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   Table of Contents - Current issue
January-June 2018
Volume 10 | Issue 1
Page Nos. 1-55

Online since Monday, July 9, 2018

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Endodontic microsurgery − A technique for the 21st century p. 1
Frank C Setzer
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Importance of depth of invasion in patients with oral squamous cell carcinoma: A review article p. 3
Narges Ghazi, Ala Ghazi, Shahrzad Shafiee, Mahsa Fayyazi
Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity. Despite several diagnostic and therapeutic advances over the last decades, the rate of mortality and 5-year survival of patients with OSCC has not been improved markedly. The unpredictable behavior of squamous cell carcinoma in digestive and respiratory system has led to search the reliable parameters as prognostic predictors. Histomorphological parameters including the depth of invasion (DOI) may be used as a prognosticate factor in patients with OSCC. It is determined microscopically by detecting the deepest invasive cells in the underlying tissues. Given that planned treatment after histological examination may be changed, measuring the DOI should be considered as a part of routine histological evaluation. In this study, we attempted to review the importance of DOI in the prognosis of cancers as well as its determination in the patients with OSCC lesions.
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Correlations between tomographic findings related to degenerative changes, condylar excursions and position, and pain symptomatology in temporomandibular disorders p. 7
Esdras F de Carvalho, Israel Chilvarquer, João Gualberto Cerqueira Luz
Aim: This study analyzed possible correlations between tomographic findings related to degenerative changes and condylar excursions and position with pain symptomatology in temporomandibular disorders (TMD). Materials and Methods: Sixty patients (40 women and 20 men; mean age: 37.9 years) with a diagnosis of TMD, according to the Diagnostic Criteria for Temporomandibular Disorders, were evaluated. The data of their tomographic examinations were retrieved in relation to their degenerative changes, estimations of condylar excursion, and condylar position. Associations between the variables were analyzed using the chi-square test (P ≤ 0.050). Results: There was a predominance of myopain (M) (35% left side), which was followed by arthralgia plus disc displacement (ADD) (23% left side) and latter myopain plus arthralgia and disc displacement (MADD) (18% left side). Regarding the degenerative changes, there was the predominance of flattening (100%), which was followed by sclerosis (85%). The estimation of condylar excursion was more frequent in the hyperexcursion form, followed by the normoexcursion form, and the hypoexcursion form, all on both sides. The position of the condyle was predominantly posterior and less frequently anterior, and there were few cases in the equidistant position. Considering the sides independently, hyperexcursion and MADD were correlated to the left side. For the total sample, condylar hyperexcursion and ADD, and also sclerosis and MADD, were correlated. There was no correlation between condylar position and symptomatology. Conclusion: There was a correlation between hyperexcursion and symptomatology, especially articular, few correlations between degenerative changes and symptomatology, and no correlation between condylar position and symptomatology.
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Assessment of gingival zenith position and distance from vertical bisecting midline in the maxillary anterior dentition − An observational study  Highly accessed article p. 14
Devapriya Appukuttan, Priyanka K Cholan, Canungo Ragothaman Ashwini, Sreenivasagan Swapna
Background: Esthetics in the maxillary anterior segment is determined by both the hard and soft tissues. Gingival contour plays a vital role in pink esthetics. The most common apical position of the marginal gingiva is referred to as gingival zenith (GZ). This study aimed to assess the position and distance of the GZ from the vertical bisecting midline (VBM) in the anterior maxillary dentition in a sample of South Indian population. Materials and Methods: A total of 105 participants were recruited based on specific inclusion and exclusion criteria. Following recruitment, alginate impressions were made, and dental cast were poured. A total of 630 anterior teeth were evaluated on the cast. The position of the GZ was marked, and a vertical line was drawn through the point. The VBM was drawn on the cast based on the crown width. Using magnification loupes (2.5×) and calibrated digital vernier caliper, the distance between the GZ and VBM was measured twice for each tooth, and the average reading was recorded. The position of GZ was recorded as mesial, distal, or coinciding with the VBM. Results: Majority of the right and left maxillary central incisors and lateral incisors were placed distal to the VBM measuring a mean distance of 0.7 ± 0.4 and 0.76 ± 0.36 mm, respectively, for centrals and 0.59 ± 0.3 and 0.62 ± 0.31 mm, respectively, for laterals. The GZ of both the right and left canines were mesial to the VBM at a mean distance of 0.59 ± 0.4 and 0.61 ± 0.3 mm, respectively. Conclusion: Familiarity with the position and distance of the GZ enables the dentist to plan an appropriate esthetic rehabilitation for the patients based on the population in question.
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Severity and clinical consequences of untreated dental caries using PUFA index among schoolchildren in Udupi Taluk, India p. 19
Deepak K Singhal, Nishu Singla
Background: Data on dental decay using the Decayed, Missing, Filled teeth (DMFT/dmft) index provides information on caries and treatment experiences only, but fails to give information on clinical consequences of untreated dental caries. Aim: The aim of the study was to determine the prevalence and clinical consequences of untreated dental caries using Pulp, Ulceration, Fistula, Abscess (PUFA) index among schoolchildren. Materials and Methods: A cross-sectional survey of 957 schoolchildren, aged 6–15 years in Udupi taluk was conducted. Caries experience was evaluated according to World Health Organization (WHO) criteria, 1997 (DMFT/dmft index) and clinical consequences of untreated dental caries by PUFA/pufa index. Results: The results showed that 77.3% of 6–10 years old children had caries (mean dmft score: 3.30 ± 2.9, mean DMFT score: 0.26 ± 0.7), 47.3% showed clinical consequences of untreated caries (mean pufa score: 1.30 ± 1.9, mean PUFA score: 0.03 ± 0.2) and 26.8% reported pain. In 11–15 years old children, 55.6% had caries (mean dmft score: 0.36 ± 0.9, mean DMFT score: 1.04 ± 1.4), 18% showed prevalence of pulpal involvement (mean pufa score: 0.15 ± 0.5, mean PUFA score: 0.14 ± 0.4) and 11.6% reported pain. Statistical analysis revealed a strong relation between DMFT/dmft and PUFA/pufa in both age groups. Conclusion: The present study revealed negligence in the dental treatment of children resulting in pulpal involvement. This index is a valuable measurement tool to record clinical consequences of untreated dental caries.
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Radiation safety protocol in dentistry: A neglected practice p. 24
T. P Kumar, Rizwana Azmi, Anu Premkumar, S. Sujatha, B. K. Y Devi, N. Rakesh, V. Shwetha
Aim: The ready availability of radiodiagnostic aids has led to its overuse in dental practice. In addition, failure to reinforce the radiation safety procedures has unknowingly resulted in the negligence of the as low as reasonably achievable (ALARA) principles among many dentists. Apart from patients, the dentists and dental assistants are being exposed to radiation in the clinics during regular practice. The current survey was designed to assess the awareness, concern, and practice of radiation protection in general dental practice. Materials and Methods: The survey consisted of 86 dentists in Bangalore city. A cross-sectional self-administered questionnaire consisting of a total of 31 items was used. The obtained data were compiled and analyzed using the Statistical Package for the Social Sciences version 20.0 software (IBM Corporation, New York, United States). Results: All the dentists responded in the study (100%); the participants had limited knowledge regarding the radiation equipment. Majority of the participants were using rounded collimator (96.5%) and short cone (61.6%). E-speed film was used by most of the dentists (90.7%). Bisecting angle technique was preferred by most of the practitioners (69.8%) for making periapical radiographs. Only 20.9% of the dentists made their patients wear lead apron during X-ray exposure. None of them were using thyroid collar. Most of the dentists practiced at a safe distance of 6 ft from the X-ray tube, whereas 10.5% of the dentists assisted holding the radiographic receptor beside the patient. Radiation monitoring was performed by only 20% of the practitioners. Conclusion: The knowledge and practice of radiation protection were not satisfactory. Repeated reinforcement in the form of continued dental education program is necessary, and, most importantly, change in the attitude of the dentist to follow ALARA should be advocated.
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Assessment of the marginal fit, ceramo-metal shear bond strength and the fractographic analysis of sinter cast gold: An In-vitro study p. 31
Hetal Turakhia, Sabita M Ram, Aruna Mehta, Abhishek S Nayyar
Introduction: The fractographic analysis is performed by observing, measuring, and interpreting the fracture surface topography that can determine many features of the microstructure of materials and the mechanics of the fracture. The aim of this study was to assess the marginal fit and the ceramo-metal shear bond strength of sinter cast gold, and to analyze the debonded sample by fractography. Materials and Methods: A total of five sinter cast gold copings were prepared on a stainless master die resembling a maxillary 1st pre-molar to receive a ceramo-metal restoration. Each of the copings was then assessed for the marginal fit before and after ceramic firing. In addition, a total of five ceramo-metal discs were fabricated for testing shear bond strength at the metal-ceramic interface. The samples were subjected to increasing shear load on a universal testing machine with crosshead speed of 0.002 mm/s. The load at which the samples debonded completely was noted, and the fractographic analysis of the samples was performed. Results: The mean marginal fit found in this study for sinter cast gold before ceramic firing was found to be 11.5 μm with a standard deviation of ±4.64 μm, and after ceramic firing, it was found to be 9.38 μm with a standard deviation of ±3.57 μm. The average shear bond strength at the sinter cast gold ceramic interface was 18.216 MPa. The fractographic analysis showed the globular microstructure of sinter cast gold on sintering, adhesive, and mix-mode type of fracture with the presence of both gold and ceramic. Conclusion: The marginal fit observed before and after ceramic firing was within clinically acceptable range, whereas the ceramo-metal shear bond strength between sinter cast gold and ceramic was found to be inadequate.
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The effect of incomplete crown ferrules on fracture resistance and the failure modes of endodontically treated maxillary incisors restored with cast posts, cores, and crowns p. 37
Krai Kaewtip, Boonlert Kukiattrakoon, Boonrat Sattapan, Kewalin Thammasitboon, Robert R White
Introduction: The purpose of this study was to investigate fracture resistance and the fracture modes of endodontically treated teeth restored with cast posts and cores in the presence of various configurations of incomplete ferrules. Materials and Methods: Fifty maxillary anterior teeth were endodontically treated and divided into five groups (n = 10) according to ferrule design: group complete ferrule (CF) had a 2-mm circumferential ferrule; group buccal-mesial-palatal (BMP) had a 2-mm ferrule on the buccal, mesial, and palatal sides; group P had a 2-mm ferrule only on the palatal side; group B had a 2-mm ferrule only on the buccal side of the tooth; and group no ferrule (NF) had no ferrule. Each tooth was restored with a cast post, core, and a Ni–Cr crown. All specimens were lingually loaded at 135° to their long axis in a universal testing machine until fractured. Fracture patterns were recorded. Data were analyzed using one-way analysis of variance and Tukey’s honestly significant difference (Tukey�s HSD) test (α = 0.05). Results: The highest load to fracture was CF (534.33 ± 100.30 N), followed by BMP (467.71 ± 54.54 N), P (462.71 ± 54.92 N), B (330.48 ± 54.86 N), and NF (275.93 ± 28.35 N), respectively. There was no statistically significant difference in load to fracture among CF, BMP, and P and between B and NF (P > 0.05). Conclusion: A tooth with incomplete ferrule had lower fracture resistance than one with complete ferrule, but it was still higher than one with no ferrule. The presence of a palatal ferrule was more effective than a buccal ferrule in providing fracture resistance to palatal occlusal loads.
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A study on the expression of CD44 adhesion molecule in oral squamous cell carcinoma and its correlation with tumor histological grading p. 42
Srilalitha Kaza, Lalith P.C Kantheti, Chandrasekhar Poosarla, Sridhar R Gontu, Kiran K Kattappagari, Venkat R.R Baddam
Background: The increasing incidence of oral squamous cell carcinoma (OSCC) combined with its poor and unchanged prognosis motivates a need for research into the aspects of tumor biology such as the expression of adhesion molecules. Alterations in the properties of adhesion molecules could play a pivotal role in the development and progression of invasive cancer and distant metastasis. Aim: This study aims to quantify the expression of cluster of differentiation 44 (CD44) in the different grades of OSCC. Materials and Methods: Immunohistochemical staining for CD44 was performed in 10 tissue sections each of normal mucosa, well-differentiated OSCC, moderately differentiated OSCC, and poorly differentiated OSCC. CD44 positivity was analyzed quantitatively in 10 representative fields of each section under 20× magnification. Statistical Analysis Used: Statistical analysis was performed using Statistical Package for Social Sciences software, version 20.0 (SPSS Inc., Chicago, IL, United States). Results: The mean value of the number of positive cells in controls was 745 ± 68.17, in well-differentiated OSCC was 694.2 ± 145.47, in moderately differentiated OSCC was 349 ± 78.40, and in poorly differentiated OSCC was 108.8 ± 34.39. Conclusion: The results of this study suggest an altered expression of CD44 in OSCC with weak immunostaining in poorly differentiated squamous cell carcinoma. Thus, it can be inferred that the loss of cell adhesion, correlated to the decrease of CD44 expression, might be of value in determining the progression of OSCC.
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Jaw pain secondary to atypical maxillary torus near the incisive canal: A cone beam computed tomography study p. 50
Anthony Albert, Mel Mupparapu
Pain in the anterior maxilla can be odontogenic or nonodontogenic. If it is not related to the teeth, then the differential diagnosis is based on a clinical exam, radiographic exam, and often, on advanced imaging. This case report is based on a 58-year-old male with a chief complaint of chronic pain with acute exacerbations in the region of the rugae of the maxillary central incisors. Clinical examination and planar radiography led to the suspicion of a cyst in the region of the incisive foramen. The patient was referred for advanced imaging. Cone beam computed tomography imaging confirmed the presence of an unusual tori in the region of the incisive foramen that led to periodic inflammation in the region. A differential diagnosis of the pain included pain secondary to a localized inflammation of the incisive canal and nasopalatine duct, and an inflammation of the soft tissue interdental col in the region of the central incisors as well as the benign and malignant minor salivary gland tumors. Because the rugae is attached to the palate, any expansion of the soft tissues in this region causes pain that must be diagnosed accurately to treat the cause.
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Osteomyelitis of the mandible exhibiting features of medication-related osteonecrosis in a patient with history of tocilizumab treatment p. 53
Mohammed A Bindakhil, Muralidhar Mupparapu
Osteomyelitis of the jaw of microbial origin manifests in bone with specific radiographic features that are key to the diagnosis. On occasion, other types of bone diseases like medication-related osteonecrosis of the jaw (MRONJ) need to be differentiated from either acute or chronic osteomyelitis. This is especially important if the medical history and physical examination are inconsistent. Apart from a thorough clinical examination, radiographic features hold an important role in the disease process which could ultimately lead to appropriate intervention. Clinician needs to be well-versed with the differential diagnosis of the bone lesions that might mimic osteomyelitis radiographically. Different medications can be attributed to osteonecrosis of the jaw (ONJ). Some monoclonal antibody medications have been attributed in the development of ONJ. Tocilizumab is a monoclonal antibody therapy used for rheumatoid arthritis. Tocilizumab-related osteonecrosis without history of bisphosphonate use has not been reported in the literature. We present a case of osteomyelitis that demonstrated similar radiographic and histological features of MRONJ in a patient treated with tocilizumab for rheumatoid arthritis without history of bisphosphonate use. Further studies are needed to assess relation between tocilizumab and ONJ.
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