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   Table of Contents - Current issue
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October-December 2020
Volume 7 | Issue 4
Page Nos. 159-239

Online since Tuesday, December 1, 2020

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ORIGINAL ARTICLES  

The impact of chronic periodontitis on glycemic control and serum lipids in comparison with periodontal health Highly accessed article p. 159
R Mathangi, Bagavadgita Jayaraman, Nagarajan Geethapriya, Alagarsamy Venkatesh, Shila Samuel
DOI:10.4103/jdrr.jdrr_124_20  
Context: Periodontitis is a chronic inflammatory oral disease. The inflammatory cytokines that are released as a consequence of periodontal inflammation has wide spread systemic effects on glycemic control and lipid profile of healthy controls. Aim: The study aims to study the impact of chronic periodontitis (CP) on glycemic control and serum lipids in comparison with periodontal health. Materials and Methods: This study is designed as hospital-based cross-sectional study. Fifty healthy controls and 50 CP subjects were included in the study. Complete information about demographic variables, glycemic control, and serum lipid profile were collected. Statistical Analysis: Statistical expressions were determined using Student's t-test, Chi-square test, and Pearson correlation coefficient. Results: Serum lipid profile and glycated hemoglobin levels were abberated in CP. Conclusion: CP influences glycemic control and induces dyslipidemia in individuals who are otherwise healthy without any systemic illness.
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Comparison of salivary and serum C reactive protein levels in periodontitis and healthy patients using ELISA – A clinico pathological study p. 165
Anshul Sawhney, Megha Ralli
DOI:10.4103/jdrr.jdrr_50_20  
Background: Periodontitis is one of the most common chronic inflammatory diseases in the world. C-reactive protein (CRP) is important due to its crucial role in atherosclerosis as a marker. This study evaluates both salivary and serum CRP levels, Gingival Index, Plaque Index, Bleeding Index, and probing pocket depth. Methodology: A total of 150 participants were enrolled, out of which 50 were healthy, i.e., did not have periodontitis, 50 patients were suffering from chronic periodontitis previously called adult periodontitis, and 50 patients were suffering from aggressive periodontitis with features of rapid attachment loss and bone destruction. All these patients were divided into three groups, and salivary as well as serum samples were collected from each group which were analyzed using enzyme-linked immunosorbent assay. Results: The results showed that both salivary and serum CRP levels were highest in aggressive periodontitis patients followed by chronic periodontitis patients and least in healthy individuals. Conclusion: Both salivary and serum CRP are effective markers in evaluating the severity of periodontal disease.
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Assessment of awareness of periodontal disease among dental undergraduates: A questionnaire study Highly accessed article p. 171
Shruti S Ligade, Shretika Pandya
DOI:10.4103/jdrr.jdrr_64_20  
Background: Periodontal disease has become a major public health problem in India with a high prevalence. Conventionally, it is believed that regular dental prophylaxis and maintenance of oral hygiene is sufficient for the prevention or control of gingival diseases, and yet there are patients undergoing various periodontal surgeries in everyday life. Periodontology treats the body as one unit, and hence, there should be in-depth knowledge of systematic diseases and their relation with the oral cavity. The awareness about the scope of periodontology and the major as well as minor surgeries is very low among the population as among the undergraduate students. This questionnaire survey was undertaken to judge the same and subsequently, if required, provide awareness. Methodology: The blinded questionnaire survey was undertaken among all the dental colleges from Pune, namely, Dr. D. Y. Patil Dental college (Pimpri), Sinhgad Dental College (Pune), Rangoonwala Dental College (Pune), and Bharti Vidyapeeth Dental College (Pune). A total of 150 students from the final year of all colleges voluntarily participated in the study. As it was a triple blinded study, no gender bias was obtained in the result. Results: On getting the results and statistical analysis using SPSS Version 11.5 software, it was found that dental undergraduate students (Bachelor of Dental Surgery) had superficial knowledge about maintenance of periodontal health, namely the students could tell the importance of chlorhexidine mouth wash but were unable to tell the appropriate method of use. Many students were not able to differentiate between the symptoms of the periodontal abscess and periapical abscess. The importance of implant landmarks and basic knowledge about the pull of frenal attachment was lacking among the majority of the participants among all the three colleges. Conclusion: It can be stated that periodontal awareness among dental undergraduates was lacking in regard to its application toward the surgeries and its importance with systemic diseases as diabetes and hypertension. This bridge of ignorance must be crossed so that patients can be rightly educated by in earliest stage, and the importance of the branch of periodontology can be duly given. Note: Please note source file has more reviewer queries found, please check and confirm
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Prevalence of Torus mandibularis and its association with para-functional activity in tertiary care centre in Shimla, H.P., India: A hospital based cross sectional study p. 177
R Guru Prasad, Neeta Sharma, Ravinder Prakash
DOI:10.4103/jdrr.jdrr_62_20  
Introduction: Oral tori are bony growths present in oral cavity and are not considered as pathological lesions. Torus mandibularis (TM) is usually present in lingual aspect of alveolar process in canine-premolar region of mandible. The objective of the study is to determine the TM' prevalence among outpatients attending tertiary care center and its relevance with parafunctional activities. Materials and Methods: The study was conducted in the out patients attending the hospital between December 2017 and May 2019. Fourteen thousand and two hundred and eight patients were screened for the presence of TM as per inclusion and exclusion criteria. The data were collected and subjected to the statistical analysis. Results: Out of 14,208 patients, 157 patients were presented with TM. The prevalence found to be 1.1%. Tori were more frequent in males than females. The most commonly observed type was bilateral solitary type. The association of TM with parafunctional activities and temperomandibular disorder was found to be significant. The higher frequency of TM was seen in the subjects residing at high altitudes. Discussion: The prevalence of TM in our study was found to be low. The study was undertaken to record the preliminary data regarding TM in this region and its association with parafunctional activity. Conclusion: We suggest performing thorough clinical examination and imaging to rule out underlying parafunctional activity, if TM is incidental finding.
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Attitude of patients/parents with cleft lip and palate toward orthodontic treatment: A survey p. 182
Sanjeev Datana, Shiv Shankar Agarwal, SK Bhandari, NK Sahoo
DOI:10.4103/jdrr.jdrr_46_20  
Background: Assessment of attitude among patients with cleft lip and palate (CLP) and their parents is vital for successful orthodontic treatment outcome. The study of variability of attitude toward orthodontic treatment among patients with CLP and non-CLP may reveal requirement of any additional care to the CLP patients. Materials and Methods: Part I of the study surveyed 50 CLP patients and their parents regarding their attitude toward orthodontic care. Part II of the study compared CLP patients with their non-CLP counterparts regarding attitude toward treatment duration, oral hygiene, dietary, and other difficulties faced during the treatment. Results: No difference in attitude toward requirement of orthodontic treatment and adequacy of number of appointments planned was observed between CLP patients and their parents (P > 0.05). The CLP parents showed a higher satisfaction with improvement in smile, overall looks, and changes in overall personality of their children (P < 0.05). Both CLP and non-CLP patients showed a similar experience with orthodontic treatment duration and difficulties experienced during treatment (P > 0.05). The CLP group had a higher difficulty in brushing with braces and required extra time for brushing than the non-CLP group (P < 0.05). Conclusions: Although the patients with CLP are emotionally comparable to their non-CLP counterparts, still special attention may be given to them during treatment because of low self-esteem secondary to impaired facial esthetics and difficulty in brushing and oral hygiene maintenance during treatment owing to various anatomical complexities in these patients.
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Orthodontists' apprehension and viewpoint regarding COVID-19: A survey of Indian orthodontists p. 187
Sakshi Rakhyani, Prashant Sharma, Pradeep Raghav, Munish Reddy, Shalu Jain
DOI:10.4103/jdrr.jdrr_58_20  
Aim: To assess the apprehension and viewpoint of Indian orthodontists about the outbreak of pandemic COVID-19. Subjects and Methods: A survey was conducted in April 2020, for which an online questionnaire was prepared in English language using Google Forms to collect the data. The questionnaire consisted of ten multiple-choice questions; one concerning the work setting of participants and the remaining concerning the information and effect of coronavirus pandemic. The data were summarized in percentage form for the ease of evaluating results. Results: 314 forms were completed and returned. 88.9% of orthodontists believed that COVID-19 and the following lockdown imposed by the authorities to prevent its spread has profoundly affected orthodontic practice. About 56.1% of the orthodontists said that more than three-fourths of their patients understand that there will be a delay in their treatment due to the pandemic. About 38.1% of the orthodontists believed that around 3–6 months will be required for the practice to normalize. Most importantly, 39.4% of the orthodontists were unable to make up their mind regarding transferring the cost of personal protective equipment to their patients when practicing emergency/elective procedures on them. Conclusions: Orthodontists as well the patients undergoing orthodontic treatment understand the gravity of epidemic and therefore more importance is being given to solve the emergencies over the call itself. Orthodontists believe that with a decrease in the disposable income of people, there will be a decline in orthodontic requirements in the country and that a time period between 3 and 6 months will be required to normalize the practice.
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Awareness on bioterrorism among dental graduates in Northern India p. 193
Sunil Kumar Gulia, Shilpa Sunil Khanna, Fatema Zahid Hussain, Rudra Sharma, Kanish Aggarwal, Ajay Kumar
DOI:10.4103/jdrr.jdrr_44_20  
Aim: This study is intended to evaluate the knowledge and awareness among dental graduates on bioterrorism. Materials and Methods: This study was conducted using a cross-sectional survey. Self-administered questionnaire survey was used to evaluate the knowledge and awareness among dental graduates pertaining to bioterrorism. In this regard, a questionnaire study was conducted with a convenience sample of 172 dental graduates studying in various institutions in Northern India. This study, while limited in sample size, benefits the general practitioners as target readers to assess the knowledge and awareness among dental graduates on bioterrorism. Results: The results of this study show that 73.8% of the dental graduates who participated in the study were aware of the term bioterrorism. However, only 56.9% of dental graduates were only aware of the different biological agents that can be employed in bioterrorism. Only 61.6% of the participants were aware where to report a bioterrorism. Even though 92.4% of the participants felt that dentists can play an active role during bioterrorism, only 7% of the participants have attended an awareness program pertaining to bioterrorism. Conclusion: Dental graduates lacked knowledge pertaining to bioterrorism. Hence, the results of this study show that there is a need to educate dental graduates regarding bioterrorism through guest lectures or continued dental education.
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Does caries in the adjacent tooth justify prophylactic odontectomy of impacted tooth? p. 197
Vijay Shekhar, Shilpa Sunil Khanna, Chaitaliben Gandhi, Rashtra Bhushan, Izaz Shaik, Shivam Sharma
DOI:10.4103/jdrr.jdrr_56_20  
Purpose: To ascertain the influence of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. Materials and Methods: A retrospective study was conducted based on the records of the patients who underwent surgical removal of lower wisdom tooth in 3 dental clinics of the different cities during December 2015 to August 2019. The orthopantomogram and intraoral periapical radiograph images of 470 patients were considered to evaluate the impact of impacted lower wisdom tooth on the initiation and progression of distal caries in the lower second molar and whether prophylactic removal of lower wisdom tooth is justified. In order to achieve this, parameters evaluated on the radiographs are the presence of dental caries in relation to lower second molar, angulation of the lower wisdom tooth, depth of impaction, presence of pericoronitis, and patient characteristics like age and gender. The results were analyzed to ascertain whether prophylactic removal of lower wisdom tooth is justified to preserve the long term health of the lower second molar. Results: The results of this study reveal that 28% of the patients developed dental caries in relation to lower second molar in the presence of a wisdom tooth. The mandibular third molars were impacted unilaterally in 63% of cases and bilaterally in 37% of cases. Caries in lower second molars was noticed when the wisdom tooth was in Class I position in 53.8% of the cases and 69% in position A. This finding is commonly encountered in the presence of a mesioangular impacted third molar. It was observed that when a wisdom tooth was in Class I relationship for any kind of angulation it increased the chances for the initiation and progression of caries in lower second molars. Conclusion: It can be concluded that to preserve the lower second molars, it is advisable to prophylactically remove an impacted third molar that have a mesial angulation and Class I and Level A position.
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CASE REPORTS Top

Single-visit apexification with biodentine and platelet-rich fibrin p. 201
Sonam Dhall, Rakesh Mittal, Monika Tandan
DOI:10.4103/jdrr.jdrr_69_20  
An open apex in a nonvital permanent tooth makes endodontic treatment a challenge. There is a necessity to induce or create an apical barrier against which the obturating material can be compacted. The present article reports the effective closure of root apex in a pulpless permanent upper incisor tooth with wide-open apex utilizing Biodentine in blend with platelet-rich fibrin in the form of a matrix showing excellent healing potential at a 12-month follow-up.
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Cemento-ossifying fibroma of maxilla: An unusual case report p. 206
Meetkamal Grewal, Swati Gautam, Renu Tanwar, Nitin Saini
DOI:10.4103/jdrr.jdrr_12_20  
Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion which belongs to the same category of fibrous dysplasia and cement-ossifying dysplasia. It arises from the periodontal membrane which contains multipotent cells that are capable of forming cementum, lamellar bone, and fibrous tissue. It is more common in the mandible than in the maxilla. We present a case of COF in the maxilla, a rare occurrence in a 66-year-old female with the chief complaint of a swelling in the left upper back tooth region for the past 3 years. A panoramic radiograph was taken, which showed an oval radiopaque lesion in the second quadrant from 24 to maxillary tuberosity. In the maxilla, the clinical and radiological differential diagnosis includes fibrous dysplasia, giant cell lesions, cementoblastoma, calcifying epithelial odontogenic tumor, and peripheral giant cell granuloma. It is sharply circumscribed and demarcated from the surrounding bone, so surgical excision is the treatment of choice.
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Successful retrieval of metal post and nonsurgical retreatment of maxillary canine using minimum armamentarium p. 210
Thimmanagowda N Patil, Raghavendra Penukonda, Harshada A Pattar
DOI:10.4103/jdrr.jdrr_61_20  
Removal of the different materials from the root canal in a failed endodontic treatment is a prime requisite for endodontic retreatment. Complete removal of the materials such as gutta percha, broken instruments, or post is of particular importance for accessing endodontic space, cleaning, shaping, and disinfection of the root canal. Intraradicular post removal poses a challenge to the clinician with associated risks. This case report focuses on removal of the metal post and endodontic retreatment of the maxillary canine with minimum armamentarium to enhance the longevity of the tooth.
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Full-mouth rehabilitation for severely attrited dentition by simplified approach p. 214
S Devameena, PS Manoharan, Vivek Rajasimhan, B Vidhya
DOI:10.4103/jdrr.jdrr_47_20  
Several reasons may cause attrition of dentition which could collapse the occlusal harmony. Apart from esthetic challenges, the dentition needs to be carefully evaluated for biological and mechanical reasons. Several techniques were formulated as a management for attrited dentition to meet esthetics and functional harmony. This paper describes a simplified systematic approach and management of a 45-year-old male with attrited dentition which helped the patient to adapt well to new restoration.
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Contemporary restorative strategies for root canal-treated traumatized maxillary incisors – Case series report p. 219

DOI:10.4103/jdrr.jdrr_65_20  
This article aims to present about the restorative strategies to be adopted for the management of root canal-treated traumatized maxillary incisors incorporating the contemporary minimal invasive options. Each root canal-treated tooth poses a unique challenge to be addressed in an individual manner. This presentation highlights the restorative assessment and technique to be adopted for restoring the root canal-treated maxillary incisor.
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REVIEW ARTICLES Top

Pigmented lesions of the oral cavity – A brief review p. 228
Debanjali Mukherjee
DOI:10.4103/jdrr.jdrr_38_20  
Pigmentation is a common clinical finding of an oral cavity, but a proper diagnosis of the lesions is very challenging. Pigmentation can be focal, multifocal, associated with systemic/genetic disorder, or due to exogenous agents. Pigmented lesions are either melanocytic or nonmelanocytic. Pigmented lesions of the oral cavity have a broad spectrum of diversity. They present as racial pigmentation, innocuous lesions (amalgam tattoo, oral melanotic macule), benign nevi, and life-threatening malignant melanoma, and they can also produce a diagnostic dilemma. Thus, a proper diagnosis of a pigmented lesion in an early stage is very important for the accurate treatment plan. In this review, pigmented lesions of the oral cavity are briefly discussed.
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Ideal tissue regeneration option following periapical surgery p. 232
Malti Tuli, Alankrutha Gangasani, Muqthadir Siddiqui Mohammed Abdul, Manpreet Kaur, Sunil Kumar Gulia, Piyush Raj Dharmi
DOI:10.4103/jdrr.jdrr_37_20  
Optimal tissue regeneration in the periapical region is essential following a periapical surgery. Literature shows that augmenting the osseous defect with artificial bone substitutes, growth factors, or barrier membranes acts as critical factors influencing the healing following surgical intervention. For the regeneration of tissues following periapical surgery, an essential requisite is progenitor/stem cells. Few studies have shown that simple use of a membrane barrier and/or bone graft following surgery might not produce adequate tissue regeneration. Literature clearly shows that few substitutes are capable of generating progenitor/stem cells and induce the undifferentiated mesenchymal cells to differentiate. Hence, this review is intended to throw light on whether tissue regeneration with the aid of bone grafts coupled with a membrane barrier will suffice or is there a need for recruiting progenitor/stem cells.
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LETTERS TO EDITOR Top

Are patients with removable oral prosthesis more susceptible to COVID-19 infection? p. 236
Priya Kotwani, Vaibhav Patwardhan
DOI:10.4103/jdrr.jdrr_85_20  
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Could there be an overlooked association of oral bacterium Aggregatibacter sp. in aggravating COVID-19 disease? p. 238
Vaibhav Patwardhan, Priya Kotwani, Deepak Saxena
DOI:10.4103/jdrr.jdrr_92_20  
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