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   Table of Contents - Current issue
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January-June 2021
Volume 13 | Issue 1
Page Nos. 1-80

Online since Monday, February 15, 2021

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ORIGINAL ARTICLES  

Human placental extract a miracle that heals the wound faster Highly accessed article p. 1
Ankita Katkurwar, Dipali Chaudhari, Swapna Mahale, Arunkumar Mahale, Pooja Kadam
DOI:10.4103/jorr.jorr_42_19  
Introduction: Human placental extract gel contains extract of human placenta and total nitrogen not more than 0.25% w/w. It is natural vitamins, peptides, nucleotides and amino acid gel. It enhances wound healing significantly; increases collagen synthesis and improves tensile strength of healing tissue. It brings about maximum increases in the percent of DNA, total protein and epithelialisation. It also has anti-inflammatory and analgesic effects. Aim and Objective: Clinical and histological evaluation of depigmented gingival epithelium on application of human placental extract gel. Material and Method: 10 healthy patients in the age group of 18-35 yrs. who were indicated for depigmentation procedure were selected for the study. Depigmentation was done with scalpel technique on maxillary and mandibular anterior region. In group A human placental extract gel was applied on the wound and non-eugenol pack was placed whereas group B was covered with non-eugenol pack only. Wound Healing index and Visual Analogue Score was assessed after 7 and 15 days. Epithelisation of wound was assessed by using toluidine blue after 7 days of surgery. Result: Application of human placental extract gel showed a statistically significant improvement clinically and histologically. Conclusion: Application of human placental extract can be a successful approach to protect the raw wound area of depigmented gingiva with better patient comfort and faster healing. Introduction: In today's era, increased aesthetic concerns have increased the number of patients receiving gingival depigmentation surgeries to create an aesthetically pleasing appearance of gingiva. Human placental extract gel contains extract of human placenta and total nitrogen not more than 0.25% w/w. It is natural vitamins, peptides, nucleotides and amino acid gel. It enhances wound healing significantly; increases collagen synthesis and improves tensile strength of healing tissue. It brings about maximum increases in the percent of DNA, total protein and epithelialisation. It also has anti-inflammatory and analgesic effects. Aim and Objective: Clinical and histological evaluation of depigmented gingival epithelium on application of human placental extract gel. Material and Method: 10 healthy patients in the age group of 18-35 yrs. who were indicated for depigmentation procedure were selected for the study. Depigmentation was done with scalpel technique on maxillary and mandibular anterior region. In group A human placental extract gel was applied on the wound and non-eugenol pack was placed whereas group B was covered with non-eugenol pack only. Wound Healing index and Visual Analogue Score was assessed after 7 and 15 days. Epithelisation of wound was assessed by using toluidine blue after 7 days of surgery. Result: Application of human placental extract gel showed a statistically significant improvement clinically and histologically. Conclusion: Application of human placental extract can be a successful approach to protect the raw wound area of depigmented gingiva with better patient comfort and faster healing.
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Correlation between dermatoglyphic pattern and dental caries among dental students in a dental college in Mangalore p. 6
Pavitra Sampath, Aneesh Shabu, Manoj Varma, Lavanya Varma
DOI:10.4103/jorr.jorr_21_20  
Introduction: Dental caries is a multifactorial disease caused by a microbial infestation of the teeth. It has been found that some individuals have a genetic predilection for being affected by caries. The fingerprint patterns found in humans are unique and form during the 3rd week of gestation from the same site from which the development of teeth occurs. Thus, it can be theorized that if a person has a genetic predilection for caries, then it would be reflected in the fingerprint pattern too. Aims: To find a correlation between the incidence of caries and the fingerprint patterns and to find which classification has the highest incidence of caries. Methodology and Materials Used: A cross-sectional study was performed on 440 students aged between 18 and 26 years. Decayed, Missing, Filled Teeth (DMFT) method was performed for collecting the data regarding caries incidence, while the stamp pad method was used for getting the fingerprints. They were then classified, and statistical analysis was done with their respective DMFT scores. Results: Among all the patterns, the loop pattern was found among 312 students (70.1%) followed by whorl (92, 20.9%) and arc pattern (36, 8.2%) Conclusion: The results of the study indicate that there is a definite correlation between the number of loops pattern and the presence of dental caries. Hence, dermatoglyphics can be used as a screening method to provide adequate preventive treatment to individuals showing a higher caries risk as detected by the hand ridge patterns.
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Early orthodontic treatment need among 6-9-year-old children of West Bengal p. 12
Sauvik Galui, Shubhabrata Pal
DOI:10.4103/jorr.jorr_34_20  
Background: Early orthodontic treatments (EOTs), which basically include interceptive and preventive orthodontic procedures, are relatively simple and cost-effective treatment approaches that target developing malocclusions during the mixed dentition period. The present study is aimed to assess the need for EOT among 6–9-year-old children of West Bengal that would benefit from preventive and interceptive orthodontic treatment to prevent or reduce the number of late/corrective orthodontic treatments, which can be complex, lengthy, and costly. Materials and Methods: A total of 1129 children from different public and private primary schools of West Bengal were evaluated using index for preventive and interceptive orthodontic need (IPION). On the basis of IPION, the overall scores of children were distributed into three groups – no treatment need, moderate treatment need, and definite treatment need. According to dental development, children were divided into two groups – IPION-6 and IPION-9. Results: Among 1129 children examined, 554 children (49.1%) came under the category of no treatment need, 174 children (15.4%) presented with moderate treatment need, and 401 children (35.5%) showed definite treatment need. The IPION groups had a significant effect on treatment need distribution (6 vs. 9, P = 0.010)); the IPION-9 scores were significantly higher than the IPION-6 scores. Conclusion: The prevalence of preventive and interceptive orthodontic treatment need is unsatisfactorily high in children of West Bengal, which highlights the importance of including preventive and interceptive orthodontic treatment in local dental health-care programs.
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Salivary total protein levels among healthy controls, chronic gingivitis patients and chronic periodontitis patients p. 18
Thaw Htet Zin, Ommar Soe, Yin Mu Thet, Soe Tun, Ye Myat Hein, Kyaw Thiha
DOI:10.4103/jorr.jorr_46_20  
Background: Periodontal diseases are one of the most common chronic infectious and inflammatory diseases in the world that can be diagnosed by clinical, radiographic signs and some biomarkers. Saliva contains locally and systemically derived markers that can aid in the diagnosis of periodontal diseases. The aim of the present study was designed to evaluate salivary total protein levels in patients with chronic gingivitis and chronic periodontitis. Materials and Methods: Five milliliters of unstimulated whole saliva samples was collected from a total of 113 individuals; each of the healthy and chronic gingivitis groups was included 39 participants and 35 patients in the chronic periodontitis group. Salivary total protein levels, gingival index (GI), papillary bleeding index (PBI), probing pocket depth (PPD), and clinical attachment level were recorded in the respective groups. Salivary protein estimation was done by direct ultraviolet absorption method, and determination was based on biuret method. Results: The mean salivary total protein levels in the healthy, chronic gingivitis, and chronic periodontitis groups were 1.52, 2.58, and 6.30 g/dl, respectively. The salivary total protein levels of gingivitis and periodontitis patients were 1.6 and 4.2 times higher than healthy controls, which were statistically significant (P < 0.001). In addition, GI (r = 0.476) and PBI (r = 0.490) were significantly correlated with protein levels in gingivitis patients. However, PPD was significantly correlated with protein contents in only periodontitis patients (r = 0.387). Conclusions: Increased total protein levels are related to the severity of periodontal diseases, and it may serve as a biomarker in inflammation of the periodontium.
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Effect of fiber reinforcement on color stability and degree of polymerization of different composite resins p. 25
Ozcan Karatas
DOI:10.4103/jorr.jorr_27_20  
Aim: The aim of this in vitro study was to determine the effect of fiber-reinforcement on the color changes and degree of polymerization of two different composite resins. Materials and Methods: A bulk-fill composite resin and a methacrylate-based composite resin with A2 shade were used in this study. Three groups of specimens (control group with no reinforcements, polyethylene fiber-reinforced composite and glass fiber-reinforced composite groups) were prepared from each composite. The color change of the specimens with polymerization was measured. Then, to determine the degree of polymerization, the hardness ratios were calculated by measuring the bottom and top surface hardness of all specimens. The data were analyzed by analysis of variance, Duncan's multiple range tests, and Independent sample t-test. Results: Statistical analysis of variance presented the significance difference between composite and fiber for color change (P < 0.05). The highest color change by polymerization was seen in the polyethylene fiber-reinforced bulk-fill composite group. It was found that the addition of fiber to composite resins significantly reduced the degree of polymerization (P < 0.05). Conclusion: The addition of fiber may lead to color change and reduce the degree of polymerization of composite resins. The amount of change may differ depending on the structural properties of the composite resins and fiber.
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The effect of different curing units on the degree of polymerization of different composite resins p. 31
Ozcan Karatas, Merve Nur Yilmaz, Pinar Gul, Omer Sagsoz, Merve Iscan Yapar
DOI:10.4103/jorr.jorr_31_20  
Objective: The aim of this study was to investigate the degree of polymerization of composite resins cured with different light-curing units (LCUs). Materials and Methods: Three bulk-fill composite (Beautifil Bulk-Fill Giomer, Filtek Bulk-Fill, and X-Tra Fill) and a methacrylate-based composite (Filtek Z250) were used in this study. Thirty disc-shaped specimens, 4 mm thick, were prepared from each composite resin. Specimens were divided into three groups and polymerized with light-emitting diode (LED), Plasma arch curing unit (PAC), and quartz-tungsten halogen LCU. The bottom and top surface microhardness of the specimens stored in distilled water for 24 h at 37°C after polymerization was measured with a universal test device. The hardness ratio (HR) of specimens was calculated by the bottom surface microhardness/top surface microhardness formula. Data were analyzed by two-way ANOVA and Tukey's least significant difference post hoc tests (α = 0.05). Results: Statistically significant differences were detected between the mean HR values of the specimens polymerized with different LCUs (P < 0.05). The mean HR values of Beautifil Bulk-Fill Giomer specimens were found to be statistically significantly lower than other composites (P < 0.05). The mean HR values of the specimens polymerized with PAC LCU were found to be statistically significantly lower than other LCUs (P < 0.05). Conclusion: The degree of polymerization of the composite resin restoration may be affected by the structural properties of the resin and the type of LCU. The clinician may use alternative techniques, especially in deep cavities.
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Comparative evaluation of two different isolation techniques in restoration of noncarious cervical lesions using flowable composite: A split-mouth in vivo study p. 37
Kakollu Sudha, Jyothsna Kasireddy, Dunnala Lakshmi Sowjanya, Mekala Ashwini, Kurati Sakyarshi
DOI:10.4103/jorr.jorr_4_21  
Context: Proper method of isolation plays a key role in the restoration of noncarious cervical lesions (NCCLs). Aims: The aim of this in vivo study was to compare the efficacy of two isolation techniques in restoring NCCLs using flowable composite. Settings and Design: Forty patients who fulfill the inclusion criteria were selected based on the power of the study (0.86). The participants were divided into two groups according to the split-mouth design. Materials and Methods: In Group A, lesion isolation was done using the Mylar matrix band with photocurable gingival barrier, and in Group B, using Metal matrix band and gingival barrier. The restorations were assessed immediately and after 6 months, using modified US Public Health Service criteria: marginal integrity, marginal discoloration, wear, retention, secondary caries, and postoperative sensitivity. Statistical Analysis: IBM SPSS (version 21.0) software was used. McNemar's and Chi-square tests were performed, considering P < 0.05 for statistical significance. Results: Both the groups demonstrated satisfactory clinical performance. Upon inter- and intragroup comparison of the two isolation methods, there was no statistically significant difference (P > 0.05). Conclusions: Within the limitations of the study, both the groups performed similarly in isolation of NCCLs. However, long-term clinical studies must be needed for further evaluation.
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CASE REPORTS Top

Management of chronic periodontitis using diode laser and tetracycline fibers p. 42
Nilofer Farjana Habeeb Rahman, Nanditha Suresh, Syed Nowfiya
DOI:10.4103/jorr.jorr_22_20  
Periodontal disease is host immune-mediated inflammatory disease with periods of progression and periods of remission. It results in the breakdown of supporting connective tissue and alveolar bone with the resultant permanent loss of the teeth. There are nonsurgical and surgical therapies available along with local and systemic antibiotic adjuncts. The diode laser therapy is an effective adjunct along with nonsurgical treatment in treating periodontitis. The diode laser not only removes infected sulcular epithelium but also infected connective tissue even in anatomically inaccessible niches. It fastens the treatment and healing with more patient comfort. To overcome antibiotic resistance due to systemic administration, local drug delivery agents are effective in eliminating the bacteria. The antimicrobial agents used as local drug delivery agents include tetracycline, ofloxacin, clindamycin, chlorhexidine, etc., Tetracycline, as well as its derivatives doxycycline and minocycline, are the most commonly used antimicrobial agents in the treatment of periodontal infections. These local drug delivery agents are used either alone or as an adjunct with scaling and root planning.
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Guided tissue regeneration p. 46
Shreeprasad Vijay Wagle, Amit Arvind Agrawal, Dinaz Bardoliwala, Chhaya Patil
DOI:10.4103/jorr.jorr_11_20  
Regeneration is a reproduction or reconstruction of a lost or injured part in such a way that the architecture and function of the lost or injured tissues are completely restored. Epithelium acts as a barrier to successful therapy because its presence interferes with the direct apposition of connective tissue and cementum, therefore would limit the height to which periodontal fibers can become inserted to cementum. Guided tissue regeneration (GTR) describes procedures attempting to regenerate lost periodontal structures through differential tissue responses and typically refers to regeneration of periodontal attachment. Barrier techniques are used for excluding connective tissue and gingiva from the root in the belief that they interfere with regeneration.
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Attach the detached to preserve the existing natural tooth by the man-made base p. 50
Ashish Jain, Umrana Faizuddin, P Shanti Priya, Sarika Akula
DOI:10.4103/jorr.jorr_14_20  
Traumatic dental injuries are most commonly seen in children and teenagers, especially in the anterior teeth. The ultimate goal of any dental treatment is to reestablish the lost tooth form and function. Numerous procedures have been proposed in the past in which there was considerable loss of remaining sound tooth structure. However, with recent technologies, the minimally invasive procedure is dominating. One such procedure is to reattach the fractured fragment to reestablish the biological form and function of the tooth. Thus, in this section, two case reports on managing complicated crown fractures were discussed, where restoration of anterior teeth with the available tooth fragment was supported with fiber post. As this procedure helps to provide life like appearance of the tooth by restoring anatomy and esthetics, it even adds to psychological stability of the patient.
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Pyogenic granuloma: A case report and a comprehensive review p. 53
Shivani Sharma, Sonali Singh, Lalita Yadav, Sumit Tyagi
DOI:10.4103/jorr.jorr_47_20  
Pyogenic granuloma (PG) is an inflammatory hyperplasia describing large range of nodular growths of the oral mucosa. PG commonly occurs on the skin or oral cavity but seldom in the gastrointestinal tract. It most commonly involves the gingiva. Extragingivally, it can occur on the lips, tongue, buccal mucosa, and palate. It is caused due to low-grade irritation, traumatic injury, or hormonal factors. Various authors have suggested other names for PG such as Crocker and Hartzell's disease, granuloma pyogenicum, benign vascular tumor and during pregnancy as granuloma gravidarum. Because it is possible to misdiagnose PG as peripheral ossifying fibroma, peripheral giant cell granuloma, hemangioma, and fibroma, its histopathological examination is essential for accurate diagnosis. Differential diagnosis is important because of its tendency to recur. This article presents a case of PG in a 17-year-old female along with a comprehensive review of the lesion.
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REVIEW ARTICLES Top

Unraveling coronoplasty in periodontics p. 60
Malvika Singh
DOI:10.4103/jorr.jorr_18_20  
The study of dental occlusion often considered mysterious has been a subject of major interest since the time of the emergence of modern dentistry due to the fact that good clinical practice excels only after having proper knowledge about occlusion. Occlusal surfaces, if and when inhibited, cause trauma to the individual, becoming a matter of attention and concern for clinicians as well as patients. Coronoplasty is the procedure that selectively reduces the supracontacts, thus relieving patient of the same. It is used to provide better stability and occlusion in a permanent dentition noninvasively. The aim of this article is to throw light on occlusion, occlusion interferences, and treating of the same so that it can be applied by clinicians, especially periodontists, for treatment of the same.
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The clinical effectiveness of adhesive agents in posterior restorations: Which adhesive strategy performs better? p. 65
Naji Ziad Arandi, Mohammad Thabet
DOI:10.4103/jorr.jorr_25_20  
The clinical effectiveness of adhesive agents has been mainly evaluated using class V restorations. Clinical studies evaluating adhesives in combination with posterior composites are scarce and of short-term periods. This paper is aimed to review the current literature on the clinical effectiveness of contemporary adhesives when used to restore posterior teeth (Class I and Class II). To conduct this review, Scopus, PubMed, and Google Scholar databases were used to search for peer-reviewed articles on the clinical performance of adhesive agents in posterior composite restorations. Search terms used included “adhesive agents,” “clinical evaluation,” “composite restorations,” “posterior teeth,” “self-etch adhesives,” “etch -and -rinse adhesives,” and “universal adhesives.” To enrich the results, reference mining of the articles that were identified was used to locate other papers. The process of cross-referencing continued until no new articles were identified. No limits were placed on the year of publication, but only articles in English were considered. The current review found that simplification in the adhesive technique so far seems to affect the clinical performance. There is a relative paucity of evidence relating to the performance of universal adhesive agents in posterior restorations. Further long-term clinical studies are needed to evaluate the clinical performance of adhesive agents.
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Consolidating facts and redesigning a novel pediatric dental practice in nCOVID-19 pandemic p. 71
Khooshbu Gayen, Supreet Shirolkar, Sauvik Galui, Subrata Saha, Subir Sarkar
DOI:10.4103/jorr.jorr_17_20  
The pandemic of coronavirus disease 2019 has been the most unprecedented event of our lifetimes, touching, and probably forever changing all realms of our lives and livelihoods. The field of general and speciality dental practice remains no exception. Among all health-care professionals, dentists as oral health caregivers are those who are most susceptible to contracting this infection. A never before situation like this has engaged all of humanity in studies and research for better understanding and possibly reducing the disaster that this terrible virus can inflict upon humanity. These efforts have led to a lot data, much of which is anecdotal evidence and thus a dire need to segregate facts has risen. Dentists in general and pediatric dentists in particular who routinely deal with children and managing them for dental care are at a heightened risk because of their job primarily in the oral cavity. Children routinely take longer appointments compared to adults and require more care to be exercised during this pandemic. This infection often presents asymptomatically which further complicates the problem. Thus, in a world that exists during and after this pandemic demands a reimagined dental practice that is safe for the health workers as well as effectively and efficiently delivers oral health care to all age groups. This can be achieved by rigorous and extensive study and consolidation of this knowledge which can then be adapted by health workers on the ground.
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Biomaterials for periodontal regeneration: A brief overview p. 76
Dhiraj B Dufare
DOI:10.4103/jorr.jorr_30_20  
The aim of periodontal regenerative therapy is to restore the original architecture and function of lost periodontal tissues as a result of trauma or following destructive periodontal diseases. This review includes the biological principles, efficacy, and effectiveness of different biomaterials and their limitation in periodontal regeneration. Various human clinical trials showed a successful periodontal regeneration with different biomaterials. The regenerative potential of biomaterials was assessed truly by human histological study. However, there were a limited number of human histological evidences to demonstrate the true regenerative potential of biomaterials; further human histological studies were required to establish strong evidences for application of biomaterials in the regeneration of periodontium.
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