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   2019| February  | Volume 11 | Issue 5  
    Online since February 7, 2019

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Efficacy of artificial salivary substitutes in treatment of xerostomia: A systematic review
Mansour K A Assery
February 2019, 11(5):1-12
DOI:10.4103/JPBS.JPBS_220_18  PMID:30923424
Aim: To provide an update on artificial saliva used to maintain the health of the oral cavity of patients with severe hyposalivation. Materials and Methods: A literature search was conducted in April 2018 in three electronic databases (The Cochrane Central Register of Controlled Trials [CENTRAL], PubMed, and Embase) by combining key words and terms related to the population and intervention of the topic. Results: The databases search resulted in 455 titles and abstracts. Of these, 21 were judged to meet inclusion criteria and full texts were read. Finally, 10 clinical trials were included for qualitative synthesis. Conclusion: Published evidence suggests that all the artificial saliva products tested in included studies reduced symptoms of xerostomia. These products should specifically be selected according to the patients’ concerns and needs. However, the included studies presented a wide range of products and suffered from high risk of bias. Therefore, long-term randomized controlled trials on effects of various products are required.
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Socket shield: A case report
Kashinath C Arabbi, Mahantesha Sharanappa, Yashi Priya, Takshil D Shah, Shobha K Subbaiah
February 2019, 11(5):72-75
DOI:10.4103/JPBS.JPBS_228_18  PMID:30923434
It is fairly common to remove a severely compromised tooth and provide rehabilitation by means of an implant. Resorption of alveolar bone after extraction resulting in loss of bone height and width is an unpleasant sequelae causing difficulty in implant placement. Few procedures have been promoted to attain the required bone height and width, such as guided bone regeneration socket preservation with the use of various graft materials and barrier membranes. The disadvantages of these techniques are some amount of ridge height loss and loss of buccal/facial, ridge contour. The socket shield technique is a new method where a buccal segment of root is retained as a shield, which aids in retaining periodontal ligament on buccofacial aspect. The implant is placed (immediate placement) lingual to this shield. This maintains the alveolar ridge height and buccofacial contour, thus providing superior aesthetics. This case report shows placement of an implant in upper anterior region using this technique.
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Comparative analysis of intravenous midazolam with nasal spray for conscious sedation in minor oral and maxillofacial surgeries
Ramesh Kunusoth, Gururam Tej, Kranti Kiran Reddy Ealla, Pavan Kumar Kathuroju, Anusha Ayyagari, Aditya Mohan Alwala
February 2019, 11(5):42-50
DOI:10.4103/JPBS.JPBS_199_18  PMID:30923430
Aim: The aim of the current study was to evaluate the efficacy of nasal spray midazolam by collating it with conventional intravenous midazolam for conscious sedation in minor oral surgeries. Materials and Methods: Sixty patients were selected randomly and divided into two groups: group A for intranasal midazolam atomized spray (n = 30) and group B for intravenous midazolam (n = 30). Physiological parameters, anxiety score, sedation rating, patient’s cooperation score, and retrograde and anterograde amnesia were recorded for each patient during preoperative, intraoperative, and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery was compared. Results: In this study, both intranasal and intravenous groups showed decrease in systolic blood pressure and diastolic blood pressure intraoperatively but within physiological limits and increase in the average pulse rates in both the groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre- to postoperative anxiety scores between the groups. Conclusion: Both intravenous and intranasal administration of midazolam showed better patient cooperation, satisfaction, and clinical effectiveness. Intranasal midazolam spray is effective in the reduction of subjective stress, reliable anxiolysis while preserving protective reflexes.
  2,138 66 -
Treatment of Stage I hard palate cancer with high-dose-rate brachytherapy using molds: Cost-based perspective
Kranti Kiran Reddy Ealla, Sri Krishna C Prakash, Prasanna Manidanappanavar, Sowmya Katthuri, Keerthika Gurram, Thakur Kshatri Shyamilee
February 2019, 11(5):67-71
DOI:10.4103/JPBS.JPBS_193_18  PMID:30923433
Introduction: Treatment of T1N0M0 (T1 = greatest tumor size < 2cm, N0 = regional lymph nodes not palpable by clinical examination, M0 = No evidence of distant metastasis) (Green FL, Page DL, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow M. AJCC Cancer Staging Manual. New York: Springer; 2002) lesions of hard palate carcinoma by radiotherapy carries equal results with the advantage of cosmesis and can avoid surgical complications. External beam radiotherapy (EBRT) will last for 6–8 weeks. Feasibility of high-dose-rate (HDR) intraoral mold brachytherapy is an alternative to EBRT, which is highly effective and reduces treatment time and is also cost-effective one, which can be practiced in a center without Linac facilities. Materials and Methods: Custom-made surface molds were prepared for each patient with dental wax, and HDR after loading tubes were placed as per tumor volume. After simulation, with the help of simulation check films, treatment was planned with PLATO Treatment Planning System (TPS) and optimization was carried out. Results: We treated six cases of T1N0M0 hard palate carcinoma by HDR intraoral mold brachytherapy. A total dose of 42–45 Gy in 14–15 fractions with 3 Gy per fraction, two fractions per day with a gap of minimum 6h was administered between two fractions. (Gray [Gy] is the unit of absorbed dose of radiation by tissues. A total radiation dose of 42–45 Gy will be delivered as per radiobiological principles, in divided number of fractions, thereby the given dose of radiation will kill the major portion of the tumor cells, which were in various sensitive phases of cell cycle and at the same time, less damage to the normal tissues. The time between two fractions of radiation is 6h, which is the experimentally proven optimal time for recovery of normal tissues from radiation damage and tumor tissues to enter into the sensitive phases of the cell cycle to radiation damage-late G2 and S phases). There was confluent mucositis and all the patients had a complete response and none of the patients had relapse. Conclusion: Early (T1N0M0) lesions of hard palate carcinoma with HDR intraoral mold brachytherapy will shorten overall duration of treatment time with excellent local control and toxicities as compared with EBRT.
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A comparative evaluation of the effectiveness of chitosan-based dressing and conventional method of hemostasis in patients on oral antithrombotic therapy without therapy interruption
Swetcha Seethamsetty, Godvine Sarepally, Arshiya Sanober, Yousuf Qureshi, Umayra Fatima, Shaik Mohammed Arif
February 2019, 11(5):18-23
DOI:10.4103/JPBS.JPBS_229_18  PMID:30923426
Aims and Objectives: To assess the effectiveness of chitosan-based dressing after extraction in individuals on antithrombotics, without modification of their treatment schedule. Materials and Methods: A randomized comparative study was carried out on 40 subjects who had two extraction sites, in dissimilar quadrants. The surgical site was chosen at random and post-extraction hemostasis was achieved by a custom-cut chitosan dressing (study site) and sterile cotton gauze dressing (suturing if required) at control site. Patients were reviewed on the first, third, fifth, and seventh postoperative days and every week till 4 weeks. The parameters assessed were timing of hemostasis, pain scores, and pus discharge. Results: Out of 40 study subjects, 24 (60%) were males and 16 (40%) were females. The age was 40–65 years (mean age 54 years). The mean time for hemostasis was 0.63±0.27min in study group, whereas for controls, it was 9.10±2.28min. The difference in postoperative pain was significant (P = 0.001) on days one, five, and seven. In chitosan group extraction sites, dry socket was not seen, whereas four patients on day three and five patients on day five after extraction experienced dry socket in pressure gauze dressings group, with an insignificant difference (P = 0.058). In chitosan group extraction sites, no pus discharge was seen. Whereas four patients on days three and five after extraction had pus discharge in patients where pressure dressings were applied, with an insignificant difference (P = 0.058). Conclusion: Chitosan dressing is a competent hemostatic agent that significantly reduced the post-extraction bleeding, with better pain control. Chitosan group had no incidences of dry socket and pus discharge.
  1,651 69 -
Necessity of antibiotics to reduce inflammatory complications after third molar extractions: A prospective study
Mohammed jafnan al harbi, Moayad Ahmed A Alomaym, Mohammed Fahad Mohammed Aldohan, Ibrahim Fahad Alkurdi
February 2019, 11(5):13-17
DOI:10.4103/JPBS.JPBS_232_18  PMID:30923425
Aims and Objectives: To determine the relationship between the usage of antibiotics postoperatively and inflammatory complications following third molar extractions. Materials and Methods: The sample was derived from Saudi Arabia private practitioners who were oral surgeons and was randomly categorized into two groups: group A, who took postoperative antibiotics, and group B, who have not taken antibiotics. The observed primary variable was the occurrence of inflammatory complications subsequent to removal of third molar. Results: The data were obtained from 35 oral surgeons, who gave details about 725 patients in whom 965 third molars were removed. A total of 455 (62.75%) patients have taken antibiotics postoperatively. The mean age was 28±14.8 years. We noticed a very high male preponderance of 543 (74.89%). Mean body mass index was 26.7±6.3kg/m2. The mean Preoperative Disease Severity Score and Operative Difficulty Score was 2.13±2.1 and 12.1±6.3, respectively. Conclusion: Fewer postoperative inflammatory complications were observed in subjects who have taken antibiotics after third molar removal.
  1,429 32 -
Comparison of the perception of pain during fixed orthodontic treatment with metal and ceramic brackets
Nivedita Sahoo
February 2019, 11(5):30-35
DOI:10.4103/JPBS.JPBS_218_18  PMID:30923428
Introduction: Pain is experienced by patients during various fixed orthodontic procedures such as placement of separators, insertion of arch wire and its activations, orthopedic appliances such as headgear, and debonding of the appliance. This study was formulated with the background that the level of pain sensation differs between conventional metal and ceramic brackets, arch wire being the same. Materials and Methods: The sample comprised 40 patients. The patients were separated into two groups: Group A (metal brackets) and Group B (ceramic brackets). In Group A, the brackets were bonded with 0.022” conventional stainless steel brackets (Unitek Gemini, 3M, Monrovia, California). In Group B, the brackets were bonded with ceramic brackets (Unitek Gemini Clear Brackets, 3M, Monrovia, California). The bonding of the brackets was carried out according to the conventional etching, priming, and curing technique. A 0.016” NiTi (nickel titanium) arch wire was used as the first arch wire. The intensity of pain was documented in a figure containing two 100-mm visual analog scales (VASs). Results: The level of pain reduced in intensity in due course. During 1 month, VAS scores increased at the end of day 1 (24h) for the metal and ceramic group. The pain then decreased for up to 5 days. The average pain intensity reached 4.44 in the ceramic group, whereas it was 2.7 in the metal group for the upper anterior region. It decreased up to 1 in the ceramic and 0.22 in the metal group. Conclusion: Patients bonded with ceramic brackets experienced a higher and more severe pain of longer duration than individuals treated with conventional brackets.
  1,333 40 -
Time-dependent effect of various irrigants for root canal on smear layer removal
Shikha Singh, Monika Singh, Abdul R Salgar, Namratha Chandrahari, Nandagiri Prathibha, Pradeep Koppolu
February 2019, 11(5):51-58
DOI:10.4103/JPBS.JPBS_195_18  PMID:30923431
Background: Existence of smear layer in root canals caused by instrumentation is believed to prevent penetration of irrigating agents, thereby resulting in endodontic treatment. Aims and Objectives: To compare and evaluate the effectiveness of two irrigants: 17% ethylenediaminetetraacetic acid (EDTA) and mixture of tetracycline isomer, an acid, and a detergent (MTAD) as final agents for eliminating the smear layer. Materials and Methods: We included 50 human lower premolar teeth whose crowns were sectioned at cementoenamel junction. The sample was randomly grouped into five groups, each with 10 teeth. Group 1: 1mL of 17% EDTA as final rinse for 1min, Group 2: 1mL of 17% EDTA for 30s, Group 3: 5mL of MTAD for 2.5min, Group 4: 5mL of MTAD for 5min, and Group 5: saline. The specimens were sectioned vertically all along the long axis and fixed on an aluminum stub for gold ion sputtering. Scanning electron microscope was used to observe the specimens, and photomicrographs were taken at coronal, middle, and apical thirds of canal, and assessed by Torabinejad scoring system by two examiners, and the observations were analyzed statistically. Results: When Group 1 and Group 2 and Groups 3 and 4 were compared, we found a significant variation in removal of smear layer at cervical and middle thirds, and insignificant difference at apical third. In comparison with EDTA and saline, MTAD was more efficient significantly in middle and cervical thirds and insignificant at apical third. Conclusion: MTAD is an efficient irrigant for removing smear layer than EDTA and saline.
  1,299 67 -
3P’s in retreatment endodontics—An often forgotten virtue
Jitendra Lohar, Himanshu Sood, Pratikgiri Gosai, Tariq M Shekh
February 2019, 11(5):76-80
DOI:10.4103/JPBS.JPBS_197_18  PMID:30923435
Separation of instrument in the root canal is a common mishap that occurs during the cleaning and shaping procedure. So many different methods have been developed to retrieve fractured instruments from root canal. Separated instrument leads to incomplete cleaning of root canal and eventually causes posttreatment disease. For successful completion of treatment, a separated instrument must be retrieved and if not, a bypass must be attempted. This article presents four cases requiring removal of separated instruments from the root canal. All four cases were successfully treated by conservative means of instrument retrieval by using two different techniques.
  1,228 97 -
Cephalometric evaluation of natural head position in Lingayat population of Karnataka
Inderpreet Singh, K Kiran Kumar, Pradeep Raj, R Haranadh Babu, Narendra Pithani, Altaf H Thekiya
February 2019, 11(5):59-66
DOI:10.4103/JPBS.JPBS_194_18  PMID:30923432
Aims and Objectives: To ascertain norms in cephalometry for 11- to 13-year-old Lingayat children in natural head position (NHP). Materials and Methods: Lateral cephalograms of children were obtained by using fluid level device. We determined the variance in Frankfort horizontal plane (FHP) inclination to extracranial horizontal in NHP. The G*Power, version 20 for Windows was used for analysis. Results: Reduced facial convexity was observed when the analysis was carried out in relation to true horizontal with significant difference of “t” value of 3.05 and percentage difference of 1.1 (P < 0.01) and for girls “t” value of 9.69 and percentage difference of 2.5 (P < 0.001). The highest correlation coefficient for Lingayat boys (r = 0.77) was seen between palatal plane and occlusal plane. We found least correlation coefficient among FHP and Sella–nasion plane (SNP). The coefficient was r = 0.62 and correlation coefficient of r = 0.70 was between FHP and determination coefficient r2 = 0.38 or 38%. For girls, highest correlation coefficient of r = 0.70 was seen among FHP and palatal plane. Conclusion: Conventional study of craniofacial forms of Lingayat children showed the average skeletal pattern as Class II with retrognathic mandible in comparison to Caucasians. However, when seen in NHP by new method of analysis based on the true horizontal, the skeletal model was Class III in comparison to Caucasians.
  1,090 37 -
A three-dimensional finite element analysis of Aramany class I obturator fabricated with different alloys
Kashinath C Arabbi, Takshil D Shah, Mahantesha Sharanappa, Shobha K Subbaiah
February 2019, 11(5):24-29
DOI:10.4103/JPBS.JPBS_226_18  PMID:30923427
Aim: The aim of the research was to develop a model that accurately represents an Aramany class I defect and its obturator prostheses fabricated with cobalt–chromium alloy and titanium alloy to compare the deflection and the stress distribution in the rehabilitated area. Materials and Methods: Aramany class I defect and the obturator prostheses were generated geometrically using ANSYS 14.5; both were superimposed on each other to mimic the prostheses and the maxilla as one unit. Meshing of models was carried out using hypermesh software and materialistic properties were assigned. The 120 newton load was constituted on the teeth in different directions. Statistical Analysis Used: Statistical analysis of Finite element was not possible. Self-explanatory decoding results in the software were used. Results: The stress distribution and deflection executed by ANSYS provided results that enabled the tracing of Von Mises stress and deflection field in the form of color-coded bands with values in mega pascal. Conclusions: The study shows that Von Mises stresses are higher for the frame work fabricated with cobalt–chromium alloy compared to titanium alloy. The framework made of titanium alloy showed more deflection than cobalt–chromium alloy.
  1,035 40 -
Attitudes and practices of dental students in providing oral health-care services to underserved rural patients attending dental institutions of Telangana, India
Rajbhushan Dande, Hari Prasad Gone, HVN Saikrishna, Abhisek R R Sayini, Sai Teja R Malgari, Varshapriyadarshini Paramkusham
February 2019, 11(5):36-41
DOI:10.4103/JPBS.JPBS_215_18  PMID:30923429
Introduction: Attitude is a relatively enduring organization of beliefs around an object, subject, or concept, which predisposes one to respond in some preferential manner. It decides one’s action. Dental students frequently come across underserved rural population and must have good attitudes toward them, so that the care delivered to them will be optimum. Aim: To assess the attitudes and practices of dental students in providing oral health-care services to underserved rural patients. Materials and Methods: A cross-sectional study was conducted among final-year Bachelor of Dental Surgery (BDS) students, interns, and postgraduate students who are involved in providing dental care in dental institutions of Telangana State, India. A 15-item, self-structured, pretested questionnaire was administered. Descriptive statistics were calculated using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Attitudes and practices of undergraduates and postgraduates were compared using paired t-test. Results: A total of 574 students participated in the study. Approximately 73.3% of the dental students agreed that they personally want to be involved in providing oral health care for the underserved and 27.1% students disagreed that underserved patients are subjects on whom they can train and expertise. Approximately 56.62% of dental students often asked patients about the expenses they bear for attending a single dental visit and 53.48% tried to minimize the number of appointments required for the patients. No significant difference was observed in attitudes between undergraduates and postgraduates. Conclusion: Dental students had moderate attitude toward underserved patients but this was not reflected in their practices.
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