Journal of Dental Specialities

Page No. 103-104

Authors: Prof. (Dr.) Vinod Sachdev

“To raise new questions, new possibilities, to regard old problems from a new angle, requires creative intelligence and marks real advance in science.” – Albert Einstein Greetings! Science, my friends, is a process of investigating. It is again impossible for a scientist to learn what he thinks he already knows, giving birth to a crystal clear context: train your mind like a parachute, for both work best, when open! And research in dental science demands a virtue as plain as common sense, as infinite as imagination, merciless to fallacies in logic. I thank, in this regard, to all my readers, for an over whelming response to our preceding issue and copious contributions consisting of high quality scientific literature. Lately, there have been deliberations concerning educational reforms, particularly in the field of medical and dental education. Here, I would like to accentuate upon the educational experience in academic health centers.

Page No. 108-112

Authors: Gurbir Singh Aulakh, Payal Sharma, Achint Juneja, Piush Kumar

Introduction: To evaluate the effect of application of two anti-oxidants, sodium ascorbate and grape seed extract after bleaching on the shear bond strength (SBS) of ceramic brackets. Materials and Method: 50 freshly extracted human first premolars for orthodontic purposes were collected and randomly divided into five groups (n=10 per group), an unbleached control group (Group I) and four experimental groups bleached with 35% hydrogen peroxide as follows: Group II (immediate bonding post-bleaching), Group III (delayed bonding), Group IV (bleaching followed by application of 10% sodium ascorbate solution, then bonding) and Group V (bleaching followed by application of grape seed extract, then bonding). Polycrystalline ceramic brackets were bonded to all the teeth. Bond strength was tested with a Universal testing machine following debonding. Results: Analysis of variance indicated a significant difference between SBS of the groups (p<0.001). The highest values for bond strength were measured in Group V (12.68±0.2) and the lowest in Group II (6.92±0.85). Group II (immediate bonding) had significantly lower bond strength than all the other groups. There was no significant difference between the SBS of Groups I, III, IV and V. Adhesive Remnant Index (ARI) scores indicated bond failure at the bracket/adhesive interface and within the adhesive. Conclusion: Bleaching with 35% hydrogen peroxide significantly reduced the bond strength of ceramic brackets. Treating the bleached enamel surface with 10% sodium ascorbate solution or grape seed extract (5% proanthocyanidin solution) before bonding, reverses the reduction in bond strength and can be used as an alternative to delayed bonding.

Page No. 119-123

Authors: Jyoti Singh, Ipseeta Menon, Avnish Singh, Mohit Dadu, Disha Latiyan

Introduction: Fear to visit the dentist is a common observation in adults & children. Aim: To study the relationship between dental fear and oral health behaviour of 12 and 15 years old school children of Muradnagar, Ghaziabad. Materials and Method: Two Hundred school going children aged 12 and 15 years were evaluated for children’s fear survey schedule dental subscale (CFSS-DS) and oral health behaviour by a questionnaire. Level of dental fear was assessed on 5-point likert scale from 1 “not afraid at all” to 5 “very afraid” covering 15 items and their behaviour towards oral health. Data analysis was done by SPSS version 18. Results: Out of 200 respondents, 142 were boys & 58 were girls.7 had scores equal to or greater than 38 & were classified as having “high dental fear”. High dental fear was present among girls and was found absent among boys. Conclusion: Reported association between oral health behaviour and dental fear should not be overlooked by the dentist for children.

Page No. 131-134

Authors: Mallika Sethi, Sumit Malhotra, Mathai Thomas, DVG Naidu

Introduction: The influence of subject-based and environmental factors on the balance between the subgingival microbial challenge and the host response in periodontal diseases illustrates the intimate link between oral and systemic health. From this stems the hypothesis that the persistent gram-negative challenge and associated inflammatory sequelae in periodontal disease may have consequences extending beyond the periodontal tissues themselves. This article addresses the design of a case-control study to examine the relationship between preterm low birth weight and maternal periodontal disease. Materials and Method: A case control study design was chosen including postpartum women between the age group of 18- 35 years of age. Cases were mothers delivering an infant weighing < 2,500g before 37 weeks' gestation and controls as mothers delivering an infant > 2,500g after 37 weeks. A full mouth periodontal examination was performed and corroborated by one examiner. The clinical parameters measured included plaque index, gingival index, pocket probing depth and clinical attachment level. Data was analyzed with Chi-square test, Fisher's exact test, Student t-test and Mann Whitney U test. Results: There was statistically no significant difference in the mean age between the case group and the control group. There was a strong association between the socioeconomic status, gingival status, plaque levels, pocket probing depth, clinical attachment level and the incidence of preterm low birth weight. Conclusion: The data from the present study, thus, shows an association between maternal periodontal disease and the risk of preterm low birth weight infant.

Page No. 139-141

Authors: Sanchi Gupta, Manisha Lakhanpal Sharma, Vandana Srivastava, Manu Dhillon

Aim: To evaluate the presence of microorganisms on mobiles phones in dental clinics, as a possible nidus for infection and to suggest the use of disposable sleeves to reduce the level of microorganisms in the dental clinics. Materials and Method: An observational study was conducted, on two groups, study group (group I) and control group (group II), having 25 mobile phones. Before entering the dental clinics, the mobiles phones were cleaned with an alcohol based disinfectant under aseptic conditions. Then, the mobile phones in group I were covered with an autoclaved disposable sleeve having a chemical indicator and group II were left uncovered. After five hours, swabs were obtained from the surfaces of mobile phones of both group I and group II. The swabs were cultured and incubated on blood agar for twenty four hours and evaluated for their microbial load. Results: The sample taken from the sleeve showed growth of microorganisms whereas, there was no growth on mobile surface of group I. On the contrary, the mobile surface of group II showed significant microbial load. Conclusion: Mobile phones can act as a fomite in dental setup and the use of disposable sleeves can effectively curtail any cross contamination of microorganisms, thereby, serving as a protective barrier. Therefore, these sleeves act as yet another protective barrier in dental clinics.

Page No. 147-151

Authors: Chanchala HP, Brinda S. Godhi, Nandlal B, Raghavendra Shanbhog, Sunita BS

Introduction: Awareness, attitude and pattern regarding oral health among general public has grown, but the practice of selfmedication is posing a threat to life. Therefore, the aim of the study was to evaluate self-medication practice and medicine knowledge among the out patients visiting dental college and hospital. Materials and Method: The study was anonymous, questionnaire-based survey conducted among 400 subjects, aged above 18 years visiting the out-patient department of a Dental College and Hospital. The questionnaire consisted of demographic details, questions regarding the type of medication, the source of knowledge of the medicines, illness for which the medication was used, reason for self-medication and reason for not adhering to the prescriptions. The collected data was analyzed using the SPSS Version 21. Results: Knowledge of usage of dental products was 74.4%, 31.6% ticked television as the source of information, 88.4% of the respondents felt that the prescription is required for the dispensing of the drug at the pharmacy. 52.2% of the respondents followed the instructions given by the dentist. Conclusion: A majority of the respondents had a fair knowledge about the dental products prior to their visit to the dental college. The major source of information was from the dentists, television and from friends. The larger population did know that the prescription was important for procuring the medication and also to follow the instruction for the proper drug dosage, time of consumption and for the duration of the course.

Page No. 157-161

Authors: Mrinal Mayank, Samhita Bijlani, Dinraj Kulkarni, Aamera Mulla, Gaganjot Kaur Sharma, Manish Sharma

Introduction: Determination of gender by anthropologists can be done by various methods e.g. skull bones, pelvic bones and other skeletal determinants. Assessment of odontometric data is a promising tool for gender prediction, which is usually preserved due to its robust nature. Aim and Objectives: The objective of the study was to predict the gender of an individual, using the odontometric data with powerful statistical tools like Logistic Regression Analysis (LRA) and Discriminant Analysis (DA). Materials & Method: 100 subjects were selected (50 male and 50 female) within the age group of 18-28 years. An alginate impression was made and models were prepared. The odontometric data was collected in the form of various mesiodistal and buccolingual measurements with Vernier calipers which was subjected to statistical analysis, using the two tests LRA and DA. Thereafter, results were compared for accurate gender prediction. Results: The statistical analysis of the measurements obtained was done by using two tests logistic regression analysis and discriminant analysis. After analysis and comparisons of the two methods for gender prediction, it was observed that LRA provides more accurate prediction than DA in determining the gender. Also, when data from both the arches was analyzed, it was more accurate in predicting the gender as in comparison to the analysis from either of the arch. Conclusion: The study has revealed that LRA may be better than DA for odontometric sex prediction. Overall, the results depict that the complete dentition, when used as a unit and through the application of flexible multivariate statistics such as LRA, has potential for its use as a prominent and sole indicator of sex prediction.

Page No. 167-173

Authors: Soumya Allurkar, Satish kumar Patil, Udupikrishna M. Joshi, Kundan Shah, Nitin Thakur, Anand Mangalg

Introduction: Miniplate fixation and screws is the method of choice for many surgeons to obtain rigid fixation and promote osteosynthesis within the maxillofacial region. The most common commercially used plates and screws are made up of pure titanium. The popularity of biocompatible devices containing titanium is due to its high resistance to corrosion in physiologic body fluids. Generally titanium fixation plates are not removed after osteosynthesis because they have high biocompatibility. This study was done to analyze the surface characteristics and changes in retrieved titanium plates and screws by scanning electron microscope (SEM) and stereomicroscope. Materials and Method: A total of 20 plates were retrieved from 12 patients visiting the department of oral and maxillofacial surgery at our institution over a period of 18months. These samples were studied by stereomicroscopy and scanning electron microscopy. Each plate and one of its screws were examined for evidence of manufacturing defects, surgical damage and corrosion. Particular attention was focused on countersink area of plate and taper of the screw head as these regions were particularly prone to micro movements and subsequent corrosion. Results: Surface contamination was detected both on retrieved and control plates. Manufacturing defects comprising of rough metal edges and protuberances were identified on the unused controls and surgical damage was evident on retrieved specimens. Two of the retrieved plates and screw showed the presence of corrosion and metal release which had been in the tissues for 14 to 20 months. Rest of the retrieved plates and screws, which had been in the tissues, between 6 months to 48 months showed no signs of corrosion or surface deterioration. Conclusion: The present study showed that 2 plates and its associated screws had signs of corrosion and metal release; but further long-term follow-up studies are desirable to assess the clinical and toxicological effects of the retention of titanium plates, especially in relation to release of particles to the surrounding tissues. The source of metal release has to be further confirmed by EDX analysis. There was no evidence from this study to support the routine removal of titanium maxillofacial miniplates.

Page No. 178-182

Authors: Karan Sharma, Manvi Malik, Vinod Sachdev

Aim: This study aims at evaluating the relative efficacy of the Tell-Show-Do and Live Modeling techniques on suburban Indian children during dental treatment based on the heart rate values. Materials & Methods: Children aged between 5 to 11 years were randomly divided into three groups as: GROUP A: Children who were presented with the Tell-Show-Do technique to undergo dental treatment. GROUP B: Children who were presented with Live Modeling technique, with mother as a live model. GROUP C: Children who were presented with Live Modeling technique, with father as the live model. A digital fingertip pulse oximeter was attached to the index finger of child’s left hand, in order to record heart rate values at a 30-second interval over a total of 11 data points. Results: Forty five of the forty six participants completed the entire protocol and participated in the study in three equal groups. Average heart rate over the entire treatment session was significantly lower among children in group B than among those in group A and group C at p<0.01. Conclusion: Live Modeling is a tangible technique in clinical pediatric dentistry as is supported by findings in other relevant fields also. Additionally, application of technique would require necessary skills, organized approach and innovation.

Page No. 187-189

Authors: Pradeep PR, Ankur Kumar Sriwastwa, Joydeep Das, Sneha Agarwal

Fracture of maxillary central incisors is the most common dental injury seen in today’s hectic life due to increased road accidents, contact sports or other accidents. It not only causes pain but affects the patient’s esthetics to a large extent. This always is the first concern of the reporting patient. Reattachment of the fractured fragment is possible when patient seeks immediate dental treatment along with the fractured fragment. The following case report describes the treatment of fractured right central incisor using fractured fragment along with prefabricated post. The fragment was attached using composite. This re-established the functions and esthetics of the patient in single visit. During follow up appointment, clinical and radiographic examination revealed no complications. This suggests the efficiency of single visit endodontic treatment and importance of retaining fractured fragment of the tooth

Page No. 194-196

Authors: Mohit Kumar, Manju Kumari, Sonali Taneja

The successful outcome of the endodontic therapy requires an adequate knowledge in context to anatomy of the root canal system. In most cases, the mandibular canines are thought to have just one root canal. Those presenting with an extra root and canal are usually rare, ranging from 1% to 5%. Thus, in spite of this low prevalence, variations in the anatomy and number of root canals in mandibular canines should always be taken into account. This paper presents a case of a mandibular canine with two distinct and separate root canals.

1

Authors: Prof. (Dr.) Vinod Sachdev.

Greetings Dear Readers! The year 2016 has been a wonderful span so far when we look into the kind of progress Dentistry has made; for a sustained oral health treatment with some phenomenal path-breaking ventures in the realm of Dental Research. Scientists have been successful in reporting dental stem cell mediated bioengineered tooth root (bio-root) and are trying their hands and minds on coalescing them with crown restorations, having moved an inch closer to the revered dream of tooth regeneration – The route is clear with target in foresight! In the succeeding context, I heartily welcome you all to the Current Issue of The Journal of Dental Specialties (JDS), an Official Publication of The Twin Dental Colleges of ITS – The Education Group.

4

Authors: Prof. (Dr.) S M Balaji.

I take this opportunity to congratulate the Editorial team of the JDS and the publishers for this new venture. The last decade, with publishing in Scholarly Journals being made mandatory by University Grants commission, the Medical Council of India and Dental council of India, saw proliferation of numerous scholarly journals. With the plummeting of scholarly journals, issue of quality of journals cropped up1,2 . Numerous societies and individuals formed journals. A couple of them did not survive the challenge due to financial hardship while a section of them did not meet the stringent ethical standards. As I read the situation, there are certain foremost aspects that need immediate attention1

10-13

Authors: Akshat Mediratta.

Objectives: To evaluate immediate and late probable side effects of interdental/intermaxillary wiring used in treatment of jaw fractures on gingival and other deeper structures. Methods: 30 patients undergoing wiring procedure as an aid for treatment of jaw fractures were selected. The immediate and late effects with a six month follow up were studied using various parameters that were Plaque index, Modified gingival index, Ramfjord’s periodontal disease index, tooth mobility (graded as ‘normal or pathological’), tooth vitality using gutta-percha hot stick and checking for ankylosis or root resorption clinically as well as radiographically. Results: Immediate effects noticed after placement of wiring were increased accumulation of plaque, inflammatory gingival hyperplasia with bleeding on probing, deepening of gingival sulcus and increased tooth mobility. Most of the changes had totally reversed after 6 months follow up. Conclusions: The late deleterious effects on teeth and periodontal tissues from interdental wiring in the treatment of jaw fractures are minimal and hardly of any significance.

21-25

Authors: Shubhra Malik, Sonali Taneja, Rupali Chadha, Manju Kumari.

Introduction: The aim of the study was to evaluate the sustained release effect of 2% chlorhexidine and its combination with 2% chitosan, in vitro. Method: The sustained release effect of chlorhexidine and its combination with chitosan was determined using a UV spectrophotometer. Results: UV spectrophotometer analysis for the sustained release of chlorhexidine showed that almost 100% of chlorhexidine was released within 4 hours. However when chlorhexidine was combined with chitosan, only 59% of chlorhexidine release was observed even at 24 hours. Conclusion: The percentage drug release of chlorhexidine was almost half when used in combination with chitosan, thus indicating the sustained release property of chitosan.

31-35

Authors: Mehak Gera, Shubhi Chaudhary, Amandeep Singh Dhillon, Vidya Dodwad, Shubra Vaish, Bhavna Jha Kukreja.

Background: Recurrence of pigmentation is seen to be associated with gingival melanin depigmentation, which starts with melanocytic migration from the adjacent free gingiva. The extent and rate of recurrence varies according to various treatment procedures used and time period of follow-up. The aim of this study is to compare surgical stripping and diode LASER techniques for gingival depigmentation and to evaluate clinical repigmentation. Methods: In this study, 20 sites from 10 patients with bilateral melanin hyperpigmentation were treated with surgical stripping and diode LASER techniques. Changes in Dummett Oral Pigmentation Index (DOPI) from baseline to 3 months postoperatively were recorded. Results: At the 3-month postoperative visit, 53% of the scalpel group and 46% of the diode LASER group showed clinical repigmentation. Paired t test was used for statistical analysis. Change in DOPI score was statistically significant. Conclusion: After gingival depigmentation, clinical repigmentation is an outcome of histologic changes in the melanocyte activity. Gingival depigmentation carried out by surgical stripping remains the gold standard, however diode LASER is seen nowadays as an upcoming treatment modality.

39-45

Authors: Priya Mittal, Ganesh Ranganath Jadhav, Ajay Logani.

Teeth with open apices present difficulty in estimation of working length because of extensive apical resorption and thin dentinal walls coupled with long-standing infection. Aim: To comparatively evaluate the accuracy of a 6th generation apex locator, digital radiograph, paper point and tactile technique for their ability to determine the working length in teeth with open apices. Methodology: Forty single-rooted maxillary anterior teeth were selected after excluding the teeth with curved roots. To simulate immature open apices, the apical 3–5 mm of the roots were removed such that ISO #80 file passed through the canal without any hindrance. The differences between dentinal-wall lengths in the same root was created using fine diamond round burs. Based on the method used to determine the working length, teeth were divided into five study groups and one control group as follows – Group I - radiographic measurement using paralleling technique, Group II - electronic working length measurement using Raypex 6 apex locator, Group III – tactile working length, Group IV – paper point working length and Group V - combination of apex locator, tactile and paper point techniques. In control group, actual working length was determined using direct observation of apical exit of file at shortest distance under dental operating microscope. Accuracy of all the methods to determine the working length was compared with the control group. The data was compiled and subjected to statistical tests and results were compiled. Results: Within ±0.5 mm, combined electronic, tactile and paper point working length (CETPPWL) method showed 99.5% of accuracy. Radiographic working length (RWL) using paralleling technique gave the least accurate result (around 78%) (n=40 for all groups). Conclusion: In teeth with open apices working length determination is a challenge. No single method is accurate. Combination of use of apex locator, tactile and paper point method is recommended.

55-60

Authors: Sagar Chawla, Mousumi Goswami, Priyanka Sachdeva, Vidhi Walia.

A thorough knowledge of the root canal morphology is essential for the endodontic therapy of primary teeth. Variations in the root canal systems in primary teeth can create a challenge to the practitioners during endodontic treatment. Meticulous cleaning and filling of all the root canals in all its dimensions, helps to eliminate or reduce the microbial load in the canals. The dentists should be aware of such variations and should be motivated to look for them in order to avoid post-operative complications. This article discusses the endodontic management of two primary maxillary second molars and one primary mandibular first molar with additional canals.

65-69

Authors: Himani Tyagi, Ujjwala Rastogi Awasthi, Priyanka Katyal, Akshay Rathore.

Sialolithiasis is the most common obstructive conditions of the major salivary glands, among which submandibular salivary gland calculi are more prevalent. Various imaging modalities are routinely practiced these days for diagnosing sialolithiasis. Today, the fast acquisition of a 3D image using cone beam CT (CBCT) has enabled us to overcome the temporal limitations of medical CT and MRI image acquisition. An initial and precise diagnosis will aid in an effective treatment. We present a series of 2 case reports wherein CBCT sialography was performed to demonstrate the obstructive salivary gland diseases for better interpretation of the ductal system of the gland. CBCT promises to modernize the practice of oral and maxillofacial stomatologist by offering foremost advantages like high resolution, less scan time dose to and the patient.

70-73

Authors: Nelson A, Kumar Chandan Srivatsav, Philips Matthew, John Hearty Deepak.

Fibrous Dysplasia is a developmental dysplastic disorder of bone in which the normal bone matrix is replaced by fibroblastic proliferation. Von Rechlinghausen was the first author who described it in 1891 and Lichtenstein was the person who introduced the term fibrous dysplasia. It can be monostotic (70%) or polyostotic (30%). The craniofacial localization occurs in 10%-25% of cases in monostotic forms and in 50% of cases in polyostotic forms. Almost all patients with extensive polyostotic forms of the disease have skull involvement, while most patients with craniofacial bone involvement have the monostotic form of the disease. Fibrous dysplasia essentially affects children and young adults, with no sex preference. Diagnosis is not always straightforward because the functional symptomology is often absent or not specific. Only symptomatic and/or gross forms are considered for treatment. We report two cases of fibrous dysplasia, one monostotic form involving only the maxilla and other polyostotic involving bilateral facial and skull bones.

82-86

Authors: Shruti Chauhan, Vinay Mohan, Rajesh Chauhan.

Eagle’s syndrome, also known as elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. Diagnosis is confirmed through clinical symptoms, radiological findings, and physical examinations. In this paper a case of ES exhibiting unilateral symptoms with bilateral elongation of styloid process is reported and the literature is reviewed.

90-94

Authors: Gurjap Singh, Neelima Gehlot, Sriram Krishnan, Abhishek Kapoor.

Oral submucous fibrosis (OSF) has multifactorial aetiology which is considered to include betel quid chewing, excessive use of chillies and spices, poor nutrition and deficiency of vitamin and iron. Various treatment modalities such as nutritional supplement, intralesional steroid and placental extract injections, antioxidants, and physiotherapy have been used for conservative management of OSF. Surgical treatment includes fibrotomy (release of fibrotic bands), coronoidectomy, third molar extractions and/ or reconstruction of buccal mucosa with various autografts and allografts. A 30-year old male patient reported to the Out Patient Department of Oral and Maxillofacial Surgery with the chief complaint of inability to open the mouth and difficulty in eating. Based on peculiar clinical findings, provisional diagnosis of OSF was established. Under general anesthesia, horizontal mucosal incision was placed along the occlusal plane with the surgical knife on the buccal mucosa 1cm below Stenson’s duct orifice bilaterally. The fibrous bands were palpated and using fingers dissection was carried out to release fibrous bands which were followed by bilateral coronoidectomy. Pedicled buccal fat pad (BFP) was used as a graft material to cover the areas on both sides. Healing was satisfactory with no breakdown or liquefaction necrosis post operatively. Approximately 30 mm of interincisal distance was achieved and maintained postoperatively with vigorous mouth opening exercises. BFP can be used effectively as a grafting material in the surgical management of OAF with good functional and esthetic outcome.

99-102

Authors: Nidhi Agarwal, Dipanshu Kumar, Samragni Banarjee, Aparna Singh.

Eruption cyst is a benign cyst associated with a primary or permanent tooth in its soft tissue phase after erupting through the bone. This case report documents a rare case in which the presence of supernumerary tooth hindered the normal eruption of permanent right maxillary central incisor subsequently the deficient space resulted in the formation of eruption cyst. The treatment included the extraction of supernumerary tooth followed by the surgical exposure of crown of the tooth associated with the eruption cyst. The present case report illustrates that the treatment of choice must be case specific with adequate analysis of clinical and radiographic findings and should be managed appropriately in order to minimize complications to the developing and erupting tooth.

03

Authors: Prof. (Dr.) Hari Parkash

The Journal is aimed to provide a platform for scientific exchange of knowledge by publishing Original Research, Case Reports, Systematic Review and Clinical Tips and Communications for the benefit of Dental Fraternity. The journal is committed to enhance Scientific and Evidenced based Dentistry with clinical Outcomes.

5-15

Authors: Threesuttacheep R, Pothacharoen P, Kongtawelert P, Ongchai S, Jotikasthira D, Chatiketu P, Krisanpra

Purposes: The aims were to monitor remaining interrupted force magnitudes, and to compare chondroitin sulphate (CS) levels in gingival crevicular fluid (GCF) of moved mandibular canines, rates of space closure and patients’ pain and discomfort between interrupted and continuous orthodontic force patterns. Materials and method: Fifteen Class I malocclusion patients (5 males and 10 females; aged 17.00 + 3.18 years) who required orthodontic treatment with first premolar extractions, were recruited. Interrupted force pattern was generated by elastomeric chains, and continuous force pattern by Nickel-Titanium closed coil springs. Initial force magnitude was 120 g. Elastomeric chains were replaced by new ones at the end of fourth week during the loaded periods. During the unloaded and the loaded periods, remaining interrupted force magnitudes were measured, and those of continuous force pattern were calibrated and controlled. GCF samples were collected with Periopaper® strips. CS levels were measured by competitive ELISA with WF6 monoclonal antibody during the 8-week control, the unloaded and the 8-week loaded periods. Rates of space closure were measured, and amount of pain and discomfort was assessed by visual analog scale (VAS) scores. Results: Medians of interrupted force magnitudes were 120.0, 60.0, 50.0, 37.5 and 25.0 g, and after elastomeric chain replacement were 120.0, 62.5, 37.5, 25.0 and 25.0 g respectively. There were no significant differences in the median CS levels between the 8-week control and the unloaded periods, and between right and left mandibular canines. Medians of CS levels during the loaded periods, both interrupted and continuous force patterns, were significantly greater than those during the unloaded period (P=0.008 and P=0.027 respectively). Differences between medians of CS levels of interrupted and continuous force patterns during each 1-week loaded period were not significant. There was no significant difference in the rates of space closure, and the patients’ pain and discomfort between interrupted and continuous force patterns. Conclusion: Both interrupted and continuous force patterns, with 120 g initial force magnitude, cause no difference in biochemically-assessed bone remodeling activity, same rate of space closure and same patients’ pain and discomfort. Initial orthodontic force magnitude, of both interrupted and continuous force patterns, may play an important role for alveolar bone remodeling and clinical outcomes.

22-28

Authors: Prarthna B, Saurabh S, Batra P, Dhillon M

Objective: The aim of this study is to describe shape and measure the size of the sella turcica in subjects with class I and class II skeletal types and to check whether sella can be considered as diagnostic marker for skeletal class II malocclusion. Material and Methods: Lateral cephalometric radiographs of 44 individuals (age; 15–30 years) were taken and classified skeletally; 22 as Class I and 22 as Class II (11 males and 11 females in both groups). The linear dimensions (length, depth and diameter) of sella turcica were measured. Student’s t-test was used to calculate differences in linear dimensions. Results: Results show that the sella turcica presented with normal morphology in the majority of subjects (61 percent). No significant differences were found in linear dimensions between genders. Significant difference was found in the depth of sella between Class I and Class II subjects (p<0.05) with smaller depth measurements in skeletal Class II subjects. Conclusions: Significant difference was found in depth of sella between Class I and Class II subjects with smaller depth measurements in Class II subjects. It is concluded that size of sella turcica can be used to approximate the size of the pituitary gland in skeletal Class II malocclusion. Skeletal class II cases due to mandibular deficiency are associated with smaller depth of pituitary fossa.

36-39

Authors: Lone EA, Utreja AK, Singh SP, Jena AK

Objective: To evaluate the effect of comprehensive orthodontic treatment on frequency and severity of white spot lesions (WSLs). Methods: Total 92 (M=43, F=49) subjects in the age range of 12-35 years seeking comprehensive orthodontic treatment were screened for the study. Among 92 subjects, 46 subjects (M=18, F=28) who fulfilled the selection criteria were included in the study. In 46 subjects, a total of 1026 teeth were examined for the evaluation of WSLs. The frequency and severity of WSLs were recorded on a standard proforma at the beginning (T0) and after completion of orthodontic treatment (T1) by direct visual assessment and by DIAGNOdent. The pre-treatment (T0) and post-treatment (T1) visual and DIAGNOdent scores were compared by using Wilcoxon Signed Rank test. The P-value of 0.05 was considered as the level of significance. Results: The frequency of WSLs among subjects seeking comprehensive orthodontic treatment was increased significantly from the pre-treatment value of 65.2% to post-treatment value of 95.7% (P < 0.001). Of 1026 teeth examined, 107 (10.4%) teeth had white spot lesions at the beginning of orthodontic treatment and 272 (26.5%) teeth had white spot lesions at the end of orthodontic treatment (P<0.001). The mean DIAGNOdent score was comparable between the pre and post-treatment evaluation (P=0.282). Conclusion: Treatment of malocclusion by comprehensive orthodontic treatment had a significant effect on the development and severity of white spot lesions.

43-47

Authors: Sharma A, Shokeen S, Arora R, Dhaginakatti SA

Introduction: Forensic odontology involves application of dental sciences in the identification of deceased individuals through comparison of ante-mortem and post-mortem records. Aim: To study knowledge, attitude and practice of forensic odontology among private dental practitioners in Ghaziabad city. Material and Methods: A questionnaire based cross–sectional survey was conducted on 137 private dental practitioners in their dental clinic at Ghaziabad city. A 20 Item Structured questionnaire was used to assess knowledge of dentist about the significance of dental records, indicators of child abuse, dental age estimation, identification of an individual, bite marks and dentist as a witness in the court for forensic evidence. Questions regarding their attitude and practice about maintenance of dental records and source for update on recent advances in dental practice were assessed. Results In our study only 11% B.D.S and 23% M.D.S dental practitioners maintain dental records in their clinic. 98.4% of B.D.S and 90% of M.D.S dental practitioners said that their knowledge level/ awareness regarding forensic odontology were perceived to be inadequate. 77% of B.D.S and 66% of M.D.S dental practitioners did not know the relevance of maintaining dental records for identification of criminals and dead-bodies. 96.7% of B.D.S and 95.9% M.D.S dental practitioners were not confident in handling forensic dentistry related cases. Conclusion: Our study revealed prevalent inadequate knowledge, poor attitude and lack of practice pertaining to patient’s dental record maintenance and clinical knowledge of forensic odontology among dental practitioners in Ghaziabad.

54-59

Authors: Kumar P, Sharma R, Saroha K, Sharma P, Singh V

Aim and Objective: To assess and compare the shear bond strength of brackets bonded with two different self-adhesive systems with and without contamination (Water, Saliva and Blood) and to evaluate the effect of Salivatact on the shear bond strength obtained with Beauty Ortho Bond. Material and Method: 15 premolars each (a total of 180) were bonded with Transbond XT plus, Beauty Ortho Bond and Beauty Ortho Bond with salivatact under various conditions i.e. dry, water, saliva and blood contamination. The shear bond strength and the ARI values were obtained and evaluated statistically. Results: Transbond plus had the maximum bond strength in dry condition and when contaminated with water or saliva. The bond strength of Beauty Ortho Bond with and without salivatect was similar in dry condition and when contaminated with water or saliva. The shear bond strength was lowest after the blood contamination in all the groups and highest for dry condition. Contamination with water and saliva resulted in similar strengths for all the groups. The bond strength achieved with all the three contaminants (water, saliva, blood) was similar when Salivatact was used. Conclusion: Contamination decreases the bond strength for all the groups and this decrease is maximum in case of blood contamination. Bond strength of Transbond color change adhesive is higher than that of Beauty Ortho Bond under all conditions except when contaminated with blood using Salivatect. Beauty Ortho Bond using Salivatact had higher bond strength when contaminated with blood.

64-67

Authors: Yadav S, Agarwal A, Singh S, Kumar S, Anand KR, Chhabra V

Purpose: The aim of this follow up clinical study was to evaluate the effectiveness of 2mm, 3-dimentional locking titanium miniplates. Patients and Method: A prospective randomized clinical trial was carried out on 10 patients with mandibular fractures. The patients were evaluated for the operating time, clinical assessment of mobility after fixation, occlusion, adequacy of reduction on post-operative radiograph and any surgical complications. The statistical analysis was carried out in SPSS software. Results: In 10 patients, 9(90%) were males and 1(10%) were females with a mean age of 28.75 years. Road traffic accident (RTA) was the etiological factor in 7(70%), inter-personal violence in 2 (20%) and fall in 1(10%) patient. The average intra-operative time was 40.10 min locking plates. This was found to be statistically significant when compared to the intra-operative time of non-locking plates in the literature. Bite force was measured in kilogram/cm2 using indigenously designed bite force measurement device. All the measurements were compared to the control group who did not sustain mandible fracture. At third month it was found that there was no significant difference in the bite between locking plates and control group. On examination satisfactory postoperative functional occlusion was found to be 100% in locking plates. Conclusions: The results obtained suggest that 3-D locking plate/screw system fulfill the treatment goals of adequate reduction, fixation and stabilization of fracture of mandible. 3-D locking plating system adequately reduces the fracture without much need for adaptation and hence reduces the intra-operative time.

76-80

Authors: Choudhury R, Kukreja P, Kumar S, Bhatnagar A, Anand KR, Chhabra V

Purpose: The aim of this study was to investigate the effects of a new flap design, the pedicle flap used for the removal of mandibular third molars on postoperative morbidity. Materials and Method: 10 patients with partially erupted mandibular third molar were studied. Swelling, pain, trismus, dry socket and wound dehiscence measures were recorded on days 2 and 7. Data were analysed using the t-independent test and Fischer’s exact test. Results: Facial swelling, pain, restricted mouth opening was seen in the postoperative period. Wound dehiscence was seen in only 1 patient and no incidence of dry socket was noted. Conclusion: Pedicle flap design has led to better wound healing and lesser incidence of dry socket.

86-88

Authors: Nagda SJ

Current training in dental education in India is mostly traditional. The method followed all over is predominantly didactic i.e. lectures and laboratories for skills and clinical training. It is time to introspect and analyze the reasons our graduates are appearing for entrance examinations and repeating their graduation in various parts of the world. We need to assess our training program and see if it meets the needs of students and community; to see how it matches to the various dental training programs globally. Our fraternity has to be aware of the global changes that have occurred in the field of education. This will enable them to improve, innovate and strengthen their skills and the program. There are many challenges facing us. They range from teaching learning methods, curriculum innovations, assessment techniques and improving attitudes and communication skills. This article will be a preliminary article on dental education in India and a series of articles will follow to address some important and pressing issues.

92-95

Authors: Gupta S, Kumar K, Raviprakash SM, Arunkumar KV

Oral verrucous carcinoma was first recognized by Ackerman in 1948 as a distinct entity. Although it occurs at various anatomic sites, most intraoral cases involve buccal mucosa, alveolar mucosa and gingiva. The purpose of this article is to describe four cases of verrucous hyperplasia and carcinoma with special emphasis on various clinical presentation and the most predilection sites. Verrucous hyperplasia and verrucous carcinoma may not be distinguished clinically or may coexist, resulting in diagnostic difficulties. It should be born in mind that leukoplakic lesions may transform into verrucous carcinoma or squamous cell carcinoma, so all such pre-cancerous lesions should be scrutinized conscientiously. Thus, it is amenability of both the oral physicians and histopathologists to be scrupulous about warty and exophytic lesions.

102-108

Authors: Kumar S, Jayan B, Bansal AK

The interest in studying the upper airway has always been there in orthodontics. Acoustic Pharyngometry is a relatively new technique in this field which measures the upper airway precisely. The technique is based on acoustic reflection technology. Sound waves are projected down the airway and reflected back out in such a way that the Pharyngometry software can analyze and quantify changes in the airway cross sectional area. It is an easy and quick technique that measures patient’s pharyngeal airway size and patency from the oropharyngeal junction to the glottis. The technique is useful in screening of patients having higher risk for sleep disordered breathing, establishing candidacy for mandibular advancement device and accurate bite recording/ titration of the appliance and also for planning surgical intervention. The aim of this article is to sensitize orthodontic professionals about this technique and to discuss the basic procedural methodology along with its clinical usefulness.

112-116

Authors: Rathi P, Sood R, Dodwad V, Vaish S

Introduction: Enlarged Gingiva is one of the prime concerns for both dentists and patients causing esthetic and functional problems. The treatment is based on the understanding of cause and underlying pathologic changes, be it inflammatory, pharmacologically induced, associated with systemic diseases, neoplastic, iatrogenic or idiopathic. Objective: To provide minimally invasive periodontal therapy to patients presenting with gingival overgrowth of five different etiological backgrounds. Materials and Methods: Patients with gingival overgrowths reported to the Department of Periodontology and Oral Implantology, ITS-CDSR, Muradnagar, Ghaziabad. Based on the individual history, the patients were categorized under five sections. First was inflammatory due to local deposits, Second was drug induced (phenytoin and amlodipine), Third was iatrogenic in patient undergoing orthodontic treatment, Fourth idiopathic and Fifth Miscellaneous in which patient himself wanted gingival correction because of esthetic concerns. Different treatment strategies were advocated depending upon the history, clinical examination and medical consent. Results: All patients were successfully treated with full mouth scaling, root planing and surgical therapy. Full mouth gingivectomy and gingivoplasty was conducted one week apart, one quadrant each week with scalpel, electro cautery and LASER depending upon the patient’s requirement. Conclusion: This case series emphasizes on the different types of gingival enlargement based on the etiology and highlights different treatment modalities advocated to manage such cases.

120-122

Authors: Konwar SK, Saxena A, Singla A, Chandna AK

Anterior crossbite is an abnormal labiolingual relation in which maxillary anterior teeth are locked behind the mandibular anterior teeth. Many methods are used to raise the bite to correct anterior crossbite. Here, a new method is described which will retain the bite blocks in place for easier correction of anterior crossbite.

123-124

Authors: Prof. (Dr.) Hari Parkash

The Journal is aimed to provide a platform for scientific exchange of knowledge by publishing Original Research, Case Reports, Systematic Review and Clinical Tips and Communications for the benefit of Dental Fraternity. The journal is committed to enhance Scientific and Evidenced based Dentistry with clinical Outcomes.

126-129

Authors: Apala Baduni, Bharat M. Mody, Shivanand Bagewadi, Manisha Lakhanpal Sharma, Bhuvana Vijay, Aanchal G

Introduction: Oral submucous fibrosis and leukoplakia are highly prevalent in India Lipids are the chief cell membrane components which are essential for various biological functions like cell growth and division of normal as well as malignant tissues. Lipids can be helpful for studying the variation in the cholesterol levels for diagnosing and treating the diseases. Aim: The present study evaluated the plasma lipid profiles in patients with Oral submucous fibrosis and leukoplakia and controls. Methodology: 21 patients were selected for the study out of which 7 had OSMF 7 had oral leukoplakia and 7 were included in control group. Patients with cardiovascular diseases, uncontrolled diabetes, acute hepatitis, thyroid dysfunction, and any drug history were excluded from the study. 5ml blood sample was taken and the serum was tested for triglycride levels(TG) , total cholesterol (TC), LDL, HDL, LDL VLDL level were analyzed using triglycerides were analyzed by auto-analyzer used for the analysis of the results is a fully automated biochemistry analyzer. Results: In this study TC, HDL, LDL level analysis showed lower levels in oral leukoplakia and OSMF patients than that of the controls. Conclusion: The alterations in the plasma lipid profile patterns were considerable and recommend a still in-depth study with larger sample size in this aspect for early diagnosis and management of oral leukoplakia to prevent malignant transformation.

140-145

Authors: Ritu Duggal, Neeta Singh

Aim: To compare distribution of apoptotic cells in the Periodontium following Orthodontic force application, to study the apoptotic index and co-relate with different phases of tooth movement. Material and methods: 100 patients, age 12-20 years, of class II div 1 malocclusion, were randomly divided into Groups I to V, requiring first premolars extraction with fixed Mechanotherapy. After leveling, canine was retracted using closed coil spring (100 gm forces). Surgical extraction of premolar was performed on 0, 3,7,14 & 21 days. Periodontium tissue was processed and apoptosis was evaluated by TUNEL assay. Apoptotic cells were counted from 4 different fields per slide and compared with the basal group. Results: The mean Apoptotic Index increased from day3 and peaked at day7 for both compression and tension sides. On tension side, at days 14 & 21 apoptosis wasn’t significant indicating earlier recovery. On compression side, there is more gradual decrease in apoptosis with lowest mean values at day 21, though not same as the basal level, indicating that the periodontal tissues require more than 21 days for complete recovery. The overall difference in apoptotic rate was statistically significant for both compression and tension sides. Conclusion: Tissue response is a time-dependant normal physiological process where periodontal cells are cleared by apoptosis. The correlation coefficient value indicates the apoptotic activity increased with force on compression side & increased significantly on tension side too, signaling towards force-dependant direct relation between the two. Cells on tension side showed a more rapid rate of recovery as compared to compression side.

150-155

Authors: Nidhi Mangtani, Rajath S Pillai, Dinesh Babu B, Veena Jain

Objectives: To assess the effect of resilient lined denture on patient masticatory efficiency, general patient satisfaction and denture quality as compare to conventional complete denture over a period of one year. Material and methodology: A total of 28 completely edentulous patients (14 males and 14 females) aged 45 to 60 years, having well-formed ridges were selected following iclusion exclusion criteria. These were divided into two equal groups, i.e. control (provided conventional mandibular complete denture –group 1) and experimental (provided mandibular denture lined with acrylic soft denture liner – group 2). All patients were clinically evaluated to assess the denture quality, and administered questionnaires for masticatory efficiency and patients general satisfaction level at three intervals i.e. one month (T0), 6 months (T1) and 1 year post-insertion (T2). Results: Statistical analysis for individual question for masticatory efficiency showed significantly higher score (P<.05) at baseline for experimental group as compared to control. While at six and twelve months time interval, significant differences (P<.05) were noted for some questions only. Intra-group analysis showed masticatory efficiency improved significantly over time in controls, while in experimental group masticatory efficiency remained the same (p>.05) for almost all the questions. Patient general satisfaction score at different time intervals for each question showed no significant difference (P>.05) on inter-group comparison. Time dependant intra-group comparison for patient general satisfaction score also showed no significant difference in scores for almost all the questions for both the groups. Statistical analysis for denture quality showed dentures in experimental group have significantly higher (P<.05) scores for denture retention and condition of supporting tissue as compared to control group, while with time denture quality decreased significantly in both the groups. Conclusion: Dentures with soft liner provided better masticatory efficiency while it had no effect on patient’s general satisfaction. Denture quality is better for one with soft liners as compare to one without soft liner.

159-163

Authors: Anand Mangalgi, Aafreen Aftab, Santosh Mathpathi, PavanTenglikar, Swati Devani, Nagesh Ingleshwar

Background and purpose: Aspirin is the most frequently used preventive and therapeutic drug for patients with cardiovascular diseases because of its antiplatelet property, which might lead to the risk of excessive bleeding during the surgery. The purpose of the study is to analyze if there is a need to discontinue low dose antiplatelet therapy before dental extraction. Methodology: The study samples consisted of 25 patients receiving 100 milligrams of aspirin daily and were scheduled to undergo dental extractions. Each patient acted as a control for himself, wherein an extraction was performed on a patient when aspirin was not discontinued and a second extraction after discontinuing aspirin for 72 hours prior the procedure.The bleeding time, clotting time, platelet count and INR were measured preoperatively at both the appointments and the amount of blood loss during the procedure was assessed. Results: The mean blood loss at the first appointment for the patients was 5.78 ml while it was 1.18 ml at the second appointment. The difference was statistically significant with a t – value of 3.2. However, the blood loss in patients during the first appointment was easily managed using local hemostatic measures which prevent any grave bleeding complication. Conclusion: From the observation in this study it can be stated that the low dose aspirin therapy can be continued prior to extraction procedure in the oral cavity without the fear of excessive intra-operative and post operative bleeding.

170-175

Authors: Nitu S S Mishra, Sangeeta P Wanjari, Rajkumar N Parwani, Panjab V Wanjari, Sumedha P Kaothalker

Background: Oral Submucous Fibrosis (OSMF) is a collagen related disorder seen in habitual betel-quid chewers. This is a high risk precancerous condition which clinically presents vertical palpable fibrous bands in buccal mucosa, generalized fibrosis of oral soft tissues with restricted mouth opening. Present study was undertaken to ascertain the changes occurring in collagen type I &III and elastic fibres in OSMF in relation to orientation, density and thickness. Study Methods: The study was performed on 15 cases in each group such as Stage I OSMF, Stage II OSMF, Stage III OSMF and normal oral mucosa (NOM). The biopsied samples were routinely processed for paraffin embedding; stained with Hematoxylin and Eosin as well as special stains like Masson's Trichrome (MT), Verhoeff Van Gieson (VVG) and Picrosirius red (PSR) and examined under light and polarized microscope respectively. MT stain demonstrated all types of collagen fibers collectively while PSR stain under polarized microscopy demonstrated collagen type I and type III separately with enhanced birefringence. VVG stain demonstrated very fine black colored elastic fibers, thus changes taken place could be accurately ascertained with progression of the disease. Results: Change in the orientation of collagen type I has been observed in stage II and stage III of OSMF from haphazard to parallel in relation to surface epithelium, while no change was noted in type III collagen fibres as well as elastic fibres in any stage of OSMF, and remained haphazardly arranged. Increased density of type I collagen was observed with increasing stage of OSMF from moderately dense to dense, while decrease in density of type III collagen was noticed in stage III than in stage II OSMF from moderately dense to sparse. The density of elastic fibres was decreasing from dense in stage I to sparse in stage III. Thickness of collagen type I was increasing with increasing grades while type III collagen and elastic fibres remained unchanged. Conclusion: The alterations in orientation, density and thickness of collagen fibres and density of elastic fibres in various grades of OSMF contribute to the clinical presentation of trismus with progression of the disease.

180-182

Authors: Pallavi Vashisth, Vatsala V, Sathyajith Naik, Mousumi Goswami Singh

The traditional techniques of chemo-mechanical instrumentation and disinfection of the root canal system used in mature teeth are limited by the immature tooth’s anatomy. The open apex is difficult or impossible to seal with conventional root filling methods because of the absence of an apical stop. Furthermore, the arrested development of the dentinal walls at the time of pulp necrosis leaves a weak tooth with thin dentinal walls that are susceptible to fracture. The purpose of the paper is to present the case of a patient wherein revascularization of the necrotic infected pulp space of an immature permanent mandibular molar was induced by stimulation of a blood clot from the periapical tissues into the canal space. The treatment approach can help rescue infected immature teeth by physiologically strengthening the root walls.

188-191

Authors: Anshdeep Singh, Himanshu Aeran, Seema Dixit, Saurabh Arora, Ashish Chaoudhary

Preservation of tooth is one of the major goals of an Endodontist. This goal can be acquired either by non surgical or surgical approach. Root resection is one of the surgical approaches for preservation of molars with furcation involvement. This procedure results in a unique environment which is dictated by the contours of the remaining roots and the residual furcation between them. Root resorption is a viable treatment option to salvage and retain a part of multirooted teeth. This case report illustrates prognosis of root resection after completion of endodontic therapy for managing a case of root resorption. This case shows external root resorption of the distobuccal root of right maxillary first molar. Due to strategic value of maxillary first molar, it was decided to employ root resection. After completion of endodontic therapy root resection was carried out. After 6 months, the absence of periradicular radiolucent lesions, periodontal pocket, pain, and swelling indicated a successful outcome of root resection.

195-198

Authors: Shaveta Garg, M.K Sunil, Ashwarya Trivedi, Neetu Singla

The Odontogenic Keratocyst (OKC), first described by Phillipsen in 1956, has been reclassified as odontogenic neoplasm and has been renamed as Keratocystic Odontogenic Tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. Odontogenic keratocysts are benign intraosseous tumors of odontogenic origin that occur most commonly in the jaw. In particular, they have a predilection for the angle and ascending ramus of the mandible. The recurrent rate of odontogenic keratocyst is 25 – 30 percent. A case of odontogenic keratocyst in 60 years old patient is presented involving mandibular third molar ramus area which was recurred after 3 years.

202-206

Authors: Chandrashekhar R. Bande, Dinesh Mohale, Manjiri Thakur, Pravin Lambade

Verrucous Carcinoma is a rare type of low grade, well differentiated squamous cell carcinoma. The author herein reports a case of squamous cell carcinoma arising within verrucous carcinoma of mandible. A 65-year old women reported to hospital with the history of swelling over the gums of lower jaw since 1yr. Her swelling was painless and gradually had spread to the whole mandible. Incisional biopsy and histopathologic examination revealed verrucous carcinoma which was treated with total Mandibulectomy.

211-216

Authors: Ashutosh Shetty, Priyanka Basu, Vivek Bhaskar, U.S. Krishna Nayak

Often many patients cannot be treated by orthodontics alone, and need the combined efforts of orthodontics and orthognathic surgery. Such patients are treated in three phases- a phase of pre surgical orthodontics that involves basically decompensating the dentition, followed by the surgery, which is then finished with final detailing of the occlusion. This article is a case report of a skeletal bimaxillary protrusion patient, who was treated with bi- jaw surgery.