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   2020| July-September  | Volume 7 | Issue 3  
    Online since October 9, 2020

 
 
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ORIGINAL ARTICLES
Comparison of smear layer removal by MTAD, TetraClean, QMix, NaOCL, coconut water, and saline as irrigating solutions in primary teeth: An in vitro study
Aparna T Purakkal, Faizal C Peedikayil, Y Shibuvardhanan, TP Chandru, Soni Kottayi, N Srikant
July-September 2020, 7(3):97-104
DOI:10.4103/jdrr.jdrr_39_20  
Background: The purpose of the endodontic treatment is to achieve thorough debridement of the root canal irregularities in the canal systems, narrow isthmi, and apical deltas prevent complete debridement by mechanical instrumentation alone. Thus, a variety of irrigants along with the mechanical instrumentation are required to clean and shape the root canals before obturation. Aims and Objectives: The aim and objective of the study was to compare and evaluate the smear layer removal efficacy of different final irrigants from the coronal, middle, and apical third of the root canals of primary teeth using field-emission scanning electron microscopy. Materials and Methods: Sixty therapeutically extracted human single-rooted primary teeth were prepared by step-back technique. Prepared teeth were randomly divided into six groups (n = 10): MTAD (Group I), TetraClean (Group II), QMix (Group III), 0.9% normal saline (Group IV), coconut water (Group V), and 5.25% NaOCl (GroupVI). After irrigation with final irrigants, the teeth were evaluated and assessed for the amount smear layer present under a field-emission scanning electron microscope using a score system criteria by Rome et al. Data obtained were analyzed using the Pearson's Chi-square test and McNemar–Bowker test. Results and Conclusions: Among the six irrigants QMix 2 in 1 showed the best smear layer removal efficacy, followed by 5.25% NaOCl, TetraClean, MTAD, coconut water, and the least efficacy was for normal saline.
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EDITORIAL
Hurdles and the future of forensic odontology in India
Rohan Ashok Gawali
July-September 2020, 7(3):95-96
DOI:10.4103/jdrr.jdrr_66_20  
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ORIGINAL ARTICLES
Exploring research opportunities and challenges facing dental students in Khartoum state
Maria Hassan, Nada Tawfig, Esraa Bakri, Hasaan Miligy, Sahar Jamal, Alaa Osama, Badria Borai, Esam Abd Algader, Yousra Gamal
July-September 2020, 7(3):105-114
DOI:10.4103/jdrr.jdrr_22_20  
Context: Research is an essential component of many predoctoral medical and dental education programs focused on training students as clinicians, educators, and researchers in evidence-based practices. Despite the importance of clinical research, a variety of factors discourage young candidates from entering clinical research careers. As the rate of conduction of clinical researches in the dental field is increasing nowadays, it is important to define the impediments that face undergraduate and postgraduate dental students and hence formulate solutions. Aim: The aim of this study was to explore the research opportunities and challenges facing undergraduate and postgraduate dental students among different universities in Khartoum state. Settings and Design: Four hundred and twenty-six questionnaires were distributed in this descriptive cross-sectional study, among both undergraduate and postgraduate dental students in five universities in the Khartoum state. Materials and Methods: The questionnaire was modified from the dental students' research inventory questionnaire which was well validated. Statistical Analysis Used: The analysis was done using SPSS Version 22 (SPSS Inc., Chicago, IL, USA). Results: Most of the participants included in this study were undergraduates (89%). The study showed that only 4.4% were found to face high challenges concerning data analysis, 46.7% have had a high challenge in writing a report and publishing their research data, and 60.4% encountered curriculum problems while conducting their research. Generally, most of the participants were unsatisfied about the different facilities and opportunities that were available to them. In addition, 84.8% of them were moderately satisfied from the knowledge and skills they gained from their research experience. Conclusion: Dental students among different universities in Khartoum state are facing challenges in several aspects while conducting a research project. Research committees should develop and enhance the needed facilities that would encourage young candidates to conduct research.
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CASE REPORTS
Lithium disilicate ceramic veneers for esthetic restoration of anterior teeth: Two case reports
Pratyasha Kaushik, Robin Singh, Elkanti Soujanya, Lokam Karthik Prasad
July-September 2020, 7(3):142-146
DOI:10.4103/jdrr.jdrr_33_20  
In recent years, laminate veneer restorations have been used in dentistry as a more conservative and esthetic treatment option. Lithium disilicate ceramic material yields most thin veneers and has better properties compared to other materials. These two case reports aim to describe the complete clinical procedure, from treatment planning to lithium disilicate ceramic veneer cementation. Patients were informed about the treatment plan. Tooth preparation was done using porcelain veneer preparation burs (Pivo, Korea) and was limited to enamel in both the cases. Veneers were etched with 9.5% hydrofluoric acid, followed by the application of a silane coupling agent. Teeth were etched using 37% phosphoric acid, and then bonding agent was applied. Dual-cure resin cement was used for cementation of veneer to the tooth structure. A layer of oxygen barrier was also applied just before light curing the resin cement. Lithium disilicate ceramic veneers are minimally invasive as these require very less tooth reduction. These veneers have esthetically promising results due to their properties similar to that of enamel.
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ORIGINAL ARTICLES
Microflora in odontogenic infections
Priyaranjan , Vijay Shekhar, Muqthadir Siddiqui Mohammed Abdul, Sunil Kumar Gulia, Faisal Noor Ahmad
July-September 2020, 7(3):105-108
DOI:10.4103/jdrr.jdrr_41_20  
Purpose: This study was intended to evaluate the various causative microorganisms responsible for fascial space infections. Materials and Methods: A total of 88 patients who reported with an orofacial space infection of odontogenic origin were included in the study. Following a thorough evaluation, using a disposable syringe, pus sample was obtained and sent for culture and sensitivity test. Offending teeth were extracted under antibiotic coverage, and incision and drainage was done as and when indicated. The results of the culture and sensitivity along with the effective antibiotic were tabulated. Results: The results of this study show that submandibular space (38.8%) is the frequently involved fascial space. Majority of the patients are in the second and third decades of life (53.9%). Staphylococcus species (41.1%) is the most commonly isolated microorganism. Penicillin remains to be the drug of choice. Extraction of the offending tooth under antibiotic coverage and incision and drainage remains to be a treatment option. Conclusion: Based on the results of this study, it can be concluded that the causative microorganisms for odontogenic infections involved mixed aerobic–anaerobic bacteria. Anaerobic as well as aerobic cultures were necessary to isolate all pathogens.
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Assessment of nasal morphological parameters in Maharashtrian population
Pushkar Andhare, Sanjeev Datana, Shiv Shankar Agarwal, SK Bhandari
July-September 2020, 7(3):115-120
DOI:10.4103/jdrr.jdrr_24_20  
Introduction: Human nose influences facial aesthetics and soft tissue harmony. Owing to uniqueness of nasal morphological characteristics, due consideration to it during treatment plan is essential. Present study aims at assessing nasal index in the Maharashtrian population and its correlation with age, gender and type of malocclusion. Materials and Methods: A sample of 410 patients was selected out of patients undergoing orthodontic treatment at the department to assess various nasal parameters. Data thus obtained was divided in groups depending on age, gender and type of malocclusion and subjected to suitable statistical analyses. Results: Mean nasal index in males was 79.08 ± 8.21 while in females was 76.65 ± 9.87 which did not differ significantly with respect to gender and age (P > 0.05). Mean nasal index differ in respect to type of malocclusion in sagittal plane and was found to be highest in patients' records pertaining to skeletal Class III malocclusion, which was statistically significant (P < 0.05). Nasal index did not show significant correlation with facial index and dorsum base ratio (P > 0.05 for both). Conclusions: Mean nasal index in Maharashtrian male is 79.08 ± 8.21 and in females is 76.65 ± 9.87 (mesorrhine nasal type). The mean nasal index was found to be reduced in Class II malocclusion cases as compared to Class I and Class III malocclusion. The facial index, nasal index and dorsum base ratio also did not show statistically significant correlation.
  182 16 -
Is dental practice in the current scenario in India safe or unsafe: A questionnaire study
Sunil Kumar Gulia, Vijay Shekhar, Saritha Maloth, Ashwani Kumar, Minerva Singh, Divesh Yadav
July-September 2020, 7(3):121-123
DOI:10.4103/jdrr.jdrr_31_20  
Aim: This study was intended to evaluate whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario of COVID-19 pandemic in India. Materials and Methods: This study was designed based on a cross-sectional survey. An self-administered questionnaire survey was used to evaluate whether it is safe or unsafe for the clinician as well as the patient to carry out dental procedures in the current scenario of COVID-19 pandemic in India. In this regard, a questionnaire study with a convenience sample of 124 dentists working in various clinics in India was conducted. This study, while limited in sample size, benefits the general practitioners as target readers to assess the awareness pertaining to safety of the dental practice. Results: The results of this study reveal that there exists a good knowledge among the dental health professionals pertaining to the COVID-19 virus and its oral manifestations in addition to the precautions to be taken for the prevention of COVID-19 in a clinical setup. Most of the dental professionals follow proper infection control biomedical waste disposal protocols, but their clinical areas are not properly ventilated. In addition to this, there exists an apprehension as well as an uncertainty pertaining to the current scenario to carry out their professional work. Conclusion: The results of this study suggest that it is relatively unsafe to carry out most of the dental procedures at this juncture in spite of taking all necessary precautions.
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Dental disease burden and projected financial implication of adult population of Uttarakhand, India: An observational cross-sectional multicentric study
Abhishek Kandwal, Saba Jamil, Sanjeeva Kumar, Shaika Negi, Nidhi Kundra
July-September 2020, 7(3):128-133
DOI:10.4103/jdrr.jdrr_35_20  
Introduction: Dental disease and oral hygiene are one of the most prevalent health problems in the world. With increasing incidence of dental caries and poor oral hygiene, the cost of oral rehabilitation significantly increases. Aim: The present study was conducted to access the burden of dental caries and oral hygiene in adults at three health care centers and the combined population. Materials and Methods: Six-hundred individuals, 200 each from three health center were enrolled. Oral hygiene index simplified (OHI-S) and decayed missed and filled teeth index (DMFT) and socioeconomic data was recorded. Approximate projected financial burden per individual was calculated for the population. Results: Nearly 94.7% of the total population has DMFT >0, while 58.7% of population had OHI-S for grade and Grade 3. Overall, financial burden per individual for the population was 2382–7716 INR. Intercenter comparison by the analysis of variance was significant P < 0.000, for DMFT and OHI-S scores. All indices were highest for center 1 followed by center 2 and center 3. Met need index was 0.46, restorative index (RI) was 25.44%, treatment 47.85% need index was and significant caries (SiC) index was 5.84. Age was statistically significant for DMFT and OHI-S (P < 0.05). Conclusion: The present study showed a very high prevalence of dental caries and SiC. Treatment needs were high, while RI and met needs were low with high projected financial burden.
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CASE REPORTS
Paradental cyst: Misdiagnosed or underdiagnosed
Flora Verma
July-September 2020, 7(3):138-141
DOI:10.4103/jdrr.jdrr_36_20  
Paradental cysts (PDCs) are odontogenic cysts having inflammatory origin contributing to 3%–5% of all odontogenic cysts. They arise either on the buccal, distal, or mesial aspects of partially erupted mandibular third molars. It has been previously known by various terms such as collateral inflammatory cyst, inflammatory lateral periodontal cyst, or mandibular infected buccal cyst. PDC is most commonly associated with recurrent history of pericoronitis and is attached to the cementoenamel junction and coronal third of the roots. While there is little doubt that it develops as a response to chronic inflammatory stimulus triggering proliferation of the crevicular and/or odontogenic epithelium, considerably same as other inflammatory odontogenic cysts, the exact histogenesis remains unclear. The PDC is commonly misinterpreted when it is associated with atypical characteristics clinically and radiographically, in turn causing diagnostic problems, leading to misdiagnosis as other inflammatory cysts including the dentigerous cyst of inflammatory origin. In this present case series, two cases with a history of pericoronitis are discussed showing overlapping clinical, radiographic, and histological features with other odontogenic cysts creating diagnostic dilemma. A combined correlation of all relevant findings helped to attain a final diagnosis of PDC.
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REVIEW ARTICLES
Relationship between Helicobacter pylori infection and recurrent aphthous stomatitis
Alberto Rodriguez-Archilla, Yasmine Abouzahr
July-September 2020, 7(3):154-158
DOI:10.4103/jdrr.jdrr_29_20  
Background: Recurrent aphthous stomatitis (RAS) is a very common ulcerative disease that affects about 20% of the population. Helicobacter pylori infection could be involved in the RAS pathogenesis by inducing an oral cytotoxic immunological response to these bacterial antigens. Objective: The objective of this study is to assess the possible relationship of H. pylori infection with RAS. Methods: A search for articles on H. pylori and RAS was performed in the following electronic databases: PubMed (MEDLINE, Cochrane Library), Web of Science (WoS), and Spanish Medical Index (IME). Ninety-eight articles (29 in PubMed, 69 in WoS, and none in IME) were found between 1997 and 2018, 28 of them duplicates. From 26 articles with full-text availability, three studies with a score below 6 points on the Newcastle–Ottawa scale were excluded. After applying these criteria, 23 studies were included in this review. Statistical Analysis: For dichotomous outcomes, the estimates of effects of an intervention were expressed as odds ratios using Mantel-Haenszel method with 95% confidence intervals. The Pearson's Chi-square test was also used when necessary. Results: RAS patients were 2.16 times more likely to be infected by H. pylori than controls with a very significant statistical relationship (P < 0.01). 42.0% of RAS patients and 33.8% of controls were infected with H. pylori with a statistically significant association (P = 0.001). Nearly 45.9% of patients infected with H. pylori were located in Asia, 34.7% in the Americas, and 33.0% in Europe, with statistically significant differences (P < 0.01). Conclusions: There is a greater detection of H. pylori in RAS patients than in controls without the disease.
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COVID-19 pandemic: Challenges to dental practice in India
Nisha Dubey, Sanjeev Tyagi, Raghvendra Kumar Vidua, Pooja Sinha
July-September 2020, 7(3):151-153
DOI:10.4103/jdrr.jdrr_43_20  
Background: The coronavirus (COVID-19) has posed a unique kind of challenge before different segments of the dental profession and invited different responses from this profession. The major challenge before the dental profession is now the risk of contracting infection and becoming a part of the transmission chain further. Aims and Objectives: The dentists and associated health-care workers are at particular risk for this infection as it may be transmitted by the respiratory route through the oral cavity, where the dentists are involved in working for hours as well as through fomites that are generated and unavoidable during the dental procedures. Therefore, the study aims to review the existing literature available to find out the impact of COVID-19 over the current dental practices. Method: It's a type of systemic review of existing literature to find out the Challenges to Dental Practice in India COVID-19 Pandemic. This article also discusses the measures employed for the prevention against this infection by dentists in this pandemic. Conclusion: COVID-19 has given a major setback on the rapidly growing dental practice and associated market business in India, but hopefully, the things will change in due course of time, and this profession will soon come out from the shackles of this infection.
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CASE REPORTS
Biodentine used as an apical barrier for the treatment of open apex
Pallavi Srivastava, Anshul Sawhney, RohitSharma , Manoj Kumar Hans, Shivam Agarwal, Shishir Dhar
July-September 2020, 7(3):147-150
DOI:10.4103/jdrr.jdrr_48_20  
An immature tooth with pulpal necrosis and periapical pathology imposes a great challenge to the endodontist. Endodontic treatment options for such teeth consist of conventional apexification procedure with and without apical barriers. Biodentine is a new material used for regenerative procedures and advertised as a bioactive dentin substitute. Apexification in one step using an apical plug of Biodentine can be considered a predictable treatment and may be an alternative to mineral trioxide aggregate apexification. This article demonstrates the use of the newer material, Biodentine, which helps in formation of a calcific barrier in a nonvital tooth and helps in the formation of the root apex. This case reports present apexification with the use of biodentine.
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Management of a separated paste carrier in the mandibular central incisor
Sweta Rastogi, Kulvinder Singh Banga, Sarang Sharma, Dhirendra Srivastava
July-September 2020, 7(3):134-137
DOI:10.4103/jdrr.jdrr_32_20  
Success and failure of root canal treatment are a debatable topic as it depends on various factors, including knowledge and expertise of the clinician as well as host responses that are subjective in nature. Knowing the canal anatomy to guide the instrument through it is as important as knowing the complications of guiding it through the canal. One such complication often encountered by clinicians is instrument separation. The protocols recommended to manage the complication include leaving the separated instrument in situ in the root canal, bypassing the fragment and incorporating it in the obturating material, removal from the root canal, and surgical management as the last resort. This case demonstrates the removal of a separated lentulo spiral from the root canal, including the use of magnification, which facilitates the treatment.
  94 11 -
ORIGINAL ARTICLES
Prevalence of Class 2 Division 1 malocclusion among schoolchildren in Dakshina Kannada, India
Savitha Sathyaprasad, Philu Achaam Philip, S Vijaynath, KS Neethu, Varsha Manoharan
July-September 2020, 7(3):124-127
DOI:10.4103/jdrr.jdrr_16_20  
Aim: To determine the prevalence of malocclusion in the district of Dakshina Kannada, India. Methodology: The study had a total of 3500 children within the age group of 8–14 years, and they were classified into four groups of normal occlusion, Angle's Class I, Class II Division 1, and Class II Division 2 malocclusion. Results: No statistically significant gender differences among the children were found. Conclusion: The prevalence of malocclusion was 66.6%, with majority of them with a Class I malocclusion (45.2%), followed by Class II Division I malocclusion (17.6%) and least being Class II Division II (3.8%).
  93 12 -