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   Table of Contents - Current issue
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January-March 2022
Volume 33 | Issue 1
Page Nos. 1-112

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EDITORIAL  

Future Research in Oral Health Highly accessed article p. 1
SM Balaji
DOI:10.4103/ijdr.ijdr_541_22  PMID:35946235
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

Tooth loss and oral health-related quality of life among adult dental patients: A cross-sectional study p. 2
Nagarani Veeraboina, Dolar Doshi, Suhas Kulkarni, Shiva Kumar Patanapu, Satya Narayana Dantala, Adepu Srilatha
DOI:10.4103/ijdr.IJDR_426_19  PMID:35946236
Background: Oral diseases seriously impair the quality of life (QoL) in a large number of individuals and they may affect various aspects of life. Aim: To determine the relationship between tooth loss and oral health-related quality of life (OHRQoL) among adult dental patients. Study Setting and Design: A cross-sectional study was carried out among 296 adult dental patients aged 35–44 years attending Department of Oral Medicine and Radiology of Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. Materials and Methods: Oral Health Impact Profile-14 (OHIP-14) was used to assess OHRQoL. Dentition status and periodontal status according to WHO criteria 2013 and position, number of teeth lost by Batista et al. (2014) tooth loss classification were assessed. Statistical Analysis: Mann–Whitney U test and analysis of variance were used to find prevalence and severity of OHIP-14 with tooth loss and logistic regression analysis to evaluate the association between OHIP-14 prevalence and severity based on variables. Results: Except for the subjects with history of previous dental visit, variables such as gender and reason for dental visit showed significant difference (P ≤ 0.05) with tooth loss. Males subjects, who visited dentist with a history of pain, presence of periodontal disease and tooth loss up to 12 teeth (score 3) emerged as significant predictors for OHIP-14 prevalence (OR = 6.7, OR = 1.13, OR = 3.31). Conclusion: The study strongly evidenced that number and position of tooth loss had negative impacts on OHRQoL.
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Substance use and oral health sensations among substance users residing in rehabilitation centres in an Indian City p. 7
Gunjan Kumar, Avinash Jnaneswar, Shilpa Rai, S Vinay, Kunal Jha, Arpita Singh
DOI:10.4103/ijdr.IJDR_213_20  PMID:35946237
Background: The term substance is usually used to address psychoactive/psychotropic drugs which include both licit and illicit drugs. These substances have varied consequences, including long-term and short-term effects, which include sensations post-consumption. Aim: To determine patterns of substance use and short-term oral health effects among substance users. Materials and Methods: A self-administered questionnaire-based study was conducted on the inmates of drug deaddiction and rehabilitation centres in Bhubaneswar city. Results: All the subjects were males and majority (60.6%) were polydrug users. Alcohol (87.3%) was the most commonly used substance, followed by ganja (57%), bhang (35.3%) and brown sugar (33%). A wide range of oral health sensations like dryness of mouth, taste change, numbness in mouth, feeling like chewing something, loose teeth and stammering/difficulty in speaking were found to be significantly associated with substance use. The age of start of substance use (P < 0.0001), socioeconomic status (P = 0.026) and marital status (P < 0.0001) were significantly associated with the pattern of substance use. About 37.6% of inmates felt that they had very good oral health before starting drug use, while only 15.4% described their oral health as very good at present. Having no oral health problem was the most common reason for not visiting a dentist, followed by ignorant attitude towards oral health. Conclusion: A wide range of oral health sensations were found to be caused due to substance use. Understanding of oral health sensations can aid practitioners detect and report cases of substance use in its early phase.
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Root canal morphology of primary molars – A cone beam computed tomography (CBCT) study p. 14
Jatinder K Dhillon, Sujoy Ghosh, Vijay P Mathur
DOI:10.4103/ijdr.IJDR_748_20  PMID:35946238
Objectives: To evaluate the root and canal morphology of primary maxillary and mandibular molars in an Indian population using cone-beam computed tomography (CBCT). Methods: A retrospective cross-sectional study was performed, where CBCT scans of children less than 10 years of age taken for valid diagnostic purposes previously were considered and images were analyzed. The number of roots, root canals, and variations in morphology were recorded. Left–right symmetry was also noted. Results: A total of 433 deciduous maxillary and mandibular primary molars were studied. It was observed that two separate roots with three separate canals were common in primary mandibular first molars, whereas two separate roots with two canals in each root were common in mandibular second primary molars. In primary maxillary molars, three separate roots with one canal each were the most common. Maxillary first molars (17.21%) and 17.35% second molars had fused distobuccal and palatal roots. It was observed that primary maxillary molars showed more left–right symmetry (86.7% in first molars and 82.7% in second molars) compared to primary mandibular molars (54.05% in first molars and 68% in second molars). Conclusions: It was concluded that in both primary maxillary first and second molars, three separate roots, a mesiobuccal root, a distobuccal root, and a palatal root with one canal in each root, were the most common. Two separate roots with three separate canals were the most common in primary mandibular first molars, whereas two separate roots with two canals each in both roots were more common in mandibular second primary molars.
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Salivary tumor necrosis factor–Alpha and malondialdehyde levels in children with class II malocclusion and sleep disorders: An evaluative study p. 18
Nagashree Prabhu, Vabitha Shetty
DOI:10.4103/ijdr.ijdr_1103_21  PMID:35946239
Context: Recently biomarkers for sleep disorders have provided an alternative and convenient means of diagnosis for children at risk. Aim: To evaluate salivary TNF-α and Malondialdehyde (MDA) levels in children with skeletal class II malocclusion and with a positive history of sleep disorders. Settings and Design: This prospective evaluative study was carried out from October 2020 to March 2021, in the Department of Pediatric and Preventive Dentistry. Material and Methods: 21 children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study (Group 1). 21 age and gender matched children with no skeletal malocclusion and no reported history of sleep disorders served as a comparison group (Group 2). All children were evaluated regarding their sleep history and clinically examined to determine craniofacial morphology. Unstimulated saliva was collected from all children. Salivary TNF-α was measured with a solid-phase sandwich ELISA. Salivary MDA was measured by using TBA reagent. Statistical Analysis: Intergroup comparison for age and normally distributed data was done using t-test. Comparison of frequencies of categories of variables was done using Chi-square test. Inter group comparison for TNF-α was done using Mann–Whitney U test. Results: There were significantly higher levels of salivary TNF-α and MDA, in children of Group 1 when compared to that of Group 2 children (p < 0.01). Conclusion: Salivary TNF-α and MDA may be a simple and non-invasive tool in the identification and screening of children at high risk for sleep disorders.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

The clinical efficacy of minocycline mouth rinse on recurrent aphthous stomatitis—A randomized controlled trial p. 24
Ankita Chugh, Arun Kumar Patnana, Pravin Kumar, Vinay Kumar Chugh, Surjit Singh
DOI:10.4103/ijdr.IJDR_478_20  PMID:35946240
Introduction: Recurrent aphthous stomatitis (RAS) is one of the most common ulcerative diseases affecting the general population. The present study aimed to evaluate the clinical efficiency of 0.5% minocycline mouth rinse prescribed along with the topical anesthetic gel and vitamin supplement over the topical anesthetic gel and vitamin supplement prescribed alone for treating RAS. Materials and Methods: A total of 60 participants were randomly divided into two groups—experimental group: 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel; and control group: vitamin supplement and topical anesthetic gel alone. The pain symptoms were evaluated using the VAS scores at baseline and first follow-up visits. The data were analyzed using Student's t test. Results: A significant reduction in the pain scores was observed in participants using the 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel on the first follow-up visit (P = < 0.001). Conclusion: The 0.5% minocycline mouth rinse prescribed along with vitamin supplement and topical anesthetic gel had shown more reduction in the pain symptoms when compared to topical anesthetic gel and vitamin supplement prescribed alone for the treatment of RAS.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Current overview for chemical disinfection of dental impressions and models based on its criteria of usage: A microbiological study p. 30
SR Chidambaram, Ashwin Mathew George, NP Muralidharan, TR Prasanna Arvind, AravindKumar Subramanian, Faizur Rahaman
DOI:10.4103/ijdr.IJDR_623_20  PMID:35946241
Objectives: The aims of this study were to compare the efficacy of two proven chemical disinfectants, glutaraldehyde and povidone iodine on dental impression and models by determining the reduction in the microbial load, and to compare changes in the physical properties of the models after adding the disinfectants. Materials and Methods: Irreversible hydrocolloid upper impressions of 90 patients were made and divided into 3 groups of 30 samples each; Group A––Control group; Impressions were run under clean tap water before pouring the model. Group B––2% Glutaraldehyde sprayed on the impression and left in situ for 10 min before pouring the model. Group C –10 ml of (5%) povidone iodine incorporated into the gypsum before pouring the model. Models from all three groups were subjected to microbiological assessment at three different time intervals, T0––24 h, T1––1 month and T2––3 months of storage by comparing the colony forming units (CFUs) of bacteria and fungi. The compressive strength of 5 models from each group was also analyzed in Newton's/mm2. Results: 2% Glutaraldehyde proved more effective than povidone iodine after 24 h of storage (T1), however at the end of 1 month (T1) and 3 months (T2) the Povidone group showed the maximum disinfection. Both the disinfectants caused a reduction in the compressive strength of the model with the povidone iodine group showing the maximum reduction. Conclusion: Although povidone iodine was the most effective disinfectant after 3 months, it showed a significant reduction in the compressive strength and caused discoloration of the model. 2% Glutaraldehyde proved to be the choice of disinfectant with minimal adverse effects.
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Evaluation of serum interleukin-33 and soluble suppression of tumorigenicity 2 (sST2) receptors in patients with and without periodontal disease p. 37
Himadri Singh, Abhinav Singh, Rohit Saluja
DOI:10.4103/ijdr.ijdr_85_21  PMID:35946242
Context: Interleukin-33 and its receptor soluble suppression of tumorigenicity 2 (sST2) play an important role in inflammation and its role in periodontal disease is yet unclear. The role of both IL-33 and sST2 together in periodontal disease as biomarkers has never been studied. Aim: To assess the levels of IL-33 and sST2 in serum samples of patients with periodontitis and healthy subjects. Methods: A total of 71 subjects (30 healthy subjects and 41 patients with periodontal disease) were included in the cross-sectional study. Community Periodontal Index (CPI) was used to assess periodontal health by utilizing a mouth mirror and a CPI probe. Venous blood was collected and serum was separated. Serum levels of IL-33 and sST2 were determined by the enzyme-linked immunosorbent assay (ELISA) assay. Statistical Analysis: Graph Pad Prism 5 was used for statistical analysis. Mann Whitney test was applied to compare the two groups. Results: The level of IL-33 was not found to be elevated among healthy subjects and sST2 was found elevated among patients with periodontal disease. The serum concentration of IL-33 was found at 472 ± 114 pg/ml and 282 ± 77 pg/ml among healthy subjects and patients with periodontal disease respectively. Significantly higher values of sST2 at 28 ± 2 ng/ml were found among periodontal patients as compared to healthy subjects with values of 18 ± 1 ng/ml. No significant differences were noted between mild to moderate and severe periodontitis for IL-33 and sST2 between the two groups. Conclusion: This study shows alteration in serum levels of IL-33 and sST2 in periodontitis patients. IL-33 and sST2 may be potential inflammatory markers of periodontitis. Further studies are required on a large sample size for better understanding. This pilot study is the first to assess the serum levels of both IL-33 and sST2 together among patients with and without periodontal disease.
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Evaluation of the effect of nonsurgical periodontal therapy on malondialdehyde and 8-hydroxy deoxyguanosine levels in chronic periodontitis p. 41
Anju Gautam, Neelam Mittal, Surendra Pratap Mishra, Tej Bali Singh, Akhilesh Chandra
DOI:10.4103/ijdr.ijdr_912_21  PMID:35946243
Background: Reactive oxygen species released on stimulation by periodontal pathogens cause oxidation of biomolecules and play significant role in periodontal disease pathogenesis. Aim: This study aimed to evaluate the levels of oxidative by-products malondialdehyde (MDA) and 8-hydroxy deoxyguanosine (8-OHdG) as biomarkers in chronic periodontitis patients compared to healthy as well as before and after nonsurgical periodontal therapy. The correlation between biomarkers and clinical attachment level was also evaluated. Settings and Design: A total of 112 subjects were included in this study. The subjects were divided into two groups (Group I included 56 healthy subjects and Group II constituted 56 chronic periodontitis patients) on the basis of clinical periodontal parameters. Materials and Methods: Group I subjects received no treatment and were evaluated once only for clinical and oxidative stress biomarker parameters. Nonsurgical periodontal therapy was carried out in Group II patients and they were evaluated at baseline and 3 months after therapy. Results: Both salivary and serum levels of MDA and 8-OHdG were found to be increased in chronic periodontitis patients as compared to healthy subjects. After nonsurgical periodontal therapy, the levels of MDA and 8-OHdG significantly reduced. Linear correlation between clinical attachment level and oxidative stress parameters was found to be positive and highly significant. Conclusion: It can be concluded that periodontal therapy is effective in improving the oxidative stress condition.
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Comparative evaluation of the apical leakage of different bioceramic retrofilling materials with and without smear layer: A stereomicroscopic study p. 46
Sheikh Shahbaz, Huma Iftekhar, Sharique Alam, Surendra Kumar Mishra
DOI:10.4103/ijdr.ijdr_313_21  PMID:35946244
Objective: Present in-vitro study aimed to evaluate the apical leakage of different bioceramic retrofilling materials with and without smear layer. Materials and Methods: Sixty human single-rooted teeth were decoronated at a standardized root length of 13 mm, chemo-mechanically prepared and obturated. After obturation, root-end resection was done and root-end cavities were prepared using ultrasonic tips. The specimens with prepared retro cavities were randomly assigned into 2 groups (n = 30) based on the smear layer removal protocol used. Each group was further subdivided into 3 subgroups (n = 10) based on the bioceramic retrofilling material MTA (Mineral Trioxide Aggregate; Proroot Dentsply/Tulsa), CEM (Calcium-Enriched Mixture; Bionique Dent, Tehran) and ERRM (EndoSequence® Root Repair Material; Brasseler USA, Savannah, GA). The extension of dye (2% Rhodamine B) penetration was measured in millimetre using a stereomicroscope at 10× zoom. Results were statistically analysed using one-way ANOVA (analysis of variance) test and unpaired Student's t test. Results: In the presence of smear layer, MTA demonstrated maximum mean apical leakage value (1.70 ± 0.30), followed by CEM (1.40 ± 0.37) and ERRM (1.40 ± 0.23), which was statistically not significant. Without the smear layer, ERRM demonstrated the least mean apical leakage value, which was statistically significant as compared with CEM (P <.05) and MTA (P <.01). Conclusion(s): All bioceramic retrofilling materials demonstrated apical leakage irrespective of the presence or absence of the smear layer. The presence of a smear layer is beneficial for the sealing ability of MTA and CEM, whereas, the absence of the smear layer is advocated while using ERRM.
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Comparative evaluation of duration of extraction space closure and degree of root resorption with conventional and self-Ligation brackets p. 52
Raj Kumar Maurya, Preeti Bhardwaj, Harpreet Singh, Harsh Ashok Mishra
DOI:10.4103/ijdr.ijdr_1127_21  PMID:35946245
Introduction: Determination of difference between conventional and passive self-ligating brackets (SLBs) in respect of extraction space closure, patient perception and root resorption. Material and Methods: Eighty patients were divided into four groups of 20 each with age-sex-matched control using a simple randomisation technique and allocation concealment with a closed opaque envelope method. Group 1 consisted of conventional brackets with Connecticut New Archwire (CNA) wire mushroom loop, group 2 consisted of conventional brackets with TAD (AbsoAnchor, Korea) supported retraction, group 3 consisted of passive SLB with CNA archwires (Libral Traders, India) mushroom loop and group 4 consisted of passive SLB brackets with TAD (AbsoAnchor, Korea) supported retraction. The rate of retraction, root resorption and patient satisfaction were assessed. All conventional brackets (Orthox, USA) and passive SLBs (CaptainOrtho, India) had 0.018 Roth prescriptions with a slot size of 0.018 × 0.025. Results: Retraction was the fastest in group 2 with a mean of 1.266 ± 0.14 mm/4 week and a duration of 23.40 weeks. Similarly, group 4 showed the most sluggish movement with a mean of 1.182 ± 0.80 mm/4 weeks with a total duration of 25 weeks; howeverdifferencesce among groups were not statistically significant (P = 0.470). Conclusion: SLBs have advantage of better patient comfort, less pain and reduced chairside time. Though the present study found increased treatment duration with SLB along with friction mechanics, refuting the previous claims of reduced friction with SLBs, however, the difference was not statistically significant and results have to be extrapolated with caution and experience considering other advantages of SLBs.
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Evaluation of different pre-treatment behaviour modification techniques in 4–7-year olds: A randomised controlled trial p. 58
Vinita Goyel, Shivani Mathur, Nikita Dhingra, Upasna Nair, Shambhavi Singh, Anuve Hrishi Phukan
DOI:10.4103/ijdr.ijdr_373_21  PMID:35946246
Purpose: The aim of this study is to evaluate and compare the effectiveness of five pre-treatment behaviour modification techniques in 4–7-year olds in reducing dental anxiety by evaluating pulse rate, partial pressure of oxygen, systolic blood pressure, diastolic blood pressure, salivary flow rate, salivary pH, and through modified facial anxiety scale. Material and Methods: Using simple random sampling technique (drawing of lots), 125 children were equally distributed into 5 groups of 25 each: Group 1: tell-show-do (control); Group 2: tell-show-play-doh; Group 3: Playmobil Dentist; Group 4: mobile dentist games; Group 5: role play as dentist. Samples in each group were treated in a single appointment after using the behaviour modification techniques. Class I or Class II cavities were prepared on carious primary molar and restored using glass ionomer cement. Patient's anxiety level was assessed by recording blood pressure, pulse rate, oxygen saturation, salivary pH, salivary flow rate, and facial anxiety scale at different time intervals, that is before the treatment, during the treatment, and after the treatment. Results: All the intervention Groups (Groups 2–5) showed reduced anxiety scores in both physiological and facial anxiety compared to the control group, that is tell, show do. The modified distraction techniques aid in better modification. Conclusion: Tell-show-play-doh, Playmobil dentist games, mobile dentist games and role play as dentist are effective distraction techniques as compared to conventional tell-show-do techniques which can be incorporated in day-to-day clinical practice to reduce dental anxiety in paediatric patients.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Post-Expansion and end of treatment outcomes of semi-rapid maxillary expansion with a modified removable appliance p. 63
Alka M Banker, Malvi N Thakkar, Bhagyashree B Desai, Sarandeep S Huja
DOI:10.4103/ijdr.ijdr_210_21  PMID:35946247
Context: Maxillary expansion is the mainstay therapy for maxillary transverse deficiency. There has been a constant search for the most effective yet biologically friendly method of maxillary expansion, alternatives being, slow, rapid and semi rapid. Aims: The purpose of this study was to explore the outcome of palatal expansion achieved using a removable plate and low continuous forces brought about by a semi rapid screw activation protocol. Settings and Design: Retrospective study. Methods and Material: Plaster models of 56 consecutive patients treated for maxillary expansion were obtained pre-treatment (T0), post-expansion (T1), and post fixed appliance treatment (T2). The radiographic images of the models were traced using Image J software. Linear and angular measurements were evaluated to measure transverse change. Statistical Analysis Used: Interclass Correlation Coefficient [ICC] and Dahlberg's formula were used for reliability test. The differences in the mean values between the three duration groups [T0, T1 and T2] were analysed using Analysis of Variance (ANOVA). For multiple comparisons, a post hoc Tukey honestly significant difference (HSD) test was performed. Results: Significant increase in inter-molar, alveolar and palatal linear widths were observed from T0 to T1 with significant relapses from T1 to T2, with an overall net gain remaining at T2. Similarly, significant increases in all angular measurements were observed from T0 to T1 with significant relapses from T1 to T2 and an overall insignificant change at T2 as compared to T0. Conclusion: The appliance and protocol were effective in producing transverse expansion with minimal molar and alveolar tipping.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Cytokine expression and anti-microbial effectiveness of different calcium hydroxide dilutions: An In Vitro study p. 69
Najla Binanzan, Fahd Alsalleeh
DOI:10.4103/ijdr.IJDR_41_20  PMID:35946248
Aims: To determine the cytokine expression by human gingival fibroblasts in response to different calcium hydroxide (Ca(OH)2) dilutions and test the effectiveness of these dilutions in root canal dentin infected with Enterococcus faecalis (E. faecalis). Methods: UltraCal XS Ca(OH)2 dilutions were prepared (60, 10, and 1 mg\mL) and co-cultured with gingival fibroblasts for 24 and 48 hours. Untreated cells were used as controls. Expressions of interleukin (IL-1β), tumour necrosis factor alpha (TNF-α), transforming growth factor beta (TGF-β), and IL-10 were analysed with real-time polymerase chain reaction (PCR). Root canals of extracted human teeth were inoculated with E. faecalis. After 21 days, canals were medicated with Ca(OH)2 dilutions for 7 days. Samples were taken to determine bacterial reduction using quantitative PCR. Analysis of variance, Tukey post-test, and Wilcoxon matched pair test were used for statistics. Results: IL-1β and TNF-α expressions of all Ca(OH)2 dilutions were higher at 24 and 48 hours compared to the control. Similarly, all Ca(OH)2 dilutions induced TGF-β expression at 24 hours compared to the control and continued to be higher in 60 mg/mL groups at 48 hours. In contrast, IL-10 was constitutively expressed by untreated cells in the control group and was down-regulated significantly by all Ca(OH)2 dilutions at 24 and 48 hours. All dilutions demonstrated a significant E. faecalis reduction (P < 0.001) with no significant difference between dilution groups (P > 0.05). Conclusions: All Ca(OH)2 dilutions had a differential inflammatory effect on fibroblasts and had a down-regulation effect to IL-10. All dilutions tested were effective against E. faecalis, with 60 mg/mL having the highest bacterial reduction.
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Anti-Bacterial effect, fluoride release, and compressive strength of a glass ionomer containing silver and titanium nanoparticles p. 75
Mariem O Wassel, Gehan G Allam
DOI:10.4103/ijdr.IJDR_117_20  PMID:35946249
Background: Many attempts have been made to enhance the anti-cariogenic properties of the conventional glass ionomer through incorporation of variable materials. However, most importantly, the incorporation of such materials should not jeopardise the physical or mechanical properties of the final restoration. Aims: To investigate the effect of adding silver nanoparticles (Ag-NPs) and titanium dioxide nanoparticles (TiO2-NPs) to conventional glass ionomer cement (GIC) on its anti-bacterial effect against Streptococcus mutans (S. mutans), fluoride ion release, and compressive strength (CS). Settings and Design: This study was an in vitro investigation where 30-disc specimens were prepared in each of the three studied groups. Materials and Methods: The specimens were categorized into the control group (Group C), in which conventional GIC was used, and Group Ag and Group Ti, in which 5 wt% of Ag-NP and TiO2-NP were added, respectively, to GIC powder. In each group, the anti-bacterial effect against S. mutans, fluoride ion release at 24 hours and 14 and 28 days, and CS were assessed. Data were analysed using one-way analysis of variance, followed by Tukey honest significant difference post-hoc test. Results: Both Ag and Ti groups showed a significantly higher anti-bacterial effect than the control group. Ag-NP increased fluoride ion release, whereas TiO2-NP decreased fluoride release; however, cumulative ion release of both experimental groups did not differ significantly compared to the control group. Adding Ag-NP and TiO2-NP increased CS, yet only the Ti group showed the highest CS mean value that was statistically significant compared to other groups. Conclusions: Adding 5 wt% TiO2-NP or Ag-NP to conventional GIC significantly increased its anti-bacterial effect and its CS without affecting fluoride release.
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Enamel surface roughness evaluation after bracket debonding: Comparison between light cure and self cure adhesive resin 3-Dimensional profilometric study p. 80
Deepak Chandrasekharan, Chandan Sourabh, Deenadayalan , Katepogu Praveen
DOI:10.4103/ijdr.ijdr_149_22  PMID:35946250
Introduction: After fixed orthodontic treatment, following bracket removal, the debonding procedure should lead to restitutio ad integrum of the enamel or, at least, restore the enamel surface as closely as possible to its pretreatment condition. Adhesion of brackets in orthodontics is that they should be strong enough to prevent failure during all treatment but also low enough, so that enamel damage would be minimal during bracket removal after treatment. Material and Methods: A total of 60 premolars were collected and stored in distilled water. The extracted teeth were divided into two groups of 30 each, group A was to be bonded with self-cure adhesive while group B light cure adhesive was to be used. A standardised protocol was followed for adhering the brackets to the tooth surfaces. All the teeth were bonded with metal brackets (3M Unitek, Gemini Twin Brackets 0.022 slot). In group A, bonding adhesive (3M Unitek self cure adhesive primer) was applied. In group B, the bonding adhesive (3M Unitek light cure adhesive primer) was photopolymerized for 10 seconds after application. Results: Surface roughness of enamel as assessed by profilometry shows that light cure adhesive creates more roughness as compared to self cure adhesive. To conclude, self cure adhesive is clinically better than light cure adhesive. Discussion: In the present study enamel surface roughness were compared after debonding. Enamel surface roughness after bracket debonding depends on a host of factors, which include – brackets, adhesive used and method of remnant removal.
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X-ray microtomography analysis of gaps and voids in the restoration of non-carious cervical lesions with different composite resins p. 85
Lanna Cristina Gonçalves da Costa Vieira, Adriano Rocha Campos, Plinio Mendes Senna, Cesar dos Reis Perez
DOI:10.4103/ijdr.ijdr_770_21  PMID:35946251
Context (Background): Resin composites are the most widely used material for restoring cervical defects. However, the high failure rate of these restorations is still a concern. Aims: The aim of this in vitro study was to evaluate, using microtomography (μCT), the interfacial gap and voids formation in Class V cavities in premolars restored with materials with lower polymerization shrinkage combined with different restorative techniques. Settings and Design: Cervical defects were created in 30 intact premolar and were randomly distributed to be restored by one of the following techniques (n = 6): Composite resin with two increments (CR), organic modified polymer (ORMOCER) with single (OR1) or two increments (OR2, or low viscosity bulk-fill composite resin with single (BF1) or two increments (BF2). Methods and Material: Each tooth was scanned before filling to determine the volume of interest (VOI) to be applied in the second μCT after restoration and to control the cavity volume among the groups. In the μCT after filling, the volume of interfacial gaps and voids was calculated for each group. Statistical Analysis: The groups were compared using one-way and Tukey HSD post hoc test (α = 0.05). Results: It was possible to identify higher gap formation in the OR1 group and higher void formation in CR group (P < 0.05). OR2 group showed better results than the group with one increment. BF2 showed the best filling capacity. Conclusions: It was possible to conclude that the material and the number of increments directly influenced the internal adaptation and voids formation of Class V restorations.
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Evaluation of antimicrobial activity of chlorhexidine-containing oral gels against aspiration pneumonia-inducing bacteria: An In Vitro study p. 90
Sun-Young Han, Jiyeon Roh, Yun-Sook Jung, Ki-Rim Kim
DOI:10.4103/ijdr.ijdr_591_21  PMID:35946252
Aim: Hospitalised patients have a high risk of developing aspiration pneumonia because of poor oral care and oral microbial flora changes. Chlorhexidine (CHX) solution has been used to reduce inflammation and prevent infections in oral cavity, but it is difficult to use in inpatients. Gel-type antimicrobial agents rather than the liquid form may be effective for the oral management of hospitalised patients. Therefore, we evaluated the in vitro antimicrobial effects of CHX-containing oral gels on aspiration pneumonia-inducing bacteria compared to the CHX solution. Materials and Methods: The experimental products of two oral gel types containing 1% and 0.1% CHX, respectively, were selected. Hexamedine, a 0.12% CHX solution, was used as a positive control. The antimicrobial activity of CHX agents against six pneumonia-causing bacteria and Streptococcus mutans, one of the most common oral bacteria, was comparatively analysed using the agar disk diffusion method. Results: In the disk diffusion assay, the 1% CHX gels showed the highest inhibitory effect on all bacteria. All CHX agents including gels and solution had the highest antibacterial activity against Staphylococcus aureus compared with other bacteria. Conclusions: We confirmed the significant antimicrobial effects of the 1% CHX oral gels on aspiration pneumonia-inducing bacteria. These results suggest that CHX gels may be an effective oral care method for preventing infection in inpatients who have difficulty using the solution.
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Comparative evaluation of remineralisation potential of bioactive glass, casein phosphopeptide-amorphous calcium phosphate and novel strontium-doped nanohydroxyapatite paste: An In-Vitro study p. 94
Ratheesh Rajendran, M Sadique Hussain, Raghu Sandhya, Arun Jacob Thomas, M Ameena, Shinu Saleem
DOI:10.4103/ijdr.ijdr_45_22  PMID:35946253
Background: Many studies explained the importance of remineralisation of early carious lesions with various remineralising agents. In the present study, we incorporated the remineralising agents in a dentifrice, applied that in artificial enamel caries and evaluated their remineralising potential and compared the efficacy among the three. Aim: To evaluate and compare the remineralisation potential of a dentifrice containing bioactive glass, casein phosphopeptide-amorphous calcium phosphate and novel laboratory synthesised strontiumdoped nanohydroxyapatite paste in artificial enamel caries. Methods and Materials: 120 enamel specimens were divided into 4 groups of 30 specimens each, based on the type of dentifrice applied: GI - conventional toothpaste (control group), GII - calcium sodium phosphosilicate (Novamin), GIII - casein phosphopeptide-amorphous calcium phosphate (GC tooth mousse) and GIV- Novel strontiumdoped nanohydroxyapatite paste (SrnHAp paste). Specimens in all the groups were subjected to demineralisation, and calcium/phosphorous ratio was analysed followed by remineralisation and the mean calcium–phosphorus ratio was assessed using a scanning electron microscope and energy dispersing X-ray analysis. Statistical Analysis: Data were analysed using IBM SPSS Statistics for Windows Software, version 22 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to calculate the mean and standard deviation. Kruskal-Wallis, ANOVA and Mann–Whitney tests were used. The level of significance was set at 5%. Results and Conclusion: All except the control group showed a net increase in calcium and phosphorous values after application of the respective remineralising agents in respective groups. Inter-group comparison revealed that Group IV - SrnHAp paste yields higher net calcium and phosphorous values than other groups. Hence, novel SrnHAp can be considered as the material of choice in remineralising early enamel carious lesions.
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SYSTEMATIC REVIEW AND META-ANALYSIS Top

Volatile Organic Compounds in Human Breath p. 100
Monika Karunagaran, Pratibha Ramani, S Gheena, R Abilasha, R Hannah
DOI:10.4103/ijdr.IJDR_493_20  PMID:35946254
A comprehensive analysis of volatile organic compounds (VOCs) from the exhaled breath sample is termed as breathomics. Breath samples are a complex mixture composed of a multitude of VOCs and other molecules. The analysis of total VOCs in exhaled breath provides a promising tool for the diagnosis of many diseases because it enables the observation of biochemical processes in the body in a non-invasive way. VOCs are produced in various physiological and pathophysiological conditions thus making it a potential biomarker for several diseases.
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EPIDEMIOLOGICAL WORK Top

Effect of life course factors on dental fear among adult dental patients attending out-reach clinics in a rural area of Southern India p. 105
Valerie G DíCosta, Deepak K Singhal, Shashidhar Acharya
DOI:10.4103/ijdr.ijdr_113_21  PMID:35946255
Objectives: The aim of the study was to assess the effect of life course factors on dental fear among adult dental patients attending out-reach clinics in a rural area of South India. The objectives were to measure dental fear and changes in socio-economic status during the life course among the study population and to know whether social mobility reduced/increased dental fear. Methods: Dental fear scale and life course data were collected from 403 respondents. The improvement status of individual life course criteria was categorised into “less/minimal”, “stable”, or “upwardly mobile”. Results: The odds of dental fear in the group showing less or minimal upward social mobility was two times that of the stable group [p = 0.022; 95% confidence interval (C.I): 1.104–3.598], whereas the odds of dental fear in the group showing more or good upward social mobility were 4.5 times that of the stable group [p = 0.001; 95% C.I: 1.928–10.515] when adjusted for covariates, that is, participant age, gender, and education and past history of dental avoidance. Conclusion: Social mobility was found to be a risk indicator for dental fear. Dental services may have been affected even with increased standards of living because of psychological factors such as dental fear.
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CASE REPORT Top

Unusual Number of Phleboliths in a Lip Vascular Malformation – A Case Report p. 110
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.ijdr_397_22  PMID:35946256
Rationale: Vascular malformation (VM) associated with jaws may cause jaw size discrepancy. Multiple phleboliths in VM are relatively rare. This case report aims to present one such case. Patient Concerns: A 33-year-old female patient sought surgical correction of her abnormally sized jaw and on examination, she was identified with VM. Diagnosis: Subsequent imaging tests revealed the presence of several phleboliths. Treatment: The patient was treated for an abnormal-sized mandible as well as partial removal of the superficial part of VM. Outcomes: The patient had satisfactory esthetics and there was less bleeding than anticipated. Take-away Lessons: VMs could cause jaw size discrepancy and the extent of the malformation could cause blood flow abnormalities leading to multiple phlebolith formation. Proper surgical planning and education of the patient are essential for successful treatment.
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