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   Table of Contents - Current issue
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July-September 2021
Volume 12 | Issue 3
Page Nos. 211-336

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GUEST EDITORIAL  

Oral health: A gateway to overall health p. 211
Dipti M Bhatnagar
DOI:10.4103/ccd.ccd_597_21  
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REVIEW ARTICLE Top

A meta-analysis of oral squamous cell carcinoma in young adults with a comparison to the older group patients (2014–2019) p. 213
Khadijah Mohideen, C Krithika, Nadeem Jeddy, Thayumanavan Balakrishnan, R Bharathi, S Leena Sankari
DOI:10.4103/ccd.ccd_466_20  
Background: The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association. Aim: The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients. Materials and Methods: We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows. Results: Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups. Conclusion: The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.
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ORIGINAL ARTICLES Top

Comparative evaluation of efficacy of different irrigating needles and devices in removal of debris from apical third of root canal: An In-vitro SEM study p. 222
Isha Srivastava, Sanjeev Srivastava, Rohit Grover, Ajay Paliwal
DOI:10.4103/ccd.ccd_468_20  
Background: Irrigants were required to eliminate the microbes and debris from the intraradicular space and must have direct contact with the entire root canal wall. Therefore, different irrigation methods have been proposed to deliver the irrigant as close as possible to the remote areas of the root canal. Aim: The aim of the present study is to evaluate the cleaning efficacy of single-beveled needle, side-vented needle, endovac, and endo-irrigator plus in the removal of debris from apical third of root canal by Scanning Electron Microscope. Materials and Methods: Forty single-rooted freshly extracted human permanent mandibular premolars were collected. Root canals were cleaned and instrumented till X2 (25/06) with rotary Protaper Next at working length 1 mm short of the apex. Teeth were randomly divided into four equal groups: Group 1 (n = 10): Endovac, Group 2 (n = 10): Endo irrigator plus, Group 3 (n = 10): Side-vented needle, and Group 4 (n = 10): Single-beveled needle. Irrigation was done with 5.25% NaOCl, followed by 17% ethylenediaminetetraacetic acid. Samples were sectioned and examined under SEM at apical levels. Statistical Analysis: Analysis of variance followed by Tukey's post hoc test was performed. Results: The level of debris removal efficacy is as follows: Endovac > Endo-irrigator plus > Side-vented needle ~ Single-beveled needle. Conclusion: Endovac showed the maximum number of debris removal and has better cleaning efficacy in the apical areas of the root canal, followed by Endo irrigator plus, Side-vented needle and Single-beveled needle.
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Microscopic assessment of dentinal defects induced by ProTaper Universal, ProTaper Gold, and Hyflex electric discharge machining rotary file systems – An in vitro study p. 230
Takhellambam Premlata Devi, Amandeep Kaur, Shamurailatpam Priyadarshini, BS Deepak, Sumita Banerjee, Ng Sanjeeta
DOI:10.4103/ccd.ccd_631_20  
Background: Biomechanical preparation of root canal can damage root dentin leading to the formation of dentinal cracks which can eventually lead to fracture and failure of the treatment. Aim: The aim was to investigate the incidence of dentinal defects in root canals prepared with ProTaper Universal, ProTaper Gold, and Hyflex electric discharge machining (EDM) rotary file systems using handheld USB digital microscope. Materials and Methods: One hundred and fifty extracted mandibular premolar teeth with single canal were randomly divided into five groups (n = 30). Group 1: unprepared (negative control). Group 2: canal preparation done with nickel–titanium hand files (positive control), Group 3: canals prepared with ProTaper Universal rotary system, Group 4: canal preparation done with ProTaper Gold rotary system, and Group 5: canals prepared with Hyflex EDM rotary system. The specimens were sliced at 3 mm, 6 mm, and 9 mm from the apex with a slow-speed saw under water cooling. Digital images of each section were captured at ×40 magnification with the aid of a microscope. Two independent evaluators assessed the images for the presence of dentinal defects. The number of dentinal defects was recorded and Chi-square test was used for statistical analysis (P < 0.05). Results: The number of specimens presenting dentinal defects was as follows: Group 3; ProTaper Universal – 9/30 (30.0%), Group 4; ProTaper Gold – 2/30 (6.7%), and Group 5; Hyflex EDM – 1/30 (3.3%). No defects were detected in the negative and positive control groups (Group 1 and Group 2). Conclusion: ProTaper Universal showed the highest percentage of defects in comparison to ProTaper Gold and Hyflex EDM.
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Influence of adjunctive photodynamic therapy on Interleukin-6, Interleukin-8, and Interleukin-10 gingival crevicular fluid levels in chronic periodontitis – A randomized controlled trial p. 235
Vishakha Vilas Kharkar, Abhay Pandurang Kolte, Rajashri Abhay Kolte, Pranjali Vijaykumar Bawankar, Vrushali Nilesh Lathiya, Girish Haripal Bodhare
DOI:10.4103/ccd.ccd_510_20  
Background: Numerous studies have assessed the effect of photodynamic therapy (PDT) both as a primary mode of treatment and as an adjunct to scaling and root planing in the treatment of periodontitis. Some results were nondefinitive and, in part, inconsistent with respect to the clinical and biochemical effects. Hence, the aim of this study was to evaluate the effect of PDT as an adjunct to nonsurgical periodontal therapy (NSPT) on the gingival crevicular fluid (GCF) interleukin-6 (IL-6), IL-8, and IL-10 levels in the treatment of chronic periodontitis (CP). Materials and Methods: In 21 patients with CP, two contralateral sites (premolar and molar) were randomly divided into: control sites (treated with NSPT only) and test sites (treated with NSPT + PDT). Clinical parameters including bleeding on probing (BOP), probing pocket depth, clinical attachment level were evaluated at baseline, 1- and 3 months and biochemical parameters of GCF levels of IL-6, IL-8, and IL-10 were evaluated at baseline and 3-month post-therapy through enzyme-linked immunosorbant assay. Results: A greater improvement in BOP score at 1 month (41.10% ± 3.58%) and 3-months (38.00% ± 3.62%) posttherapy was found in the test site as compared to control site. Regarding cytokines, test sites exhibited significant reductions in IL-6 (4.29 ± 0.67 pg/ml) and IL-8 (308.16 ± 36.04 pg/ml) levels and increase in IL-10 (14.25 ± 0.83 pg/ml) level at 3 months (P < 0.0001). Conclusion: Additional application of PDT, adjunctive to NSPT, resulted in a significant reduction in BOP score as well as GCF pro-inflammatory cytokine levels along with an increase in anti-inflammatory cytokine levels, compared to NSPT alone.
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Comparative evaluation of marginal integrity of three esthetic restorative materials – An In-vitro study p. 241
Sukhdeep Singh, Dhirja Goel, Neha Awasthi, Deepak Khandelwal, Aakansha Sharma, Seema Patil
DOI:10.4103/ccd.ccd_318_20  
Context: Microleakage is the major cause for the failure of dental restorations, especially in Class V cavities, as margins of such restorations are generally located in dentin or cementum. Microleakage evaluation is necessary as a means of evaluation of the marginal integrity of restorative materials. This would assist in developing techniques and materials that would reduce damage caused by the failure of the restorative marginal seal. Aim: The aim of this study is to analyze and compare the marginal integrity among three esthetic restorative materials, namely GC Fuji II LC, GC G-Aenial anterior composite resin, and GC Equia forte fil. Setting and Design: Sixty orthodontically extracted caries-free premolar teeth with Class V restorations were divided into three groups. Microleakage was measured using an ordinal scale of 0–4, as given by Khera and Chan, in increasing order of dye penetration, which was observed under a microscope. Materials and Methods: Study was conducted in sound human extracted premolars in which Standardized Class V cavities were prepared. Teeth were randomly and equally assigned to three groups (GC Fuji II LC, GC G-Aenial anterior composite resin, and GC Equia forte fil). Teeth were sectioned longitudinally into two halves using diamond discs and the sectioned halves of the teeth were evaluated for dye penetration under stereomicroscope. Statistical Analysis Used: Intergroup comparison of mean dye penetration scores were compared using the Kruskal–Wallis test along with post hoc pairwise comparison by Mann Whitney U test. The level of statistical significance was set at 0.05. Results and Conclusion: All the three groups (GC Fuji II LC, GC G-Aenial anterior composite resin, and GC Equia forte fil) tested showed microleakage at the tooth restoration interface. It was evident that microleakage was found to be highest with the Fuji II LC, both at occlusal and cervical levels. GC Equia forte exhibited the best performance in limiting microleakage around the restoration margins.
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Cancer stem cell traits in tumor spheres derived from primary laryngeal carcinoma cell lines p. 247
Vijay Mahadev Kumbar, Uday M Muddapur, Kishore G Bhat, HR Shwetha, Manohar S Kugaji, Malleswara Rao Peram, Santosh Dindawar
DOI:10.4103/ccd.ccd_252_20  
Objective: Cancer stem cells (CSCs) belong to a subpopulation of undifferentiated cells present within tumors that have the potential to regenerate, differentiate, maintenance of pluripotency, drug resistance, and tumorigenicity when transplanted into an innate host. These can influence the growth and behavior of these tumors and are used to investigate the initiation, progression, and treatment strategies of laryngeal cancer. Research on CSC science and targeted therapies were hinge on their isolation and/or enrichment procedures. The object of the study is to isolate cancer stem cells from primary laryngeal carcinoma (CSCPLC) by tumor spheres enrichment. We checked the properties of self-renewal, stemness, clonogenicity, and chemotherapeutic resistance. Materials and Methods: We performed tumor sphere formation assay (primary, secondary, and tertiary) chemotherapy resistance by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay were performed to evaluate the CSC cells. Immunofluorescence for stem cell markers (CD133+, CD44+) and gene expression of stem cell markers for CD133+, CD44+, OCT4, SOX2, and NANOG was done using the real-time polymerase chain reaction technique. Results: We were able to isolated CSC subpopulations from PLC cell lines by the tumor sphere method. These cells exhibited good primary, secondary, and tertiary tumor sphere formation efficiency and also disclosed a resistant index of more than 2. Immunofluorescence for stem cell markers (CD133+ and CD44+) confirms the presence of CSC. There was significantly higher mRNA expression of stem cell markers in CSC enriched subpopulations compared to the parental cell lines. Conclusion: We conclude that tumor spheres enrichment is an efficient, economical, and reliable approach for the isolation and characterization of CSC from PLC cell lines. These cells demonstrated the properties of self-renewal, stemness, clonogenicity, and chemotherapeutic resistance.
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Comparison of self-reported empathy levels among dental undergraduate students in Northern India: A questionnaire-based cross-sectional study p. 255
Sonali Saha, Ridhi Narang, Vikram Pal Aggarwal, Godhi S Brinda, Dhinsa Kavita
DOI:10.4103/ccd.ccd_744_20  
Context: Empathy is one of the fundamentals of communication relevant within the practice of dentistry, and the research is limited in this field. Aims: The present study was conducted to assess the self-reported empathy levels among dental undergraduate students in Lucknow city of Northern India. Settings and Design: A descriptive cross-sectional study was conducted among three dental colleges of Lucknow city during July 2019–September 2019. Subjects and Methods: E-survey link was circulated among 790 students through e-mails. It has two parts. The first part included sociodemographic information, wherein the second part, the empathy level of students was assessed using the Jefferson Scale of Physician Empathy-Health Profession Students Version Questionnaire. The possible score range is 20–140: the higher the mean score, the higher the self-reported empathy level. Statistical Analysis Used: The data collected were analyzed using SPSS software version 24. Chi-square test was used to test gender distribution differences among different years. One-way analysis of variance including post hoc tests was used to compare the differences between study variables. Results: The mean ± standard deviation empathy score was 92.55 ± 11.85, 91.85 ± 12.23, 93.25 ± 11.24, 93.37 ± 12.31, and 88.34 ± 12.01 among the first-year, second-year, third-year, final-year, and interns' students, respectively, with a statistically significant difference. Conclusion: It can be concluded from the results of the present study that the mean empathy score was highest among final-year students which is suggestive of the impact of education in behavioral sciences.
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Cutting efficiency of welded diamond and vacuum diffusion technology burs and conventional electroplated burs on the surface changes of the teeth – An In vitro study p. 259
Tanya Kabir Sethi, Ramesh P Nayakar, Anandkumar G Patil
DOI:10.4103/ccd.ccd_261_20  
Context: Welded diamond and vacuum diffusion technology (WDVDT) burs in comparison to electroplated burs claim to approach the solution of dental hard tissues by increased cutting efficiency, decreasing the overheating of oral tissues and thus reducing the microcracks on the prepared tooth surface. Aims: This study aimed to evaluate the cutting efficiency of two different rotary diamond burs used for tooth preparation with their repeated usage on the surface changes of the prepared tooth. Settings and Design: This in vitro comparative study evaluated the cutting efficiency and surface changes of the teeth prepared with conventional electroplated burs and WDVDT burs. Subjects and Methods: Thirty freshly extracted, healthy, noncarious human premolars were divided into Group A and Group B with 15 each, and were further subdivided into three subgroups depending on the different usage intervals as first, fifth, and tenth (A1–A3 and B1–B3). The surface of each prepared specimen was evaluated quantitatively using a surface profilometer, and qualitative analysis was done using a scanning electron microscope. Statistical Analysis Used: Two-way ANOVA and Turkey's multiple post hoc tests were used. Results: The mean surface roughness of Groups A1, A2, and A3 was 1.50 ± 0.40, 2.39 ± 0.39, and 2.65 ± 0.65 Ra, respectively. The mean surface roughness of Groups B1, B2, and B3 was 0.76 ± 0.23, 0.92 ± 0.10, and 1.24 ± 0.07 Ra, respectively. The mean surface roughness of the prepared tooth surface was significantly higher in Group A and its subgroups when compared to that of Group B and its subgroups. Conclusions: The study results showed that surface roughness was considerably lesser and also had less wear and increased cutting efficiency of tooth preparations using burs made with WDVDT compared to the preparations using conventional electroplated burs.
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Evaluation of radiation exposure in open dental clinics using thermoluminescence dosimeters and questionnaires p. 266
Bahija T Basheer, Renad I Allahim, Samar S Alarfaj, Tala A Alkharashi, Amal A Fallatah, Amerah S Alqahtani, Shuruq S Aljarallah
DOI:10.4103/ccd.ccd_598_20  
Aim: The aim of this study was to evaluate radiation exposure in dental open clinics in King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) using thermoluminescence dosimeters (TLDs) to check if it exceeds the annual assigned exposure limit and to assess students' practices regarding radiation protection measures and their knowledge regarding the application of digital remote-control settings and TLDs. Materials and Methods: This pilot institutional-based observational study was conducted among the clinical year students and interns at KSAU-HS College of Dentistry open clinical areas using TLDs and questionnaires. Sixteen lithium fluoride TLDs (TLD-100) were distributed evenly in the clinical areas occupied by clinical year dental students and interns for 24 working days from September 15 to October 20, 2019. Each TLD was labeled with a serial number and fixed at the assigned clinic of each specialty. The TLDs were placed in a zigzag manner at the right corner of the selected clinic to prevent overlapping of the area coverage by each dosimeter. Results: The mean monthly TLD readings were found to be 69.265 uSv with a higher mean value in the female clinical area (74.2975 uSv) than the male clinical area (64.234 uSv). Taking into account the 8 months of clinical exposure during the academic year, the expected annual radiation exposure would be 0.554 mSv which is significantly lower than the annual limit of radiation exposure recommended by the International Commission on Radiological Protection, i.e., 1 mSv. Conclusion: TLD readings concluded that radiation exposure was within safe limits with an estimation of 0.544 mSv per year. However, students require further education regarding protective and safety measures and the utilization of radiation equipment. Clinical Significance: The lack of studies regarding the amount of radiation exposure from dental imaging and the safety of intraoral radiographic machines present in open clinics in any educational institute necessitates conducting this kind of study.
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Comparative evaluation of sclerostin levels in gingival crevicular fluid in the treatment of chronic periodontitis patients using diode laser as an adjunct to scaling and root planing: A clinico-biochemical study p. 276
B S Jagadish Pai, Nithya R Krishnan, Amit Walveker, Sreedevi Keeneri, Ansu Emmanuel, Neethi R Krishnan, Menezes Anosca Lira
DOI:10.4103/ccd.ccd_19_20  
Aims: Sclerostin is an inhibitor of bone formation, and laser irradiation enhances osteoblast proliferation. The objective of this study was to assess and compare the gingival crevicular fluid (GCF) sclerostin level and clinical parameters of chronic periodontitis patients following the application of diode laser (810 nm) as an adjunct to scaling and root planing (SRP). Subjects and Methods: Fifteen systemically healthy chronic periodontitis patients (age 35–55 years) with probing pocket depth ≥5mm were included in this split-mouth study. SRP and pocket irradiation with diode laser were done in the test group and SRP alone in the control group at baseline. Low-level laser therapy application and saline irrigation were done in both the groups, respectively, in the 2nd and 3rd visits. Two microliters of GCF samples was collected from both the groups at baseline before treatment and on the 90th day for the assessment of sclerostin concentration. Results: This study showed a statistically significant reduction of clinical parameters in the test and control groups at the end of 3 months. Both the groups showed a statistically significant reduction of sclerostin levels in GCF after 3 months, in which the test group (125.80 ± 28.21 to 82.80 ± 9.31) showed a highly significant reduction (P = 0.000). Conclusions: The adjunctive use of laser had shown a beneficial effect in terms of clinical parameters and osteoblast proliferation by the reduction in the levels of sclerostin in GCF. From the observations of this study, it can be concluded that the therapeutic effectiveness of diode laser as an adjunct to SRP is having a beneficial effect and sclerostin can be used as a potent biomarker.
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Efficacy of preprocedural boric acid mouthrinse in reducing viable bacteria in dental aerosols produced during ultrasonic scaling p. 282
Swet Nisha, Avinash Bettahalli Shivamallu, Sheela Kumar Gujjari, Pratibha Shashikumar, Nada Musharraf Ali, Madhuri Kulkarni
DOI:10.4103/ccd.ccd_374_20  
Introduction: Aerosols and droplets contaminated with bacteria and blood are produced during ultrasonic scaling. Measures to control aerosol contamination in dental clinics are recommended by the Centers for Disease Control and Prevention. This study aimed to evaluate the efficacy of preprocedural boric acid (BA) mouthrinse in reducing bacterial contamination in dental aerosols generated during ultrasonic scaling. Materials and Methods: This was a randomised clinical trial in 90 systemically healthy subjects (25-55 yrs) diagnosed with chronic periodontitis who were allocated into three groups of 30 subjects each to receive, Group A - 0.12% chlorhexidine (CHX), Group B - 0.75% BA and Group C-water, as a preprocedural rinse for 1 min. The aerosol generated while performing ultrasonic scaling for 30 min was collected at three locations on blood agar plates. Incubation of the blood agar plates at 37°C for next 48 h for aerobic culture was performed and subsequently colony-forming units (CFUs) were counted. Results: CFUs in Group A were significantly reduced compared with Group B (P < 0.001). When we compare CFUs in all the three groups, CFUs in Groups A and B were statistically significantly reduced compared with Group C (P < 0.001). Furthermore, it was also observed that the assistant's chest area had lowest CFUs whereas patient's chest area had highest. Conclusion: This study recommends routine use of preprocedural mouthrinse as a measure to reduce bacterial aerosols generated during ultrasonic scaling and that 0.12% CHX gluconate is more effective than 0.75% BA mouthwash in reducing CFUs count.
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Platelet indices be a new biomarker for periodontal disease p. 289
Ramesh Babu Mutthineni, Arpita Ramishetty, Prathibha Gojja, Gayathri Muralidaran, V V Alekya Burle
DOI:10.4103/ccd.ccd_461_20  
Background: Platelets play an important role in inflammation and hemostasis. Periodontitis, a chronic inflammatory disease, is linked to an increase in platelet activation leading to increased risk for atherosclerosis and cardiovascular diseases. Aim: The aim was to evaluate whether platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and plateletcrit [PCT]) can be a biomarker for determining the severity of periodontal disease and to assess the relation between platelet indices in patients with periodontitis and healthy controls. Materials and Methods: The study included 3 groups – moderate periodontitis, severe periodontitis, and systemically healthy controls without periodontitis. Clinical parameters recorded were clinical attachment level and probing pocket depth and venous blood samples were drawn for the analysis of MPV, PDW, and PCT. Results: ANOVA test with post hoc Tukey's test was used to compare among 3 groups. Statistical analysis of platelet indices was done using sample t-test. The mean values of MPV, PDW, and PCT gradually increased from normal to severe periodontitis. Conclusion: Periodontitis, a chronic inflammatory process, causes not only increase in the quantity of platelets but also causes platelet activation which leads to change in platelet size, platelet shape, and platelet aggregation. As periodontitis causing platelet activation which seems to be a contributing factor in the development of cardiovascular diseases.
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Effectiveness of salivary glucose in diagnosing gestational diabetes mellitus p. 294
Anuradha Ganesan, Arvind Muthukrishnan, Vishnupriya Veeraraghavan
DOI:10.4103/ccd.ccd_530_20  
Context: Frequent monitoring of glucose is important in the management of diabetes. A noninvasive painless technique was used to detect glucose levels with the use of saliva as a diagnostic fluid. Aims: The aim of our study was to correlate the blood glucose levels with stimulated and unstimulated salivary samples and also to assess the reliability of using salivary glucose in diagnosing and monitoring the blood glucose levels in gestational diabetic patients. Settings and Design: The study was conducted among 100 clinically healthy nondiabetic individuals and 99 individuals suffering from gestational diabetes mellitus (GDM). Subjects and Methods: Fasting blood glucose estimation and postprandial salivary glucose estimation were done in stimulated and unstimulated salivary samples using glucose oxidase/peroxidase method. Statistical Analysis Used: Data obtained were subjected to normality test, and P ≤ 0.05 was considered to be statistically significant. The correlation between blood and salivary glucose levels was evaluated using Pearson's correlation test. Results: A positive correlation was obtained for stimulated and unstimulated salivary samples in fasting and postprandial conditions. Linear regression analysis and receiver operating characteristic curve were plotted, and the optimal cutoff value for unstimulated and stimulated salivary glucose under fasting conditions was 5.1 mg/dl and 5.4 mg/dl, respectively. The optimal cutoff value for unstimulated and stimulated salivary glucose was 8.8 mg/dl and 9.3 mg/dl, respectively, in postprandial conditions. Conclusions: Saliva appears to be a reliable biofluid to assess the blood glucose levels and can definitely be a reliable alternative to blood glucose in GDM patients.
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A comparison of NovaMin and casein phosphopeptide-amorphous calcium phosphate fluoride on enamel remineralization – An In vitro study using scanning electron microscope and DIAGNOdent® p. 301
K Dhanya, Prakash Chandra, Latha Anandakrishna, Vineetha Karuveettil
DOI:10.4103/ccd.ccd_240_19  
Aim: The aim of this study was to compare the efficacy of NovaMin (SHY-NM) and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) (tooth mousse plus) on enamel remineralization using DIAGNOdent® and scanning electron microscope (SEM). Methodology: Eighty-six natural permanent maxillary first premolars were selected and randomly divided into two groups of 43 each, Group A (NovaMin) and Group B (CPP-ACPF). All the samples were assessed using DIAGNOdent® (KaVo) at the baseline, after demineralization, and remineralization after 7 days. Two samples were randomly selected from each group after remineralization to evaluate the surface changes using SEM at × 1000 and × 2000. Results: The mean value of remineralization was highest for Group A NovaMin (6.56 ± 0.93) compared to Group B, CPP-ACPF (tooth mousse plus) (6.02 ± 1.09). The maximum demineralization to remineralization value within the groups showed that the mean values in Group B CPP-ACPF (7.02 ± 3.02) was higher than Group A NovaMin (6.42 ± 2.21). The difference in remineralizing potential between the groups and demineralization to remineralization value in within-group comparison was not found to be statistically significant. Conclusion: On comparing Group A NovaMin and Group B CPP-ACPF, Group B CPP-ACPF showed a higher amount of remineralization than Group A NovaMin. From the present study, it can be inferred that both the experimental groups have the potential for remineralization.
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Comparative evaluation of effectiveness of 2% lignocaine hydrochloride with clonidine hydrochloride versus 2% lignocaine hydrochloride with adrenaline bitartrate as local anesthetic for adult patients undergoing surgical extraction of impacted mandibular third molars: A randomized controlled clinical study p. 308
Shreyas H Gupte, Rinku D Kalra, Thomson M Dcruz, Sahil Kamble, Ranjana S Patnaik
DOI:10.4103/ccd.ccd_665_20  
Background and Objectives: Clonidine is a common additive to local anesthetics for various regional and local nerve blocks. However, its effectiveness in dentistry has not yet been fully explored. Thus, this study was performed to evaluate the quality of anesthesia, vasoconstrictive effects, hemodynamic response, and pain control using a solution of 2% lignocaine hydrochloride with clonidine hydrochloride in comparison with the standard solution of 2% lignocaine hydrochloride and adrenaline bitartrate for pterygomandibular nerve blocks. Materials and Methods: A parallel arm, triple-blind randomized controlled study was conducted on 152 patients belonging to ASA-I (American Society of Anesthesiologists) category in the age group of 18-45 years, requiring surgical extraction of impacted mandibular third molars. The patients were divided equally into two groups randomly by computer-generated sequence; Group 1: 2% lignocaine hydrochloride with 1 ml of clonidine hydrochloride (150 μg/ml) and Group 2: 2% lignocaine hydrochloride with adrenaline bitartrate 1: 80,000 (12.5 μg/ml). The variables evaluated were systolic, diastolic, and mean arterial blood pressures, heart rate (HR), blood loss, onset, depth (pain), and duration of anesthesia. Results: There was a statistically nonsignificant difference seen between the two groups (P > 0.05) for the onset of anesthesia, pain assessed, and blood loss, whereas a statistically highly significant difference was seen for cardiovascular variables (systolic, diastolic and mean arterial blood pressures, and HR) at various intervals with higher values for Group 2 (P < 0.001) and for the duration of action of local anesthesia (LA), with higher values for Group 1 (P < 0.001). Conclusions: Clonidine as an additive to lignocaine has proved to have the onset of action, vasoconstrictive properties, and pain control, equivalent to adrenaline. However, with better stability of hemodynamic variables and prolonged duration of action of LA with clonidine, it can be considered as a better, safer, and more effective additive to lignocaine than adrenaline
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CASE REPORTS Top

Ceramic laminate veneers luted with preheated resin composite: A 10-year clinical report p. 313
Rogério L Marcondes, Verônica P Lima, Cristina P Isolan, Giana S Lima, Rafael R Moraes
DOI:10.4103/ccd.ccd_788_20  
Resin cement and preheated restorative resin composite may be used for luting laminate veneers. The main advantage of resin composite is increased wear resistance, which could lead to better marginal performance in long term. This article reports a clinical treatment with feldspar laminate veneers luted to the maxillary teeth with preheated resin composite in a private practice. Case was finalized in May 2009 and followed by 10 years. Excellent clinical service and remarkable long-lasting marginal integrity were observed after 123 months. Scanning electron microscopy analysis showed no wear, gaps, or ditching at the margins. Restorative margins showed a smooth transition between ceramic and tooth with no signs of degradation. Preheated resin composite for luting ceramic laminate veneers may be considered an excellent clinical option.
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Titanium allergy in dentistry: A new allergen in rapidly evolving implant dentistry p. 317
Nishi Tanwar, Chander Prakash, Kuldeep Chaudhary, Shikha Tewari, Subramony Bhagavatheeswaran
DOI:10.4103/ccd.ccd_773_20  
Although titanium is considered as the biocompatible material and widely used in medical and dental fields, the clinical application of this material is still a critical issue due to the possible adverse host response. Very few case reports related with titanium-based hypersensitivity reactions with dental implants proved the existence of titanium allergy. The present case report describes 56-year-old male showing allergic symptoms after 1 week of dental implant placement with no perioral or facial signs, but eczema was shown on the distant body parts, and the complete remission was attained after removing the dental implant.
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Extraction of supernumerary nasal tooth by endoscopic approach p. 321
Tanzeem Ahmed, Samsuddin Ahmed, Nikhil Kaushal
DOI:10.4103/ccd.ccd_778_20  
The occurrence of the supernumerary tooth in the nasal cavity is uncommon. If not diagnosed and treated early, it may lead to various complications. Nasal endoscopy not only helps in proper diagnosis but also is an effective approach towards the extraction of the nasal tooth. It increases precision and reduces morbidity associated with the surgery.
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Solitary median maxillary central incisor: A case report with 3-year follow-up and literature review p. 324
Triveni Mohan Nalawade, Rachappa M Mallikarjuna, H P Suma Sogi, Kishore G Bhat, Vijay M Kumbar
DOI:10.4103/ccd.ccd_713_20  
A solitary median maxillary central incisor (SMMCI) is a rare anomaly that can occur alone or be associated with other systemic abnormalities. Early diagnosis of SMMCI is crucial as it might indicate the presence of an associated congenital or developmental abnormality. The prevalence of live-born children with SMMCI is determined to be 1:50,000 and is more common among females. The purpose of this paper was to report an unusual case of a 9-year-old girl with SMMCI who had no growth deficiency or any other systemic involvement. Since pediatricians and dentists are the first professionals to evaluate an SMMCI's patient in most cases, it is important that they be aware of the possibility of other related systemic problems that require systemic care. Appropriate treatment, diagnosis, and referral should also include neuropediatric evaluation, genetic testing, and craniofacial profile analysis along with multidisciplinary approach.
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Enhanced gingival recession coverage by Er,Cr:YSGG laser root biomodification p. 328
Thamaraiselvan Murugan, Dipika Inbasekaran, Karthikeyan Murthykumar
DOI:10.4103/ccd.ccd_720_20  
Gingival recession predisposes to functional and aesthetic concerns, for which many surgical procedures are available. Among these, till now subepithelial connective graft is considered as the gold standard technique for its higher predictability of achieving recession coverage. However, it does not heal by new attachment, thus many techniques to promote new attachment such as root biomodification are done. This case enumerates the use of Er, Cr: YSGG laser for root biomodification to treat a wide and deep gingival recession defect by subpedicle connective tissue graft. Six months results show better recession coverage inspite of a wide and deeper defect. Thus, Er, Cr: YSGG laser can be an adjunctive tool to enhance the recession coverage.
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Midline mini-implant-assisted true intrusion of maxillary anterior teeth for improved smile esthetics in gummy smile p. 332
Prathapan Parayaruthottam, Vincy Antony
DOI:10.4103/ccd.ccd_425_20  
A 15-year-old female patient reported with a chief complaint of reduced facial esthetics due to proclination of incisors and excess visibility of teeth during smile. On clinical and radiographic examination, she had convex facial profile, Angle's Class I malocclusion, proclination of incisors with deep bite and excessive gingival display on smile. Comprehensive orthodontic therapy using fixed appliances, with four first premolar extraction and simultaneous intrusion and retraction of the anteriors with the help of midline mini-implant resulted in achieving all the treatment objectives without any adverse effects on the periodontium or the dentition.
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NOTICE OF RETRACTION Top

Retraction: Treatment of Class III malocclusion with activation-deactivation rapid palatal expansion and reverse headgear in a growing patient (Alternate-Rapid Maxillary Expansion and Contraction) p. 336

DOI:10.4103/0976-237X.326337  
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