseline, 1 month, and 3 months postoperatively. Furthermore, microbial examination of the plaque samples was done at baseline, 1 month, and 3 months. Results: Both treatment strategies showed significant improvement in GI, PI, BoP, PPD, and clinical attachment level, at both follow-up visits by comparison with baseline levels. At study termination, chlorhexidine varnish implemented treatment strategy resulted in additional improvement in the clinical parameters, and more reduction in the total anaerobic count at 1 month and 3 months. Conclusions: These findings suggest that a chlorhexidine varnish implemented treatment strategy along with scaling and root planing may improve the clinical outcome for the treatment of chronic periodontitis in comparison to scaling and root planing alone.
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Comparative study on the tensile bond strength and marginal fit of complete veneer cast metal crowns using various luting agents: An in vitro study p. 138
B Devi Parameswari, M Rajakumar, G Lambodaran, Sundar Shyam
Introduction: Several commercially available luting agents are used to cement the dental restorations such as intra-coronal, extra-coronal, and fixed partial dentures. Tensile bond strength (TBS) and accurate marginal fit are the essential factors to determine the good clinical results in fixed prosthesis. The retentivity of the luting cements is assessed by their adhesive capacity over the tooth surface and metal surface. Generally, the adhesive ability has been evaluated with in vitro testing, with tensile bond tests. The failure of fixed prosthesis may be happened as a result of incomplete seating during cementation. Most research on cementation of crowns relates seating failure to the thickness of the cement film. Materials and Methods: The study is divided into four groups with 10 samples for each of the luting cement taken up for testing TBS and four groups with 5 samples for each luting agent chosen for assessing marginal fit. The results were tabulated and statistically analyzed. Results: In this in vitro study, the TBS of luting cements, and marginal fit in relation to luting cements were tested by using appropriate testing devices. The TBS of cement is measured using universal testing machine, and the results are tabulated. The marginal gap that exists between the margin of the cast metal crown, and the finish line is measured using travelling microscope before and after cementation. The difference between these two values gives the discrepancy that is due to the film thickness of cement used for luting the restoration. Summary and Conclusion: The TBS value of zinc phosphate cement and glass ionomer cement were found to be almost same. The chemical adhesiveness of the glass ionomer with calcium ions of enamel and dentin may be the attributed reason (ionic bonding). In this study, the polycarboxylate is the one that showed low TBS, and it may be attributed to the weakness of the cement due to reduced film thickness, though this cement has a chemical bonding nature. The observation of results of marginal fit in this study is the increased gap found in zinc phosphate cement followed by resin cement, zinc polycarboxylate, and glass ionomer cement. It is agreeable to estimate the marginal fit of the restoration, which could be affected by the film thickness of the luting cement along with other factors.
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A descriptive study on awareness about oral health among pediatric practitioners in Kanchipuram district p. 144
S Rajalingam, V Leela Rani
Background: Pediatricians and other health-care providers could play an invaluable role in ensuring the maintenance of optimal preventive as well as curative dental health in children. This study was aimed at assessing the pediatrician's perspective on basic oral health care in children in Kanchipuram district. Materials and Methods: A questionnaire survey was carried out among Pediatricians which covered various aspects of knowledge, attitude, and role of pediatricians in preventive dental care. The collected data were tabulated, and percent frequency distributions for responses to every question were assessed. Results: None of the participants reported that pediatricians are responsible for infant oral health presumes that pediatricians are not examining the oral cavity as a part of routine. All of the pediatricians gave nutritional counseling to the parents but only 7% of them of caries. All the pediatricians liked the concept of an association between lack of knowledge among pediatricians and pediatric dentist and establishment of a dental home along with a medical home. Conclusion: From the present study, we conclude that there is a lack of awareness about prevention of dental caries among pediatricians in Kanchipuram district. To overcome this, advocating dentists as part of well-child care and establishing dental home along with medical home. Publishing pediatric journals concerning about the oral health to improve the knowledge is also essential in promoting good oral health hygiene.
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Correlation of serum levo-fucose levels as a biomarker with tumor node metastasis staging in oral cancer patients p. 147
P Redwin Dhas Manchil, E Tatu Joy, M Shashi Kiran, J Eugenia Sherubin, M Farakath Khan, BS Aravind
Background: oral cancer is a result of disordered cellular behavior initiated by various stimuli which is characterized by the alteration of serum glycoproteins consisting of different monosaccharides. One of these is levo-fucose (L-fucose), a methyl pentose. Elevated levels of protein-bound fucose have been reported in various malignancies. Aim: The present study attempted to correlate levels of serum L-fucose as a biomarker with the various tumor node metastasis (TNM) stages of oral cancer. Methodology: The study was carried out on 90 subjects consisting of 30 healthy controls and 60 histopathologically proven oral squamous cell carcinoma (OSCC) cases. The serum fucose level estimation was done based on the method adopted by Winzler. Statistical analysis included independent sample's t -test, one-way ANOVA test, Karl–Pearson correlation test, and Tukey's HSD post hoc test to evaluate the significance and variability of values between groups. Results: Significant elevation in serum fucose levels was noticed among OSCC patients when compared with the controls and a progressive ascent of L-fucose levels were noted as the stage of severity increased. Serum fucose levels were independent of histopathological grading, age, and sex. Conclusion: Serum L-fucose levels were increased in OSCC patients, and a positive correlation was observed between serum L-fucose levels and TNM staging of OSCC. Thus, serum L-fucose can be used as an effective diagnostic and prognostic biomarker in OSCC patients.
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A computed tomography study in the location of greater palatine artery in South Indian population for maxillary osteotomy p. 151
I Packiaraj, K Retnakumar, G Sai Anusuya, M Aarti Rajambigai, M Baskaran, Vimal Joseph Devadoss
Introduction: The greater palatine artery is one of the important feeding vessel to the maxilla. The surgeon should know the surgical anatomy of greater palatine artery to avoid trauma in maxilla which leads to ischemic problems. Aim: The CT evaluation of the distance between Pyriform aperture and the greater palatine foramen in various ages of both sexes. Result: The distance varies according to sex and age which are measured by CT and standardised. Discussion: The lateral nasal osteotomy can be done upto 25 mm depth, instead of 20 mm. Conclusion: By this study it shows that the lateral nasal wall osteotomy can be performed without injury to greater palatine artery.
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Comparative evaluation of shear bond strength of two different chairside soft liners to heat processed acrylic denture base resin: An in vitro study p. 154
N Rajaganesh, S Sabarinathan, NS Azhagarasan, Chitra Shankar, Jaya Krishnakumar, S Swathi
Background: Chairside softliners are used more frequently than is reported and studies regarding the bond strength of chairside softliners to heat-polymerized denture base resin are few and limited. Hence, this study was conducted to comparatively evaluate the shear bond strength of two chairside soft relining materials viz., autopolymerizing plasticized acrylic resin liner and a silicone-based liner bonded to heat polymerized polymethyl methacrylate denture base resin and to analyze the mode of interfacial bond failure. Materials and Methods: Forty test specimens (n = 40) were prepared by bonding plasticized acrylic- and silicone-based soft liner to heat polymerized acrylic resin blocks. Twenty specimens, ten from each group, were subjected to thermal cycling and later to shear bond strength testing. The debonded specimens were then qualitatively analyzed for the mode of failure using scanning electron microscopy. The results obtained were tabulated and statistically analyzed. Results: The mean shear bond strength values obtained for acrylic-based soft liner before and after thermal cycling were 0.3365 ± 0.025 MPa and 0.3164 ± 0.04 MPa, respectively. The mean shear bond strength values obtained for silicone-based soft liner before and after thermal cycling were 0.4159 ± 0.025 MPa and 0.4335 ± 0.02 MPa, respectively. Silicone-based soft liner showed higher shear bond strength than the acrylic-based both before and after thermal cycling (P = 0.0001). Scanning electron microscopy analysis showed a predominantly mixed mode of failure with silicone-based liner and predominantly adhesive mode of failure with acrylic-based soft liner. Conclusion: The silicone-based soft liner showed higher shear bond strength to heat polymerized acrylic resin than acrylic-based soft liner both before and after thermal cycling.
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Case reports and clinical guidelines for managing radix entomolaris p. 160
Bejoy J Thomas, A Nishad, Benin Paulaian, Jonathan Emil Sam
Knowledge about the external and internal anatomy of the tooth is essential for successful dental practice. Anomalies in the tooth are often encountered which poses difficulties in dental treatments. As like any other tooth, mandibular first molars are also prone for anatomic malformations. One such anatomic variation is the presence of extra root distolingually. This distolingual root is called radix entomolaris (RE). The presence of an additional root can lead to difficulties during endodontic therapy. This article is a report of two cases describing the management of the first mandibular molars with an RE and clinical guidelines for its management.
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Large radiopaque lesion in the posterior mandible: A challenging case p. 164
B Sasirekha, Philips Mathew, M Ganeshkumar, Ravi David Austin, Raj Prabhu
Radiopaque lesions of the jawbones are frequently encountered in dental radiographs. A variety of conditions such as chronic inflammation, soft tissue calcifications, fibrosseous lesions, odontogenic tumors, and bone neoplasms can manifest as radiopaque lesions on the jawbones. These radiopaque lesions are often difficult to distinguish from each other, hence making the formulation of differential diagnosis challenging. A thorough patient's history and clinical examination supplemented by appropriate investigations will enable the clinician in narrowing down the differential diagnosis and to identify the condition accurately. Presented here is a case of the large radiopaque lesion on posterior mandible surrounded by lytic areas in a 20-year-old male patient.
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Mucocele: A diagnostic dilemma!! p. 168
Maruthamuthu Karthikeyan, Alex K Varghese, Govindarajan Vasupradha, Jayapal Dinakaran
Oral mucocele is the most common benign lesion of minor salivary gland caused due to any form of mechanical trauma to the excretory duct of the gland. It is of two types – mucous extravasation phenomenon and mucous retention type. Extravasation type is more common. Here, we report a case of a 65-year-old male patient with a complaint of painful swelling in the lower lip for 1 month with a history of trauma in the lower lip. It was clinically diagnosed as traumatic fibroma, and an excisional biopsy was done. However, the histopathology was basically that of mucous extravasation phenomenon coexisting with the features of a reactive lesion implicating the potential role of chronic irritation in the impairment of normal healing process. Considering the fact that long-standing chronic inflammation in a benign lesion can even lead to malignant transformation of that lesion; here, we highlight the role of a good clinicopathologic correlation and the significance of prompt intervention and treatment. Furthermore, emphasizing the potential need for postoperative follow-up by the dentist, how much ever trivial the lesion may appear to be in the best interest of the patient.
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Rehabilitation of complicated crown-root fracture by invisible approach p. 171
V Leela Rani, S Rajalingam, R Hemalatha, J Jananee
Dental trauma is one of the most common and significant problems met in all dental offices almost every day. In particular, injury to the anterior teeth is more vulnerable as it may affect the psychosocial behavior, severe emotional complications can occur leading to disturbances in their mental attitude. Cosmetic (lingual) orthodontics is the recent development in the field of dentistry in the last few decades. Patients are more concerned about their appearance during the treatment and are affected by psychosocial issues because of labially placed brackets, thus leading to the evolution of lingual orthodontic appliances. In this article, we are sharing our clinical experience treating a complicated crown-root fracture using the lingual orthodontic technique.
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Difficulties encountered in preauricular approach over retromandibular approach in condylar fracture p. 175
Perumal Jayavelu, R Riaz, AR Tariq Salam, B Saravanan, R Karthick
Fracture of mandible can be classified according to its anatomical location, in which condylar fracture is the most common one overall and is missed on clinical examination. Due to the unique geometry of the mandible and temporomandibular joint, without treatment the fractures can result in marked pain, dysfunction, and deformity. The condylar fracture may be further classified depending on the sides involved: unilateral/bilateral, depending on the height of fracture: intracapsular (within the head of condyle), extracapsular - head and neck (high condyle fracture), and subcondylar (low condyle fracture), and depending on displacement: nondisplaced, displaced (anteromedially, medially, and lateral), and dislocated. The clinical features include swelling and tenderness over the temporomandibular joint region, restricted mouth opening, and anterior open bite. A 34-year-old male patient reported to the Department of Oral and Maxillofacial Surgery at Madha Dental College and Hospital; suffered fall trauma resulting in bilateral condyle fracture, dentoalveolar fracture in mandible with restricted mouth opening, and anterior open bite.
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Ellis–Van Creveld syndrome in siblings: A rare case report p. 179
Sabitha Gokulraj, N Mohan, J Babususai Raj, S Yasmeen Ahamed, CJ Stephen Arokiaraj, A Cicilia Subbulakshmi
Ellis–Van Creveld syndrome or chondroectodermal dysplasia is a rare autosomal recessive disorder presenting several skeletal manifestations and congenital heart malformations. Ellis–Van Creveld syndrome comprises of a tetrad of clinical manifestations of chondrodysplasia, polydactyly, ectodermal dysplasia, and cardiac defects. Here, we are presenting a very rare case of Ellis–Van Creveld syndrome in siblings.
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Massive expanding hematoma of the chin following blunt trauma p. 182
K Thanvir Mohamed Niazi, Dharmesh Kumar Raja, R Prakash, VR Balaji, D Manikandan, G Ulaganathan, R Yoganandha
Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.
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Aggressive nasopalatine duct cyst with complete destruction of palatine bone p. 185
D Sankar, Veerabahu Muthusubramanian, JA Nathan, Ravi Sankar Nutalapati, Yasmin Mary Jose, Y Naren kumar
Nasopalatine duct cyst is the nonodontogenic developmental cyst, frequently occurring in the midline of the anterior maxillary region. The clinical presentation of the cyst is often varied and presents a diagnostic difficulty and frequently misdiagnosed as developmental or inflammatory odontogenic cystic lesion. This paper represents a large infected nasopalatine duct cyst presenting with complete destruction of anterior palate and pyriform rim.
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Unusal canal configuration in maxillary and mandibular second molars p. 189
Ramachandran Ragunathan, AV Rajesh Ebenezar, Ajit George Mohan, S Anand
This clinical article describes three different case reports of maxillary and mandibular second molars with the unusual anatomy of single root with a single canal and their endodontic management. An unusual case of bilateralism is observed in the first two cases in the form of single-rooted second mandibular molars in both the quadrant of the same patient. The presence of maxillary second molar with single root and single canal in the third case is unusual.
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Retraction: Combination restoration in full mouth rehabilitation p. 192

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