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   2019| September-October  | Volume 30 | Issue 5  
    Online since December 18, 2019

 
 
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CASE REPORTS
Customization of attachments in tooth supported overdentures: Three clinical reports
Jyoti Devi, Poonam Goyal, Mahesh Verma, Rekha Gupta, Shubhra Gill
September-October 2019, 30(5):810-815
DOI:10.4103/ijdr.IJDR_238_16  
In elderly patients with few remaining teeth, overdenture is a good treatment option. Roots beneath the denture protect the alveolar ridge, offer proprioception and improve retention, stability and masticatory efficiency of dentures. Customization of attachments available is a viable alternative for some patients in which prefabricated attachments cannot be placed or in which cost is a factor; to improve the final outcome of the treatment. Due to competitive commercialization, implant treatment has become the norm in current dentistry and the concept of tooth supported overdentures has eclipsed, but with proper case selection, thorough treatment planning and modifications in the denture such as customization of attachments, amalgam stops, cross-linked teeth, and metallic mesh can be applied to prolong the longevity and success of the attachment overdenture prosthesis.
  8,073 216 2
Digital smile design for gummy smile correction
Yara Loyanne de A S. Levi, Letícia Vitória de S. Cota, Luciana P Maia
September-October 2019, 30(5):803-806
DOI:10.4103/ijdr.IJDR_132_18  
Some tools can be used as an aid to the surgical planning for gummy smile correction, such as digital smile design (DSD), which allows to determine patterns of harmony and eventual asymmetries between teeth and gums. This work aims to report a gummy smile correction using DSD as reverse planning. The clinical examination revealed the presence of gummy smile and extensive bone exostosis in the premolar region. DSD was performed in the upper arch, determining the amount of gingiva to be removed, thus providing more safety and precision to the procedure. The surgery was performed by performing using an internal bevel incisions, detachment of a full thickness flap, and osteotomy and osteoplasty. After 6 months of preservation, there was an increase in the clinical crown of the teeth, with smile harmony, less exposure of the gingiva in the smile and a high level of patient aesthetic satisfaction.
  8,155 130 2
ORIGINAL RESEARCH: RETROSPECTIVE STUDY
Recurrent black stains and periodontal disease
Ratika Lihala, Deepika Jayaprakash, Praveen Jayaram, AN Savitha, Anirban Chatterjee, M Rajini
September-October 2019, 30(5):763-766
DOI:10.4103/ijdr.IJDR_260_17  
Objectives: The objective of this study was to identify the anaerobic pigment-forming bacteria present in black stain and correlate its occurrence with dental caries incidence and periodontal destruction. Materials and Methods: A total of 50 healthy subjects with the chief complaint of recurrent black stains were selected based on the inclusion and exclusion criteria. decayed/missing/filled surfaces score, community periodontal index, Gingival Crevicular Fluid (GCF), black stain score, and microbial analysis were done. Results: The data presented indicate that black stain has a constant microflora, dominated by various gram-negative rods, gram-positive cocci and rods (P ≤ 0.1). However, the incidence of gram-positive rods decreased with the increase in plaque score and probing depths and decrease in black stain score. Conclusions: Presence of black stains is predominated by various gram-positive and negative rods, and gram-positive cocci. Increase in the plaque score decreases the severity of black stains, thereby increasing the probability of periodontal destruction and dental caries incidence in adult subjects. Further studies are required to corroborate the results.
  4,819 71 -
ORIGINAL RESEARCH: EVALUATIVE STUDY
Comparative assessment of chronological, dental, and skeletal age in children
Shweta Bhadana, KR Indushekar, Bhavna Gupta Saraf, Divesh Sardana, Neha Sheoran
September-October 2019, 30(5):687-691
DOI:10.4103/ijdr.IJDR_698_17  
Background: Age of a child can be assessed from various parameters such as chronological age, height, weight, secondary sexual characteristics, skeletal age, or dental age. The present study was planned to assess and compare chronological age with dental age (Demirjian's method and Willem's method) and skeletal age (Fishman's method). Materials and Methods: The present study was done on a sample of 100 children in the age group of 9–14 years. The chronological age was computed through the birth certificates and dental age was calculated from their orthopantomograms (OPGs) using Demirjian's and Willem's methods. Hand-wrist radiograph of the left hand was used to compute skeletal age using Fishman's method. Paired t-test and Pearson's correlation coefficients were calculated as a part of statistical analysis at a significance level of P < 0.01. Results: The mean chronological age among the group was 12.37 ± 1.34 years, the mean dental age by Demirjian's method was 12.36 ± 1.72 years, the mean dental age by Willem's method was 12.36 ± 1.51, and the mean skeletal age by Fishman's method was 13.03 ± 1.34 years. Out of the all methods evaluated in the study, Fishman's method of age estimation showed the least value of correlation coefficient (r = 0.728) with the chronological age, whereas Willem's method showed the maximum correlation with the chronological age (r = 0.885). Conclusion: It can be concluded from the present study that the dental age estimation evaluated by the digital OPG by both the methods, that is, Demirjian's method and Willem's method, has shown high accuracy when applied to the children of Faridabad. Skeletal maturation evaluated by Fishman's method using hand-wrist radiographs was found to overestimate the age when compared to chronological age in both the sexes.
  4,059 126 -
Cytological intracellular glycogen evaluation using PAS and PAS-D stains to correlate plasma glucose in diabetics
S Shamala Ravikumar, TR Menaka, G Vasupradha, K Dhivya, J Dinakaran, V Saranya
September-October 2019, 30(5):703-707
DOI:10.4103/ijdr.IJDR_815_18  
Background: Oral cytology studies have claimed that cytoplasmic Periodic Acid Schiff (PAS) positivity in type-2 diabetics is due to glycogen content. But, it can also be due to mucin and glycoconjugates. Aim: 1. To confirm that cytoplasmic PAS positivity in type-2 diabetics is due to glycogen using diastase. 2. To know the effect of diabetes by determining the number of glycogen-containing cells in the smear. 3. To assess the impact of duration of diabetes based on PAS staining of cells. 4. To correlate between random blood glucose level and the number of PAS-positive cells. Materials and Methods: Study population comprised 45 individuals with 30 type-2 diabetics as case group (Group I < 5 years duration; Group II > 5 years duration) and 15 healthy volunteers (age and gender-matched) as control. For all subjects, random blood glucose was estimated and two cytosmears were obtained. The smears were stained with PAS and PAS-diastase stains (PAS-D). Staining intensity was documented as score 1 (mild-to-moderate) and score 2 (moderate-to-intense) and data obtained were statistically analyzed in SPSS version 16.0. Results: Mann-Whitney U test revealed that in diabetics cytoplasmic PAS positivity is because of glycogen (P < 0.05). There is an increase in the number of glycogen-containing cells (P < 0.05) in diabetics. The duration of diabetes had less impact on intracellular glycogen accumulation (P > 0.05). Spearman's correlation test revealed no significant correlation (P > 0.05) between random blood glucose and a number of PAS-positive cells. Conclusion: PAS positivity is because of intracellular glycogen accumulation in type-2 diabetics. It can convey the glycaemic status of an individual in the recent past, thus a beneficial role in screening and therapeutic monitoring.
  3,171 67 1
Prevalence of Oral mucosal lesions and their association with Pattern of tobacco use among patients visiting a dental institution
Swati Verma, Hunny Sharma
September-October 2019, 30(5):652-655
DOI:10.4103/ijdr.IJDR_23_18  
Background: Oral mucous membrane is an integral part of the complex oral cavity which is associated with maintenance of oral as well as general body health. Oral mucosal lesion (OML) is one of the most prevalent diseases in India, which is caused by consumption of smokeless and smoked forms of tobacco. Aim: To assess the prevalence of OMLs and their association with pattern of tobacco use among patients visiting dental institution in Bhilai. Materials and Methods: This descriptive cross-sectional study included 872 participants who visited the Department of Oral Medicine and Radiology, Rungta College of Dental Science and Research, and fulfilled the inclusion criteria, and the study was carried out from July to September 2016. Self-designed proforma was used for recording demographic details, and WHO Assessment Form for Oral Mucosal Diseases was used to record the tobacco use status and findings of the clinical and laboratory investigation. Statistical analysis was performed using IBM SPSS version 23, and the mean, frequency, and percentage were calculated. Results: Among the 872 participants, 69.26% were male and 30.74% were female. The mean age of the study population was 46.19 ± 12.33 years. The prevalence of tobacco use among study participants was 51.26% and that of the OML was 36.36%. Aphthous ulcer was the most prevalent OML followed by oral submucous fibrosis and leukoplakia. Conclusion: The study emphasizes the harmful effects of tobacco use toward oral mucous membrane and also serves as a path for future tobacco cessation programs that would be helpful to prevent OML.
  3,038 183 2
EPIDEMIOLOGICAL WORK
Knowledge and attitude toward use of internet in smartphones for dental education
Shanmuga R Priya, Krishnan Padminee, Robert Deboral, Govindarajan Sujatha, Madasamy Ramasamy, Pradeep Y Kumar
September-October 2019, 30(5):798-802
DOI:10.4103/ijdr.IJDR_386_17  
Introduction: Internet has become ubiquitous with the advent of smartphones. The dental fraternity keeps themselves updated and share knowledge through webinars, video conferences, research publications, etc. Hence, the internet serves as an imperative tool for dissemination of information. The usage of internet in dental education can be exploited to the fullest, especially due to the increased ownership rates of smartphones. Materials and Methods: A total of 490 students from four dental colleges in Tamil Nadu were asked to fill a close-ended questionnaire to assess the knowledge and attitude of dental students toward internet usage in smartphones. This study was conducted from November 2016 to January 2017. Results: The response rate was 100%. Almost all the students (98%) had knowledge on browsing. The percentage of internet use in smartphones were the highest (55.2%) followed by computers or laptops at home (26.5%). About 34.6% of students used internet in smartphones daily. More than half of the students (52.2%) used internet in smartphone at least 2–3 h a day. About one quarter (23.4%) of students used internet on a daily basis while 29.59% of students accessed the internet thrice a week for searching content related to dentistry. The preferred source for collecting dental-related information was through the internet (28.9%) and textbooks (28.5%). Conclusion: Dental students have considerable knowledge in using the internet for dental education and some of them utilize internet more frequently because of the possession of smartphones.
  3,107 82 -
ORIGINAL RESEARCH: EVALUATIVE STUDY
Comparative evaluation of implant stability in two different implant systems at baseline and 3–4 months intervals using RFA device (OSSTELL ISQ)
Vidya Hiranmayi Kastala, Mulpuri Venkata Ramoji Rao
September-October 2019, 30(5):678-686
DOI:10.4103/ijdr.IJDR_446_17  
Introduction: Osseointegration as formulated by Alberktson is crucial for implant survival and success. Osseointegration is a measure of implant stability. Measuring implant stability helps to arrive at decisions as to loading of an implant, allows protocol choice on a patient to patient basis and provides enhanced case documentation. The RFA technique provides with clinically relevant information about the state of the implant–bone interface at any stage after implant placement. Aim: Evaluation of primary and secondary stability between implants of two different systems by resonance frequency analysis device. Methodology: This study was conducted among 17 patients divided into two groups. Group 1 (n = 10) receiving 20 MIS seven implants and Group 2 (n = 7) received 20 Alphadent active implants. The primary implant stability was measured at the time of implant placement and secondary stability is measured at 3–4 months interval using RFA device OSSTELL ISQ. Statistical analysis was performed using paired t test for intra group and independent sample test for intergroup comparisons. Results: No statistically significant differences in primary and secondary stabilities were found between the implant systems at either time intervals (P > 0.05). A positive correlation was noticed between mesiodistal stability and implant diameter in MIS seven group (P < 0.05). A positive correlation was noticed between mesiodistal, labiolingual stabilities and implant diameter in Alphadent group (P = 0.03). A positive correlation was noticed between mesiodistal, labiolingual stabilities and implant length in Alphadent group (P = 0.03). Conclusion: From the present data, it can be concluded that within the limitations of study, implant systems used and their design features showed no significant correlation to implant stability between the groups. More studies are required to assess the effect of implant designs and surface conditions on implant stability on a long-term basis.
  3,043 106 3
Evaluation of oral health of 6 to 10-year-old asthmatic children receiving bronchodilator through inhaler
Sudhir Kumar, Namita Kalra, Rishi Tyagi, M M A Faridi, Amit Khatri, V N V Satish
September-October 2019, 30(5):670-677
DOI:10.4103/ijdr.IJDR_593_14  
Aim: The aim of this study was to evaluate the oral health status in 6 to 10-year-old asthmatic children receiving bronchodilator (salbutamol, salmeterol, etc.) through inhaler and compare them with nonasthmatic healthy children. Settings and Design: The present study was carried out at pediatric and pedodontic department and neighboring government school. It was an observational and case–control study. Statistical Analysis: All data were analyzed using SPSS 20.0 software program and presented as mean ± standard error of mean. Chi-square test was used for the categorical data between groups. Numerical data were analyzed by Mann–Whitney U-test and t-test. Kruskal–Wallis test was performed for comparisons of median value of decayed, missing, filled surface and Decayed, Missing, Filled Surface (dmfs and DMFS) for different variables within asthmatic group. Mann–Whitney U-test for multiple comparisons and P value was adjusted according to Bonferroni correction. Negative binomial analysis was used to calculate adjusted dmfs and DMFS, and univariate analysis of variance was used for adjusted mean plaque and gingival index. Materials and Methods: The study group composed of 70 asthmatic and 70 nonasthmatic children with the same age and social background aged between 6 and 10 years old. Oral health status was assessed using caries, plaque, and gingival index. Dental caries examination was done using the WHO criteria (1997), plaque index by Silness and Loe in 1964 and gingival health by Loe and Silness in 1963. Results: The children in the asthmatic group had significantly higher caries prevalence, severity of dental plaque, and gingivitis compared with the nonasthmatic group. Plaque accumulation and gingivitis increased significantly as severity and duration of asthma increased. Conclusions: Bronchial asthma had an overall deleterious effect on caries prevalence and severity, plaque, and gingivitis on primary and permanent teeth.
  3,028 86 -
ORIGINAL RESEARCH: COMPARATIVE STUDY
Comparing different bar materials for mandibular implant-supported overdenture: Finite-element analysis
Mohamed I El-Anwar, Ahmad K Aboelfadl
September-October 2019, 30(5):716-721
DOI:10.4103/ijdr.IJDR_97_18  
Aim: This study was conducted aiming to optimize the selection of bar material that can minimize stresses on mandibular bone. Subjects and Methods: One finite-element model was created under ANSYS environment to evaluate the use of different materials as a bar-manufacturing material in mandibular implant-supported overdenture (OD). Model components were created on engineering computer-aided design software and then assembled under the finite-element package. A force of 200 N was unilaterally and vertically applied on the left second premolar area. Results: Within these study conditions, the polyether ether ketone bar produced the lowest Von Mises stress on OD and the maximum value of deformation. Stainless steel bar produced the maximum OD total deformation. Conclusions: Cortical and spongy bones are not sensitive to the bar material. Increasing bar material stiffness increases Von Mises stresses in the bar itself and reduces its total deformation, in what is called overconstrained system.
  2,968 85 1
CASE REPORTS
Maxillary rehabilitation after complete destruction by fungal osteomyelitis
SM Balaji, Preetha Balaji
September-October 2019, 30(5):807-809
DOI:10.4103/ijdr.IJDR_711_19  
Treatment of uncommon fungal infection such as Rhinosporidiosis is challenging, especially when occurring in a non-immunocompromised patient in non-invasive form. Extensive involvement, extending into maxillary jawbone would need aggressive, chemotherapeutic and surgical approach. There are few reports of successful rehabilitation of maxillary jaw with dental implants after treatment of such fungal infection. After adequate medical treatment, the iliac graft and recombinant bone morphogenetic protein-2 was effectively utilized to reconstruct the lost maxillary bone. Later, dental implants were placed, that osseointegrated well.
  2,773 81 1
ORIGINAL RESEARCH: COMPARATIVE STUDY
Assessment of alveolar bone mass using radio morphometric indices in urban and rural postmenopausal women and their correlation with serum vitamin D3 level
Saba Nasreen, Devara Neela Sundara Venkata Ramesh, Rukmangada Thriveni, Amit Bayatnal, Ripon Md Chowdhury, Shweta Kattimani, Raunaque Saba
September-October 2019, 30(5):722-730
DOI:10.4103/ijdr.IJDR_369_18  
Introduction: The number of women with osteoporosis i.e. with reduced bone mass and disruption of bone architecture, is increasing in India due to severe deficiency of Vitamin D. It has been reported throughout the country in urban and rural post-menopausal women. Vitamin D synthesis is affected by geographical location, atmospheric pollution, clothing, melanin pigmentation and sunlight exposure. Moreover, ageing is also associated with decreased vitamin D synthesis. Vitamin D deficiency is the most underdiagnosed medical condition in postmenopausal woman. Objective: Therefore, this study was planned to estimate and to evaluate alveolar bone mass using radio morphometric indices in postmenopausal women and its correlation with serum vitamin D3. Materials and Methods: We conducted a study comprising of a study group of 60 post-menopausal women, divided into 2 sub-groups, each group comprising of 30 individuals, depending on their occupation and domicile. Blood samples were taken to evaluate serum vitamin D3 level. Also, panoramic radiographs of all the study subjects were recorded for evaluation of 3 radio morphometric indices viz. mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI). Results: Statistical analysis revealed higher significant values in rural than in urban postmenopausal woman. Conclusions: A high overall prevalence (90%) of vitamin D deficiency was also observed in the study subjects.
  2,740 68 2
ORIGINAL RESEARCH: RETROSPECTIVE STUDY
Role of angiogenesis in oral submucous fibrosis using vascular endothelial growth factor and CD34: An immunohistochemical study
Ettishree Sharma, Nutan Tyagi, Vineeta Gupta, Anjali Narwal, Hitesh Vij, Dheeraj Lakhnotra
September-October 2019, 30(5):755-762
DOI:10.4103/ijdr.IJDR_186_17  
Background: Oral submucous fibrosis (OSF) is an insidious, chronic, disabling disease, in which there is lack of perfusion due to reduced level of the vasculature and this is said to be responsible for the epithelial atrophy seen in OSF. The degree of vasculature of the affected mucosa and its effects on the epithelial thickness remains controversial till date. Aims: This study attempts to analyze the role of angiogenesis in OSF and its progression using vascular endothelial growth factor (VEGF) and CD34 markers. Materials and Methods: The study samples for the present study comprised of 10 cases each of early OSF, moderately advanced, advanced OSF, and 10 cases of normal oral mucosa were used as controls. All the cases were subjected to immunohistochemical staining with VEGF and CD34 markers. Results: Among the different grades of OSF, we did not find any noticeable difference in VEGF expression although we found a upregulation in microvessel density (CD34) in early and moderately advanced OSF followed by a downregulation in advanced OSF. Conclusions: As the disease progresses, there is an increased production of the extracellular matrix component (collagen I and II and fibronectin) and results in fibrosis. Subsequently, it leads to the reduction in the level of corium vascularity and results in hypoxia which ultimately causes reduction and constriction of the vascular channels. This sequence of events alerts us to the relevance of early disease diagnosis and management in an irreversible pathology such as OSF.
  2,682 77 4
ORIGINAL RESEARCH: EVALUATIVE STUDY
Assessment of the existing dental education environment at a dental teaching institution
Shrikanth Muralidharan, Farha Rizwan Sikalgar, Ramandeep Dugal, Dinraj Kulkarni, Surekha Shinde, Arunkumar Acharya
September-October 2019, 30(5):661-664
DOI:10.4103/ijdr.IJDR_96_18  
Introduction: An important aspect of creating a competent medical practitioner is the teaching-learning environment that shapes the mentality and instigates an urge among the students to learn. To facilitate a motivating learning setup, the faculty members need to inadvertently establish a successful and safe learning environment which is extensively feasible, given that the faculty gets to control their own style of teaching. A lot of research focuses on student's perception of the learning environment, seldom studies have reported the teacher's perspective. This present study focuses on the teacher's side of the story regarding the current scenario of the workplace that is one of the essential factors to alter the approach toward andragogy. Materials and Methods: A cross-sectional questionnaire study was carried out using the Assessment of Medical Education Environment by Teachers (AMEET) questionnaire. The AMEET questionnaire was administered to 50 staff members at MA Rangoonwala College of Dental Sciences and Research Centre, Pune. All the participants were assured of confidentiality of their personal details and they all signed a written informed consent before participating in the study. Results: Majority of the participants had a positive attitude which was seen more in the seniors compared to the juniors. The teacher's perception of teaching is that there needs to be a greater emphasis on what the student learns rather than what the teacher does. Junior staff members felt that students do not prepare and come for classes nor are the expected outcomes clear to them. Assignments are also a task for the students that are never on time. Conclusion: It was observed that more senior faculties were positive toward the existing education environment. In addition, even though opportunities are available for the staff as well as students for upgrading and imbibing newer information, they were not being benefitted by the same due to underutilization.
  2,604 85 1
ORIGINAL RESEARCH: COMPARATIVE STUDY
Gingival crevicular fluid response to protocols of non-surgical periodontal therapy: A longitudinal evaluation
Vanessa Rossi, Rachel Romagna, Patricia Daniela Melchiors Angst, Sabrina Carvalho Gomes
September-October 2019, 30(5):736-741
DOI:10.4103/ijdr.IJDR_148_16  
Context and Aim: Gingival crevicular fluid (GCF) volume reflects the level of periodontal inflammation. This secondary analysis aimed to evaluate the GCF volume in patients submitted to non-surgical periodontal therapies under a split-mouth design. Materials and Methods: GCF volume of 25 participants (47.24 ± 6.47 years) with moderate-to-severe chronic periodontitis was collected at Days 0, 30, 60, 90, 120, 270, and 450. The participants were submitted to three different non-surgical therapies randomly assigned per quadrant [GI: supragingival control (Supra) as only intervention (one quadrant); GII: Supra plus scaling and root planing (SRP) on Day 0 (two quadrants); GIII: Supra on Day 0 and SRP 30 days later (one quadrant)]. During treatment (0–60 days) and maintenance (90–450 days) participants were submitted to supragingival plaque control reinforcements. GCF volumes were analyzed after logarithmic transformation (log10) and linear models were used for intra- and inter-group comparisons, considering the data dependence. Results: Baseline GCF volumes were similar between groups (GI: 0.39 ± 0.22 μl; GII: 0.42 ± 0.26 μl; GIII: 0.41 ± 0.14 μl;P > 0.05). At Day 60, GCF volumes were significantly reduced (GI: 0.20 ± 0.13 μl; GII: 0.18 ± 0.11 μl; GIII: 0.22 ± 0.13 μl; P < 0.001), without inter-groups differences. These results were maintained along maintenance period (P > 0.05). Even in sites bleeding on probing (BOP) + the means of GCF volume did not differ between groups (P > 0.05). Conclusions: All therapies determined reductions on the GCF volume along time. Supragingival plaque control modulated the subgingival area during the study, reinforcing the importance of this control over the subgingival inflammatory response.
  2,578 67 2
EPIDEMIOLOGICAL WORK
Knowledge, attitude, and practice of senior dental students toward management of complications in exodontia
T Srinivasa Prasad, Govindarajan Sujatha, R Shanmuga Priya, M Ramasamy
September-October 2019, 30(5):794-797
DOI:10.4103/ijdr.IJDR_508_17  
Introduction: Dental graduates have a professional responsibility of being competent in managing the complications in exodontia, a very commonly performed procedure. Aim: The aim of this paper was to assess the knowledge, attitude, and practice of senior dental students toward the management of complications in exodontia. Materials and Methods: Four hundred dental students participated in the study voluntarily. Verbal consent was obtained after elaborating the purpose of the study. A short validated questionnaire consisting of 12 close-ended multiple choice questions was distributed to all the students. The questionnaires were collected back and results from fully filled questionnaires were tabulated in Microsoft Excel 2007. Results: Nearly 93.4% of the students perform extractions in their practice on a routine basis. Among those 32.5% of the students have encountered complications, out of which only 20% of the students are confident in managing them. The remaining 64.8% of students who have not encountered complications are not confident in managing the same. Conclusion: This study revealed the need for increase in cases which will in turn help the students to transfer their theoretical knowledge into professional skills.
  2,554 72 -
ORIGINAL RESEARCH: EVALUATIVE STUDY
Visualization features of canalis sinuosus with cone beam computed tomography
Yuri G Sedov, Anatoly M Avanesov, Oleg S Mordanov, Dina D Zurnacheva, Rita S Mustafaeva, Anastasia V Blokhina
September-October 2019, 30(5):656-660
DOI:10.4103/ijdr.IJDR_26_19  
Introduction: One of the key stages of evaluating an edentulous ridge prior to dental implant placement is the analysis of neighboring anatomical structures such as canalis sinuosus (CS) with cone-beam computed tomography (CBCT). CBCT visualization has its own features, such as the change of slice thickness. The aim of the study was to analyze CS prevalence in relation to the slice thickness and CS diameter according to CBCT scans. Materials and Methods: In total, 100 CBCT scans of 39 males and 61 females in the age span of 46 to 81 years were retrospectively studied. Terminal alveolar part of CS was analyzed in Ez3D2009 (Vatech) software on panoramic and cross-sectional views with 0.5 mm, 1 mm, 3 mm, and 10 mm slice thicknesses. The prevalence was documented with regard to the diameter and slice thickness and was statistically compared in age and gender groups. Results: This CBCT study demonstrated 55.5% CS prevalence. There was no statistically significant difference in presence between age and gender groups regarding diameter as well as within different slice thickness. The study also showed the importance of the slice thickness choice for CS visualization: the best visualization was reached with 0.5 mm and 1 mm slice thicknesses. Visualization with 0.5 mm and 1 mm slice thicknesses was absolutely the same (55.5%). General CS prevalence with a 10 mm slice thickness (16.5%) was significantly lower (P < 0.05) than the prevalence with a 3 mm slice thickness (20.5%). The correlation between the slice thickness and a diameter more than 1.5 mm in size was not found. Conclusion: CBCT analysis showed that the highest CS prevalence was detected with the use of 0.5/1 mm slice thickness. As well, the higher CS diameter, the better is its visualization.
  2,446 104 -
ORIGINAL RESEARCH: RETROSPECTIVE STUDY
Do Patients with Osteoporosis Have Higher Risk to Present Reduced Alveolar Ridge Height? An Imaging Analysis
Luciana Munhoz, Daniela Y Takahashi, Danielle A Nishimura, Erika A. dos Anjos Ramos, Jefferson da Rocha Tenorio, Emiko S Arita
September-October 2019, 30(5):747-750
DOI:10.4103/ijdr.IJDR_497_18  
Background: Osteoporosis and periodontitis are both diseases that induce bone resorption. The objective of this study was to verify through panoramic radiography analysis whether patients with osteoporosis have a greater risk of periodontal disease (horizontal alveolar bone defect and vertical alveolar bone defect) when compared with patients without osteoporosis. Methods: In all, 100 women were selected: 50 with osteoporosis (T-score < -2.5 DP) and 50 without osteoporosis (T-score > -2.5 DP), using the T-score of proximal radius. Logistic regression test was performed to assess the risk of panoramic radiographic periodontal defects (horizontal and vertical bone defect), age, and bone mineral density influence. Results: Advanced age women were three times more likely to present osteoporosis. Patients with osteoporosis have significantly higher risk (4.46 times) of presenting horizontal alveolar bone defect. Vertical alveolar bone defect results were nonsignificant. Conclusion: Our study results corroborate the literature trend that osteoporosis may influence the progression of alveolar ridge height loss (horizontal alveolar bone defect). Panoramic radiography may be used as a screening tool to help the diagnosis of periodontal bone loss in patients with osteoporosis.
  2,464 51 -
ORIGINAL RESEARCH: EVALUATIVE STUDY
Validation of Hindi (Indian) version of the child perceptions questionnaire (CPQ11-14) among 11–14 year old School Children
Radhey Shyam, BC Manjunath, Adarsh Kumar, Ridhi Narang, Ankita Goyal, Mamta Ghanghas
September-October 2019, 30(5):697-702
DOI:10.4103/ijdr.IJDR_588_17  
Context: Oral health is a fundamental aspect of general health which significantly affects quality of life (QoL) of an individual. Oral health-related QoL is a multidimensional concept determined by race, education, culture, and experiences related to oral diseases. Aim: This study aims to evaluate the Hindi (Indian) version of the child perceptions questionnaire (CPQ11-14) among 11–14-year-old school children in Rohtak City, Haryana, India. Materials and Methods: A cross-sectional study was carried out among 586 children in Rohtak city, Haryana, India, to find out the translation and cross-cultural adaptation of CPQ11-14. The original version of CPQ11-14was translated to Hindi language, and the dental caries experience was measured by caries assessment spectrum and treatment index. Statistical Analysis: The data were entered into Microsoft Excel and analyzed using SPSS 18. Reliability was assessed in 2 ways: internal consistency reliability and test-retest reliability. The level of significance was set at 0.05. Results: Construct validity was confirmed demonstrating statistically significant associations between total CPQ11-14 score and global ratings of oral health (P = 0.00) and overall well-being (P = 0.00). Mean CPQ11-14scores (20.30 ± 10.91) including all the domain scores were higher among children without dental caries when compared to children with dental caries (19.79 ± 9.88) and the instrument was not able to discriminate between two clinical groups significantly (P = 0.08). Conclusion: The Hindi version of the CPQ11-14 questionnaire is a reliable instrument having good reliability, good construct, and convergent validity but lacks discriminant validity. Shorter forms of CPQ11-14may be more useful when compared to original construct.
  2,381 84 1
ORIGINAL RESEARCH: IN VITRO STUDY
Displacement and periodontal stress analysis on palatally impacted canine - A finite element analysis
Komal Nagendraprasad, Silju Mathew, Prashantha Shivamurthy, Sharanya Sabrish
September-October 2019, 30(5):788-793
DOI:10.4103/ijdr.IJDR_1_17  
Objective: The aim of the study was to analyze the displacement and stress pattern in periodontal ligament (PDL) of palatally impacted canines (PIC) lateral incisors (LI) and first premolars (FP) adjacent to the impacted teeth when different magnitudes of orthodontic extrusion forces were applied along with variation in the inclination of the impacted teeth. Methodology: A three-dimensional finite element model of a maxilla containing a palatally impacted canine was made with three different inclinations of the palatally impacted canine (model one, model two, and model three). Forces of 50, 70, and 100 g were loaded on the impacted tooth. Results: There was steady increase in the initial rate of displacement in the three teeth when the magnitude of the force that was applied on to the PIC increased. The initial rate of displacement was more in the FP tooth as compared to LI and the impacted teeth. The von Mises stress on the PDL varied along with the variation in the inclination of the impacted canine. Conclusion: The study showed that there was variation in the displacement and the stress distribution in the impacted canine when it was placed in different angulations. The rate of displacement of the impacted teeth reduced when the crown of the palatally impacted canines (PIC) was inclined more mesial. The use of minimal forces is ideal to extrude the impacted canines as observed from the study that the PDL stress increases with increase in the magnitude of force.
  2,286 54 -
A novel, new generation drill coating for osteotomy site preparation
Pooja P Wadkar, Suraj Khalap, Devanand Shetty, Abhishek Gupta, Arvind Shetty, Suyog Dharmadhikari
September-October 2019, 30(5):767-771
DOI:10.4103/ijdr.IJDR_795_18  
Background: Implant success and survival rate ranges from 93% to 97%; however, failures are not very uncommon. These failures can be caused due to a variety of reasons out of which increased heat during drilling of osteotomies is a major contributor.Aim: The aim of this study was to develop a new generation diamond-coated drill and compare the thermal changes between commercially available drills and the experimental diamond coated drill during implant site preparation in artificial bone. Material and Methods: Three types of drills were selected for the study; Group A (Carbide), Group B (Stainless Steel), and Group C (Experimental). A total of 60 implant site preparations were performed with all the drills in artificial bone using a surgical unit linked to a testing device, in order to standardize implant drilling procedures. Bone temperature variations were recorded when drilling at a depth of 10 mm. A constant irrigation of 50 ml/minute and drilling speed of 800 r.p.m. was maintained. Results: The mean temperature of Group A, Group B, and Group C was 35.57°C, 36.83°C and 34.23°C, respectively. The results were assessed and statistically analyzed using ANOVA test and post hoc Bonferroni test. Statistically significant higher temperatures were obtained with stainless steel drill and carbide drill when compared with the experimental diamond coated drill. (P = 0.000). Conclusions: Diamond coated osteotomy drills have shown promising results in reducing heat generation at the osteotomy. Further studies need to be conducted to maximize the potential use of diamond as components of drills in implant dentistry.
  2,255 64 1
ORIGINAL RESEARCH: EVALUATIVE STUDY
Late hyaluronidase injection in local anesthesia: Morphofunctional evaluation in rat sciatic nerve block
Anna Carolina Ratto Tempestini-Horliana, Marcelo Lazzaron Lamers, Maurício Yonamine, Patricia Verónica Aulestia-Viera, Marinilce Fagundes Dos Santos, Maria Aparecida Borsatti
September-October 2019, 30(5):692-696
DOI:10.4103/ijdr.IJDR_745_16  
Introduction: Despite the enhancing effects of hyaluronidase (HYAL) over duration of anesthesia, this enzyme could cause adverse effects when injected concomitantly with local anesthetics in dental blocks. Objective: This study aimed to assess the tissue alterations caused by a local anesthetic protocol consisting of a late HYAL injection and confirm its functional effectiveness. Materials and Methods: The protocol efficacy was proved by evaluating sensory and motor functions in rats. The sciatic nerve was blocked with 2% lidocaine (LID) with epinephrine (n = 25). Thirty minutes later, 75 TRU/ml HYAL was injected into the same site (experimental group, LID/HYAL). One week later, this protocol was repeated in the contralateral hindlimb, injecting only HYAL's vehicle (control group, LID/vehicle [LID/V]). To observe the integrity of the local tissues, histological specimens were obtained 1, 24, 48, and 72 h after treatment with LID/HYAL or LID/V (n = 16 each) and stained with hematoxylin/eosin and picrosirius red. Results: Local inflammation was similar in both groups. The integrity of the nerve fibers was preserved, in spite of some inflammation-associated injuries in the surrounding tissues. The reversible tissue disorganization caused by HYAL, probably facilitated the diffusion of the residual anesthetic to the nerve, resulting in a prolonged anesthetic effect (P < 0.05). Conclusions: No irreversible morphological alterations are caused by the administration of HYAL prior the end of the LID-induced block. Moreover, this protocol prolongs LID's anesthetic effect.
  2,247 44 -
ORIGINAL RESEARCH: COMPARATIVE STUDY
Effect of local bee honey on dihydrofolate reductase enzyme inhibitor-induced mucositis: A histological study on albino wistar rats
Laxman Khanal, Prabhakar Yadav, Presha Baral, Rajan Shah, Gagendra Prasad Rauniar
September-October 2019, 30(5):708-715
DOI:10.4103/ijdr.IJDR_689_17  
Introduction: Mucositis is a common complication in around 40% of patients receiving chemotherapy which profoundly impact the quality of life. Despite the availability of many therapeutic agents that claim to prevent or reduce the severity of oral mucositis, no intervention that is completely successful at preventing oral mucositis exists. The present study aimed to demonstrate the effect of local honey on methotrexate-induced mucositis of the tongue. Materials and Methods: The study was done in albino rats (n = 24), divided into four groups: honey-normal saline group (H/NS), distilled water-NS group (DW/NS), DW-methotrexate group (DW/MTX), and H/MTX group. Local honey was given (2.5 g/kg) twice a daily for 8 days. NS or methotrexate (60 mg/kg) interrupted the experiment procedure on day 4. At day 8, rats were sacrificed and middle third of tongue was removed for preparation of histological slides. Slides were examined for inflammatory cell infiltration (ICI), cell vacuolization (CV), congested blood vessels (CBV), thickness of epithelium (both dorsal and ventral mucosa), and thickness keratin. Results: Statistically significant association was found between the groups for ICI and CV, χ2 (3) = 11.97, P= 0.003 for ICI, and χ2 (3) = 8.307, P= 0.023 for CV. Mean number of CBV per microscopic filed was 0.445, 0.389, 1.28, and 0.5 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of dorsal epithelial thickness (μm) was 96.78 ± 13.59, 100.50 ± 9.75, 75.53 ± 9.24, and 98.75 ± 10.92 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. Mean value of ventral epithelial thickness (μm) was 70.45 ± 13.60, 58.38 ± 14.26, 37.04 ± 5.37, and 52.80 ± 7.97 for H/NS, DW/NS, DW/MTX, and DW/H groups, respectively. The thickness of epithelium of DW/MTX group was significantly different from other groups (P < 0.05). Conclusion: The present study demonstrated the palliative effect of local honey over the mucositis induced by the chemotherapeutic drug (methotrexate).
  2,201 51 1
ORIGINAL RESEARCH: IN VITRO STUDY
Evaluation of surface integrity of root end cavities prepared using conventional and piezoelectric devices: A scanning electron microscopy study
Mithra N Hegde, Manjiri Nagesh Honap, Sreenath Narayanan
September-October 2019, 30(5):772-776
DOI:10.4103/ijdr.IJDR_237_18  
Introduction: An array of factors control the success of endodontic surgery. One of them is the technique used to prepare the root end cavities which is conventionally being done with burs. In past decades, ultrasonic instruments have been introduced for the same. Studies comparing these instruments on root surface integrity are scarce. Thus, an in-vitro Scanning Electron Microscopy study was designed to evaluate the surface integrity of root end cavities prepared using conventional and piezoelectric devices. Methodology: Twelve single-rooted human intact mandibular premolar teeth were endodontically treated and included in the study. They were divided into two groups. In the first group, 3 mm root-end cavities were prepared using conventional retro preparation burs and in the second group, 3 mm root-end cavities were prepared using piezoelectric retro-tips. The specimens were coded for blind evaluation and analysed under scanning electron microscope at 100x, 500x and 1000x magnification for smear layer and debris. Gutmann's scoring criteria was followed to score the specimens. Statistical analysis was carried out using Shapiro Wilk test and the independent sample t-test was used to check mean differences between variables. Results: It was noted that significant statistical differences existed in mean debris and smear layer scores (p<0.001) between the two groups. In the piezoelectric group, significantly lower debris layer and smear layer was found, compared to the conventional bur group. Conclusion: Root-end cavities prepared using piezo retrotips produced cleaner, well-centered and more conservative surface with minimal debris & smear layer, compared to root-end cavities prepared using conventional burs.
  1,973 65 -
ORIGINAL RESEARCH: RETROSPECTIVE STUDY
Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study
Ali Lotfi, Sina Shirkavand, Sepideh Mokhtari, Saman Salehi Zalani, Saede Atarbashi-Moghadam
September-October 2019, 30(5):751-754
DOI:10.4103/ijdr.IJDR_392_17  
Purpose: Dentigerous cyst (DC) is the most common type of developmental odontogenic cysts which apparently develops via accumulation of fluid between the reduced enamel epithelium and crown of the tooth. The aim of this study is to analyze the frequency of DC in Iranian population. Materials and Methods: The files of oral pathology, Shahid Beheshti University of Medical Sciences, served as the source of the materials from 1992 to 2012 for this study. All lesions diagnosed as DCs were subjected to microscopic reevaluation. Patient's age, sex, location, and microscopic characteristics were recorded. Based on these data, a descriptive statistical analysis was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant. Results: DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years and most cases are diagnosed in the second and third decades of life. The male-to-female ratio was 1.52. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. DCs showed Vickers and Gorlin (ameloblastomatous) changes in 2.36% of cases. The mean age was significantly lower in the premolar area (P = 0.00). Conclusion: Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.
  1,947 45 -
ORIGINAL RESEARCH: COMPARATIVE STUDY
Analysis of collagen fibers in keratocystic odontogenic tumor and ameloblastoma: A polarizing microscopic study
Kalavani Peddapelli, Venkateswara Rao, Manchikatla Praveen Kumar, Taneeru Sravya, Dumpala Rakesh
September-October 2019, 30(5):731-735
DOI:10.4103/ijdr.IJDR_77_16  
Introduction: Collagen forms an integral part of connective tissue and maintains its structural integrity. It has natural birefringence which is attributed to the arrangement of its fibers and is enhanced by special stains such as picrosirius red through polarizing microscopy. The polarization colors differ according to the fiber thickness and pattern of arrangement which in turn related to aggressiveness. Hence, the present study was conducted to evaluate collagen fibers in keratocystic odontogenic tumor (KCOT) and ameloblastoma using polarizing microscopy. Aim: This study aims to compare and correlate different types and patterns of collagen fibers in KCOT and ameloblastoma using picrosirius red stain under polarizing microscopy to delineate their aggressiveness. Materials and Methods: The color, thickness, and orientation of collagen fibers in the KCOTs (n = 15) and ameloblastomas (n = 15) were studied histochemically by staining the sections with picrosirius red and examined under polarizing microscope using image analyzer software. Results: When collagen fiber bundles in KCOT and ameloblastoma were compared, significant difference was noted between yellowish-orange collagen fiber bundles, but no significant difference was observed between greenish-yellow and orange-red collagen bundles. With respect to orientation and organization, the results are statistically significant (P < 0.05). Conclusion: The connective tissue stroma of KCOT could be regarded not just as a structural support but as a functional part of the lesion. In KCOT, the thin, parallel, and loosely arranged greenish-yellow collagen fibers may be attributed to its high recurrence rate and biological aggressiveness.
  1,896 68 -
ORIGINAL RESEARCH: IN VITRO STUDY
Nanoneedle-like zinc oxide as a filler particle for an experimental adhesive resin
Vicente Castelo Branco Leitune, Priscila Raquel Schiroky, Bruna Genari, Melissa Camassola, Felipe Antonio Lucca S, Susana Maria Werner Samuel, Fabrício Mezzomo Collares
September-October 2019, 30(5):777-782
DOI:10.4103/ijdr.IJDR_779_16  
Aim: The aim of this study was to develop an experimental adhesive resin with nanoneedle-like zinc oxide (N-ZnO), an inorganic filler, that could avoid particle agglomeration and lead to a homogeneous stress distribution within the material and characterize it. Materials and Methods: N-ZnO particles obtained by a thermal evaporation technique were characterized regarding size and surface area and added at 0 (control), 1, 2, 5, and 10 wt%, to an experimental adhesive resin. The following experimental adhesive resins' properties were assessed: radiopacity, contact angle to conditioned enamel and dentin, color, degree of conversion, flexural strength, resistance to degradation, and cytotoxicity. Statistical analysis was performed using one-way ANOVA and Tukey's post hoc test and paired Student's t-test. Results: Particles presented a mean particle size of 40 nm and a specific surface area of 16 m2/g. N-ZnO10%showed an increased radiopacity when compared to N-ZnO0%. Contact angles were significantly higher for N-ZnO10%at enamel and N-ZnO2%, N-ZnO5%, and N-ZnO10%at dentin. All groups showed color change when compared to N-ZnO0%. Higher the N-ZnO concentration, lower the degree of conversion. There were no significant differences between the groups for flexural strength and resistance to degradation. The addition of N-ZnO showed no difference in cytotoxicity when compared to positive control, N-ZnO0%, and all groups showed higher values than negative control. Conclusions: N-ZnO possibly exceeded potential limitations due to particles' agglomeration and improved the transference and distribution of stress within the material. It could be effectively used as a filler for adhesive resins.
  1,893 51 4
Microleakage in posterior teeth with different materials and different types of cavities
Everton Ribeiro dos Santos, Adair Luis Busato
September-October 2019, 30(5):783-787
DOI:10.4103/ijdr.IJDR_113_15  
Background: The purpose of this study was to investigate the behavior of a resin-based 2,2-bis (p-[2′-hydroxy-3′-methacryloxypropoxy] phenylene) propane and a composite resin modified with oxirane, regarding the ability of marginal sealing, both with direct restorations and indirect restorations. Materials and Methods: To achieve this, mesio- and disto-occlusal cavities were made on the same tooth, totalling 100 cavities. These cavities were restored with two materials, Filtek P90 (3M ESPE) and Opallis (FGM). Then, they were divided into two groups: Fifty direct restorations, each sample restored with the two materials, following the manufacturer's protocol and fifty indirect restorations, and then cemented with a paste obtained by diluting the resin in its adhesive. The templates were thermally cycled, 30 s at 5°C and 30 s at 55°C for 500 cycles and then were immersed in methylene blue for 24 h. Afterward, they were trimmed using a plaster trimmer from occlusal toward a gingival direction. These samples were analyzed with stereomicroscope (×3) by two blinded observers. Then, a system which considers the average number of surrounding walls that have suffered infiltration on a scale of 0–3 was used. Results: Data were subjected to statistical analysis (Mann–Whitney and Kruskal–Wallis tests) with a significance level of 5% maximum. Conclusion: It was concluded that the indirect restorations showed the greatest number of restorations with score 0 and 1 (34) and lowest score 2 and 3 (16). This suggests that indirect restorations regardless of the material used behaved more effectively regarding the marginal sealing of restorations.
  1,862 65 2
GUEST EDITORIAL
The future of Indian dental research
Vinay Pitchika
September-October 2019, 30(5):649-650
DOI:10.4103/ijdr.IJDR_607_19  
  1,728 120 -
ORIGINAL RESEARCH: PROSPECTIVE STUDY
Validation of Manipuri version of oral health-related early childhood quality-of-life tool for preschool children
Charan Kamal Kaur Dharmani, Jatinder Kaur Dhillon, Vijay Prakash Mathur
September-October 2019, 30(5):742-746
DOI:10.4103/ijdr.IJDR_5_18  
Introduction: Early childhood caries can affect quality of life (QoL) in children and their parents. The Oral Health related Early Childhood Quality of Life scale (OH-ECQoL) is used for measuring oral health-related QoL in North Indian preschool children. Same tool cannot be utilized only by linguistic translation in culturally different Manipuri population. Aims and Objectives: The aim of this study is to translate OH-ECQoL tool into Manipuri language and to reestablish its psychometric properties. Methods: The OH-ECQoL tool was translated into Manipuri language by forward–backward translation. The questionnaire was tested on 300 parents/primary caretakers of healthy children with the age range of 24–71 months. It was also retested on 20 parents after a gap of two weeks. Demographic characteristics and socioeconomic status were recorded in a predesigned proforma. Oral health status of children was recorded as per WHO oral health assessment form (2004). Statistical Analysis: The data were tabulated using Microsoft Excel 2010 and analyzed using SPSS version 11 software. Results: The tool possessed good internal consistency (Cronbach's alpha = 0.836) and test–retest reliability (ICC = 0.94). Parents of children who scored higher on Manipuri-OH-ECQoL questionnaire perceived their children's general and oral health as poor when compared to children with lower scores, proving acceptable concurrent validity scores. Spearman's correlation coefficient between child and family impact scores of 0.668 is supporting convergent validity, which means that dental problems affect QoL of both children and their parents. Conclusion: The translated Manipuri-OH-ECQoL tool was found to be adequately valid, reliable, and repeatable without affecting the psychometric properties of the original tool. This suggests that it can be used in studies assessing the impact of oral diseases on QoL of preschool children and their families in Manipur.
  1,783 62 3
ORIGINAL RESEARCH: EVALUATIVE STUDY
Effect of different exposure times on caries detection and pixel value in a wireless digital system
Daniela Pita De Melo, Andrea Dos Anjos Pontual, Francisco Haiter-Neto, Marcelo Correa Alves, Frab Norberto Bóscolo, Paulo Sérgio Flores Campos
September-October 2019, 30(5):665-669
DOI:10.4103/ijdr.IJDR_406_12  
Objectives: The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values. Materials and Methods: Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times – 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression. Results: The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases. Conclusion: The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality. Clinical Relevance: Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.
  1,793 51 1
EDITORIAL
Electronic cigarettes and its ban in India
SM Balaji
September-October 2019, 30(5):651-651
DOI:10.4103/ijdr.IJDR_906_19  
  1,656 77 -
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