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   Table of Contents - Current issue
July-December 2022
Volume 14 | Issue 2
Page Nos. 79-162

Online since Thursday, December 29, 2022

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Publication credits and author sequencing … Need for a global consensus p. 79
Sonali Vijay Deshmukh
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Three-dimensional printing and three-dimensional aligner - A success story p. 81
Suresh Ludhwani
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An update on sterilization and disinfection of endodontic instruments p. 83
Vaishnavi Satish Borse, Varsha Sanjay Pandit, Ashwini A Gaikwad, Aishwarya N Handa, Abhijit B Jadhav, Ruchira K Bhamare
Infection control is a term used to describe the precautions, policies, and procedures undertaken in a healthcare setting in order to minimize the risk of spreading an infection. It helps prevent the transmission of disease-producing agents such as bacteria, viruses, and fungi from one patient to another, from the dental practitioner and dental staff to patients, and from patients to dental practitioner or other dental staff. Among the many aspects of infection control, sterilization and disinfection of instruments and associated appliances play a crucial role for any infection control regimen to be successful in a health-care setting. Sterilization and disinfection of instruments can be described in general as decontamination procedures for treating instruments, enabling their safe usage. Failure to adhere to recommended sterilization guidelines and protocols can lead to serious cross-infection causing a disease which could be far more incapacitating than what the patient was originally suffering from. It also increases the chances of persistence of the infection. In either case, treatment outcomes are drastically reduced, rendering the entire treatment unfruitful. Sterilization and disinfection of instruments are of particular significance in the field of endodontics due to the intrinsic nature of the various procedures involved as part of the field and the type of instruments that are used. Routine decontamination procedures are usually not effective due to the complex, intricate, and minute design of various endodontic instruments. In addition, it is very important to take into account the effect of various sterilization protocols on the material of the instrument. This review article aims to describe the various sterilization and disinfection procedures for endodontic instruments in a concise manner, taking into consideration the potential effects that the sterilization/disinfection procedure might have on the instrument to be sterilized. Hopefully, it will make it easier for clinicians to choose the most suited/appropriate sterilization and disinfection procedure for any given endodontic instrument.
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Role of Porphyromonas gingivalis in the downregulation of NLRp3 inflammasome in periodontitis p. 91
Neelam Gavali, Amit Chaudhari, Pramod Waghmare, Yogesh Khadtare, Pooja Shendge, Shubhangi Wadgounkar
The innate immune response is the body's first line of defense against pathogens. The innate immune system recognizes pathogens, including bacteria and viruses by engagement of the germline-encoded pattern recognition receptors (PRRs). There are five families of PRRs which are able to sense vast families of microbial components, referred to as pathogen-associated molecular patterns and damage-associated molecular patterns (DAMPs), they are host cell components produced during inflammation or environmentally derived. Although PRRs are predominately expressed by innate immune cells, many of the PRRs are also found on other cells including epithelial, endothelial, and cells of the adaptive immune system. PRR engagement by its ligand induces downstream signaling cascades that induce multiple effects, including activation of innate immune cells and cytokine/chemokine production for the recruitment of immune cells to the site of infection or tissue damage. There are multiple inflammasomes that are formed, which are named for their sensor PRR that induces its activation. It is still not clear how many sensors are capable of forming inflammasomes, with strong literature support for over 10 different inflammasomes, including NLRP1, NLRP3, NLRP6, NLRP12, pyrin, NAIP/NLRC4, RIG-I AIM2, IFI16, NLRC3, and NLP6 5,7 which are recently reviewed. The study of periodontal disease thus represents an excellent model to study the role of inflammasomes due to the abundance of Microbe Associated Molecular Patterns (MAMP) and DAMPs and the elevated proportion of macrophages in the tissue microenvironment.
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Sclerotherapy in the Management of Oral Mucocele: A Literature Review p. 96
Trupti Vijay Gaikwad, Anuj Paul Maini, Arunima Sarma, Sukanya Das, Sayali Lokhande, Shristi Rakesh Prasad
Mucocele is a mucous-filled cavity that can occur at various locations in the body including the oral cavity. There are various treatment options for mucoceles ranging from surgery, laser surgery, cryosurgery, etc. Due to the invasive surgical procedures and high chances of recurrence even after surgery, the focus of interest has now shifted to nonsurgical ways of management which show negligible side effects including the use of corticosteroids and sclerotherapy using various drugs. Further, no need for local anesthesia is an added advantage of the sclerotherapy procedure.
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The dentist's handbook: Exploring the emerging domain of dental negligence Highly accessed article p. 101
Ajay R Bhoosreddy, Seema Bhoosreddy, Sonali Vijay Deshmukh, Jaiyesh Bhoosreddy, Priyanka Giri, Aryaman Bhoosreddy
Medicine is of all the arts the most noble; but, owing to the ignorance of those who practise it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. -Hippocrates Every aspect of human activity is influenced by law and dentistry in this regard is no exception. A dentist while providing oral healthcare to patients has to follow certain standards to avoid any litigation in the name of malpractice. Inadequate knowledge regarding the medicolegal aspects halts the effective delivery of oral health-care services. A dentist is bound by law and ethics while providing treatment to patients. Negligence is a breach of legal duty and care that a dental professional has toward his patients. It is necessary that a patient should be aware of complete information regarding the treatment to avoid any clauses of negligence against the doctor even if there is no contract between them. The two main categories under which health-care malpractice can be challenged in court of law is civil and criminal. The third category lies under the Consumer Protection Act 2019 came into force in 2020 in which patient can file lawsuits against the professional services provided by dentists in consumer courts. Studies conducted to assess the level of awareness among the dental and medical professionals have found that they are ignorant about the laws governing their profession. It is essential for health-care professionals to be aware of such laws which would be beneficial not only to the dental professionals and patients but to the society as a whole. Thus, this review provides an overview of negligence, the determination of negligence and its prevention, liabilities of dental professionals which comprehensively form an integral part of the medicolegal aspect of dental practice.
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The effect of vibrational devices on pain in patients undergoing orthodontic treatment: A systematic review and meta-analysis p. 110
Shilpa Chawla, Lishoy Rodrigues, Shailesh Deshmukh, Gaury Anant Vajarekar
Objective: To critically evaluate the existing evidence with respect to the effect of vibrational devices on pain levels during orthodontic treatment. Materials and Methods: Unrestricted electronic search in PubMed/MEDLINE, Directory of open access journal, Cochrane Central as well as manual searches was conducted up to June 2020. Only randomized-controlled trials (RCTs) were included. Study selection, data extraction, and bias assessment were done by two independent reviewers. The Cochrane risk-of-bias tool was used, and the quality of evidence was graded using the grading of recommendations assessment, development, and evaluation approach. A fixed-effects meta-analysis of continuous data, with its 95% confidence intervals (CIs), was used. Results: Nine RCTs were included for qualitative synthesis and the overall quality was moderate and had an overall low risk of bias. Several shortcomings were observed because of the lack of blinding of the participants as well as the investigators. We conducted a meta-analysis for two studies which assessed the pain using (visual analog scale) which showed (standard mean difference 1.83, 95% CI, −7.18–10.84) with fixed effect model based on the heterogeneity value of I2. Results also showed a statistically nonsignificant difference regarding the effect of vibrational devices on pain levels when compared with no vibratory stimulus and sham devices. Conclusions: There is weak evidence indicating the effect and use of vibrational devices in orthodontic treatment. The meta-analysis aided us to conclude that there is no significant difference in the pain outcome after the use of vibrational devices as compared to the control group and having no effect on pain levels in patients undergoing orthodontic treatment.
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Analysis of clinicopathological parameters of oral squamous cell carcinoma in different age groups p. 120
Smita Jembu Chaware, Varsha Ajit Sangle, Aarti Mahendra Mahajan, S Sajda Gajdhar, Surabhi Ashok Sarode, M Shilpa Kendre
Context: Oral squamous cell carcinoma (OSCC) is the most common malignancy of oral cavity. OSCC shows geographical variation with respect to the age, sex, site, and habits of the population. In general, OSCC is most commonly seen in men in the 6th to 8th decades of life and is rare in patients younger than 40 years. In recent years, it have been observed an increased incidence of OSCC in young individuals. Aims: To compare and correlate the clinical parameters of OSCC in different age groups. Settings and Design: Ninety histopathologically diagnosed cases with OSCC were included in our prospective study. These patients were divided into three groups: Group I: 30 patients below 40 years of age; Group II: 30 patients who were between 41 and 60 years of age; and Group III: 30 patients who were above 60 years of age. Subjects and Methods: The relevant information regarding clinical parameters, i.e., age, sex, site of lesion, risk factors, duration of habit, tumor, node, metastasis (TNM) staging, and clinical diagnosis were collected and tabulated. Statistical Analysis Used: The Chi-square test was applied to evaluate the significant difference among different age groups. Results: There was a statistically significant difference in the duration of habit and TNM staging among different age groups. Conclusions: OSCC in different age groups shows some differences as well as similarities in the parameters that were analyzed.
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Comparative evaluation of root coverage with amniotic membrane under macrosurgical and microsurgical approach: A prospective clinical trial p. 126
L Princee Mani, PS Gautami, N V SG Sruthima, K S V Ramesh, Vivek Bypalli, K Radha Rani
Objectives: Gingival recession is a major concern as it causes unesthetic appearance during smiling, dentinal hypersensitivity, and root caries. Several surgical procedures have been undertaken to cover these exposed root surfaces, with the most predictable and effective being coronally advanced flap (CAF) with subepithelial connective tissue graft. Because amniotic membrane (AM) contains embryonic stem cells, it can be utilized as a possible autograft/periodontal-guided tissue regeneration substitute. Magnification improves visibility and causes less tissue trauma during surgery. Therefore, the goal of this study was to evaluate the efficacy of root coverage with AM utilizing a conventional macrosurgical technique (MaT) versus microsurgical technique (MiT) employing loupes. Materials and Methods: This randomized clinical trial included 24 patients, 12 of whom were treated using MaT and 12 utilizing MiT with 4x magnification loupes. Clinical parameters such as amount of root coverage in terms of vertical gingival recession (VGR), horizontal gingival recession (HGR), increase in width of keratinized gingiva (WKG), clinical attachment loss, and patient satisfaction analysis for the evaluation of discomfort, dentinal hypersensitivity, and esthetics were recorded at baseline and 3 and 6 months after surgery. Results: Both the groups demonstrated improvement in all clinical parameters. However, the test group showed a significant reduction in VGR and HGR with a mean difference of 0.95 mm (P = 0.007) and 2.167 mm (P = 0.002) at 6 months, respectively. There was no significant difference in the mean WKG and hypersensitivity scores between the two groups. Conclusion: Both treatment approaches, i.e., MaT and MiT with the use of AM, were effective in improving the clinical parameters and the amount of root coverage. However, the test group showed a better reduction in discomfort and hypersensitivity postoperatively with enhanced esthetic outcomes. Clinical Relevance: Magnification-assisted root coverage attained predictable outcome.
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Assessment of the greater palatine foramen position in an Indian population: A cone-beam computed tomography study p. 135
Surekha Rathod, Srushti Dhande, Vrushali Lathiya, Abhay Kolte
Background: During minor dental surgical procedures, the greater palatine nerve block is commonly utilized to achieve anesthesia. The greater palatine nerve and arteries are transmitted through the greater palatine foramen (GPF). Furthermore, this region serves as a soft-tissue donor site. The goal of this research was to interpret the location of the GPF and its diameter in an Indian population by utilizing cone-beam computed tomography (CBCT). Materials and Methods: The position of GPF relative to the maxillary molars was estimated by utilizing 120 CBCT scans. Furthermore, the GPF's diameter and distance between the mid-palatine suture and the alveolar ridge were also determined. Results: Of the 120 GPFs examined, 102 were found to be in the third molar region. The GPF's distance from the mid-palatine suture and alveolar ridge was 14.01 ± 1.12 mm and 6.74 ± 1.95 mm, respectively. The mean anteroposterior diameter was 3.43 ± 0.3 mm. On considering the age group ≤45 years, the GPF's average distance from the mid-palatine suture (14.35 ± 1.10 mm) and alveolar ridge (7.87 ± 2.09 mm) was significantly higher than >45 years (P = 0.0329 and P < 0.0001, respectively). All the measurements were significantly higher in males. Conclusion: The location of GPF is variable but more closely related to the third molar. Sound knowledge of the GPF anatomy is crucial for an effective nerve block and also for preventing complications.
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Photographic assessment of facial components in facial esthetics as perceived by orthodontists, artists, and photographers – An In vivo study p. 141
Khaniya Bharathan, Indra Annamalai, Prema Anbarasu, Saravana Kumar Subramanian
Background: Facial esthetics was primarily the subject of study for artists and philosophers. Facial appearance is an essential diagnostic criterion for a complete comprehensive orthodontic treatment planning. The aim of this study was to establish the perception of facial esthetics by different professionals, namely orthodontists, artists, and photographers, and to investigate the most influential facial characteristics involved in rating the overall attractiveness. Materials and Methods: Twenty-two subjects of age 18–24 years fulfilling the inclusion criteria were selected as the study samples. The subjects were asked to relax, gently touch the lips together, and then start smiling. This dynamic range of smile was video recorded using a digital camera. This video was then converted into 300 frames. The frame that best represented the subjects' natural/posed unstrained social smile was selected and cropped to create three types of images: the face with the smile, the face without the smile, and the smile image. The evaluators (orthodontists, artists, and photographers) were instructed to answer the questions from 1 to 8 looking at image 1 (face with smile), question 9 by looking at image 2 (face without the smile), and questions 10 and 11 by looking at image 3 (smile only). Results: According to orthodontists and artists, the feature most strongly associated with overall attractiveness was symmetry of face, whereas the photographers showed the highest score for cheekbones. The highest correlation was found between the orthodontist and artist groups. Conclusion: The perception by the three professionals confirms that the overall facial attractiveness is more important than dental attractiveness.
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Oral health status of psychoactive substance abusers p. 150
Rashmi Bhavasar, Vandana Shah
Introduction: Among varied substance abuse, tobacco abuse is a common relapsing addiction among youth. The relationship of tobacco abuse in varying grades of dental caries (DC) is worthy of study. This study was planned with a null hypothesis, there is no difference in varying grades of DC in tobacco and related substance abusers to those of nonabusers in the population visiting institute. Materials and Methods: The present study comprised 270 adults, 135 participants in each group, with age ranged from 20 years to 50 years including both gender. Study group formed of smokers, tobacco abusers, smokeless tobacco abusers, gutka, betel nut, and a combination of these two, whereas the healthy, nonhabit group formed control. DC was measured using the decayed, missing, and filled teeth (DMFT) index. Oral hygiene was evaluated by recording a simplified Oral Hygiene Index (OHI). Results: DC was found higher in individuals with habits (mean DMFT: 4.73 ± 4.32) as compared to those of nonhabit group (mean DMFT: 3.17 ± 3.11), and the difference was statistically significant (P = 0.001). OHI was significantly higher in tobacco abusers than those of nonabusers (P = 0.0001). In the case of both moderate and severe caries, the duration and frequency of tobacco abuse was significantly associated with a pattern of DC (P = 0.001). As the frequency of tobacco and related substance abuse increased, caries (DMFT) also increased (r = 0.15 and P = 0.013), and it was statistically highly significant. Conclusion: Psychoactive substance abuse along with poor oral hygiene, in any form of smokeless or smoking form of tobacco habit, is a risk for increased caries activity, and it is higher in smokeless tobacco abusers as compared to smokers.
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EEC syndrome: A rare case management p. 156
Payel Agarwala, Krittika Samaddar, Chitradeep Chakraborty, Sudipta Kar, Shabnam Zahir
Ectrodactyly–ectodermal dysplasia–cleft lip/palate (EEC) syndrome is a rare congenital anomaly. Infants affected with this syndrome experience feeding difficulties due to the presence of orofacial clefts, which in turn impedes nutrition and affects overall health. Due to the presence of oronasal communication in such infants, there is a lack of negative pressure necessary for suckling. Due to the cleft lip, these infants face trouble closing their mouths around the nipple of the mother or bottle and due to the cleft palate, the infants suffer from choking and nasal regurgitation during feeding due to the inability of the palate to separate the oral and nasal cavities. A feeding appliance is a crucial aid because it obturates the cleft and creates a platform against which the infant can press the nipple and extract milk until the cleft is surgically repaired. However, conventional feeding plates may be potentially dangerous due to the risk of accidental swallowing. Furthermore, the wire component of certain feeding appliances may cause tissue injury. KRIPA's feeding appliance incorporates an adjustable head strap and Polyvinyl chloride (PVC) tube-enclosed retentive hooks which render it safer and more acceptable. This case report represents the fabrication of KRIPA's feeding appliance for a 3.5-month-old infant with EEC syndrome.
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Repositioning of buccal corticotomy: An innovative surgical technique for removal of lingually placed cyst p. 161
Shilpa S Bawane, Pushkar P Waknis, Prathamesh V Bhujbal
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