Indian Journal of Clinical Research in Dentistry
The DTR Technique © for Rehabilitation of Non-Restorable Teeth: A Case Report
The rehabilitation of non-restorable teeth in implant dentistry presents a significant clinical challenge, particularly in cases associated with thin buccal cortical plates and a high risk of post-extraction ridge resorption. Direct Through Root (DTR) implant placement is an emerging technique that utilizes the retained root as a guide for implant osteotomy, followed by atraumatic root removal, thereby facilitating precise implant positioning while minimizing surgical trauma. This case report describes the management of a mandibular posterior region involving non-restorable first and second molars with severe attrition and compromised crown structure. A DTR approach was employed to preserve alveolar ridge architecture and ensure optimal implant positioning. Following decoronation, osteotomy was initiated through the retained root structure, and the remaining root fragments were atraumatically extracted. A Bioner implant (5 × 10 mm) was placed with satisfactory primary stability. The peri-implant gap was grafted using Regeneross to enhance bone regeneration. After a healing period of three months, prosthetic rehabilitation was completed using a screw-retained PFM crown. The case demonstrated favorable functional outcomes with stable peri-implant tissues. Within the limitations of a single case, the DTR technique appears to be a minimally invasive and effective approach for the rehabilitation of non-restorable teeth. Further long-term clinical studies are required to establish its predictability and broader clinical applicability.
Direct Through Root (DTR), Dental Implants, Non-Restorable Teeth, Ridge Preservation, Implant Rehabilitation
Copyright (c) 2026 Indian Journal of Clinical Research in Dentistry
Long-Term Clinical Effectiveness of Topical Chlorhexidine as an Adjunct to Non-Surgical Periodontal Therapy: A Narrative Review
Abstract Background: Mechanical debridement remains the foundation of non-surgical periodontal therapy. Chlorhexidine, an antiseptic widely used in dentistry and delivered as a mouthrinse, gel, or subgingival irrigation, is widely prescribed following treatment. Its primary purpose is to aid in the management of periodontal diseases such as gingivitis and periodontitis, as well as conditions like gingival recession. However, evidence regarding its long-term clinical effectiveness is inconsistent, with studies reporting contradictory results. Aim: To evaluate whether treatment with chlorhexidine following scaling and root planning leads to marked healing, plaque control or reduction in microbial activity. This was done by using parameters like improvement in Probing depth (PD) and Clinical attachment level (CAL), during follow-up. Methods: A structured literature search was conducted using PubMed, Embase, and Cochrane Central to identify relevant studies evaluating chlorhexidine (CHX) as an adjunct to scaling and root planing (SRP) in periodontal therapy. Studies assessing CHX delivered as mouthrinse, gel, or subgingival irrigation were considered. Randomized controlled trials (RCTs), controlled clinical trials(CCTs), systematic reviews, and meta-analyses reporting clinical periodontal outcomes with follow-up were reviewed. Results: The reviewed studies suggest that adjunctive chlorhexidine (CHX) mouthrinse/gel improves plaque control and is associated with short-term reductions in bleeding on probing (BOP). However, consistent improvements in probing depth (PD) reduction or clinical attachment level (CAL) gain compared with scaling and root planing (SRP) alone were not demonstrated at longer follow-up periods. Subgingival CHX gel or irrigation showed minor early clinical benefits, although these effects tended to diminish over time. Overall, long-term differences between adjunctive CHX use and SRP alone in terms of disease progression appear limited. Conclusions: The available literature suggests that the adjunctive use of chlorhexidine with scaling and root planing provides limited additional clinical benefit beyond conventional mechanical therapy. While its antimicrobial and anti-plaque properties do contribute to plaque control during the early phases of treatment, the long-term therapeutic value of topical chlorhexidine in periodontal therapy remains uncertain. These findings indicate that effective mechanical debridement and regular periodontal maintenance continue to be the primary determinants of long-term periodontal stability.
From Rinse to Resin: Evaluating the Effect of Mouthwashes on Bulk-Fill Composite Microhardness- An in-vitro study
ABSTRACT AIM: The aim of this in vitro study was to evaluate the effect of different commercially available mouthwashes on the surface microhardness of a bulk-fill composite resin. SETTING AND STUDY DESIGN- In-vitro study MATERIALS AND METHODS: Forty-five disc-shaped specimens (8 × 4 mm) were prepared using a bulk-fill composite resin and randomly divided into three groups (n = 15): Group I—Listerine, Group II—Colgate Plax, and Group III—artificial saliva (control). Baseline surface microhardness values were recorded using a Vickers microhardness tester and specimens were immersed in 20 ml of the respective solutions for 24 hours at 37°C to simulate one year of daily mouthwash use. Post-immersion microhardness was measured under identical testing conditions. STATISTICAL ANALYSIS USED: Data were statistically analyzed using one-way ANOVA and Tukey’s post hoc test (p < 0.05). RESULTS: A statistically significant increase in surface microhardness was observed in the artificial saliva group following immersion (P < 0.05). In contrast, specimens immersed in the alcohol-containing mouthwash (Listerine) demonstrated a statistically significant reduction in microhardness (P < 0.05). These findings indicate that immersion media significantly influence the surface microhardness of bulk-fill composite resin. CONCLUSION: Within the limitations of this in vitro study, artificial saliva exhibited a protective effect on the surface microhardness of bulk-fill composite resin, whereas alcohol-containing mouthwash adversely affected its surface integrity. KEYWORDS: Bulk-fill composite resin; Mouthwashes; Surface microhardness; artificial saliva; Vickers hardness KEY MESSAGE: The routine use of alcohol-containing mouthwashes may compromise the longevity of bulk-fill composite restorations.
Artificial Intelligence–Enhanced Virtual Articulators: A Narrative Literature Review
Accurate analysis of mandibular dynamics is fundamental to prosthodontic rehabilitation. Mechanical articulators replicate only simplified jaw movements and do not account for neuromuscular influences. Virtual articulators improve digital simulation but remain restricted by static algorithms and operator-dependent inputs. Artificial intelligence (AI) provides an opportunity to enhance digital occlusal modelling through predictive simulations and adaptive learning. This narrative review synthesizes evidence (2010–2024) regarding AI integration in virtual articulators and analyzes technological advancements, clinical benefits, current limitations, and future research needs. Electronic searches were carried out using PubMed, Scopus, Web of Science, and Google Scholar. Search terms included “virtual articulator,” “artificial intelligence,” “mandibular kinematics,” and “digital prosthodontics.” Studies focusing on AI-based mandibular modelling or occlusal simulation were eligible. AI-enhanced virtual articulators consistently demonstrated superior accuracy in condylar trajectory reproduction, occlusal-contact prediction, parafunctional pattern recognition, and biomechanical load analysis. They reduce operator variability, improve restorative predictability, and enhance digital workflows. Limitations include dataset heterogeneity, absence of standardized protocols, and reduced interpretability of deep-learning models. In conclusion, AI-supported virtual articulators hold considerable potential for increasing the precision and personalization of prosthodontic treatment, although further validation through clinical trials is required.
Management of a distoangular impacted mandibular first molar with severe carious destruction: a case report
Abstract: Impaction of the permanent mandibular first molar is an uncommon clinical finding and is rarely diagnosed in adulthood. Management becomes particularly challenging when the tooth is deeply impacted, unfavorably angulated, and structurally compromised by advanced carious destruction. This case report describes the surgical management of a distoangular impacted mandibular first molar in a 35-year-old female who presented with pain in the lower left posterior mandibular region. Clinical examination and panoramic radiographic assessment revealed a deeply impacted, non-restorable mandibular first molar with complete root formation and no radiographic evidence of proximity to the inferior alveolar canal. Owing to unfavourable angulation and advanced structural compromise, surgical extraction under local anaesthesia was planned. Controlled crown sectioning followed by staged removal of the roots was performed to minimise surgical trauma. Autologous platelet-rich fibrin was placed in the extraction socket to support postoperative healing. The postoperative course was uneventful, with no evidence of neurosensory disturbance. This case highlights that carefully planned surgical extraction represents a viable management option for deeply impacted, non-restorable mandibular first molars diagnosed in adult patients. Keywords: Mandibular first molar; Tooth impaction; Surgical extraction; Platelet-rich fibrin Introduction The permanent mandibular first molar typically erupts between six and seven years of age and plays a crucial role in establishing functional occlusion, mastication, and maintenance of vertical facial height. Failure of eruption of this tooth due to impaction is exceedingly rare when compared with other permanent teeth. The reported prevalence of impacted permanent teeth ranges from 0.01% to 0.08%, with mandibular first molars accounting for only a small proportion of these cases [1]. The aetiology of tooth impaction is multifactorial and may involve local factors such as inadequate arch space, abnormal positioning of the tooth germ, prolonged retention or premature loss of primary teeth, and obstruction by odontogenic cysts or tumours [2]. Systemic and genetic influences, including disturbances in eruption pathways, have also been described [3]. Disruption of the gubernacular canal, which normally guides erupting teeth, may further contribute to eruption failure. Delayed diagnosis of impacted mandibular first molars into adulthood is uncommon and often associated with complete root formation and unfavourable angulation, limiting orthodontic treatment options. Such cases may present with pain, caries, periodontal compromise of adjacent teeth, and occlusal disturbances [4]. Reports describing the management of deeply impacted mandibular first molars with severe carious destruction in adults remain limited. This case report describes the surgical extraction of a distoangular impacted mandibular first molar in an adult patient and discusses the clinical considerations influencing treatment selection. Case Report A 35-year-old female presented with a five-day history of progressively worsening, continuous pain in the lower left posterior jaw region, associated with difficulty in mastication. The patient reported no history of systemic illness, deleterious habits, trauma, or relevant medical conditions. Extraoral examination revealed no facial swelling, asymmetry, trismus, or lymphadenopathy. Intraorally, crown of mandibular left first molar region was partially visible and was tenderness on percussion. No intraoral or extraoral purulent discharge or sinus tract was observed. Panoramic radiograph revealed, distoangular impacted mandibular left first molar (tooth #36), with its crown located beneath the adjacent second premolar and second molar. The tooth had extensive carious involvement and was involving pulp. The adjacent mandibular second molar exhibited mesial tipping, closely abutting the distoocclusal surface of impacted first molar. Root formation of tooth #36 was complete, with no evidence of periapical bone changes. The inferior alveolar canal was positioned inferior to the roots, maintaining a safe anatomical distance (Figure 1). Based on the clinical and radiographic assessment, a diagnosis of distoangular impaction of the mandibular left first molar associated with advanced carious destruction was established. Orthodontic uprighting was not considered due to extensive tooth structure damage, and thus, surgical extraction under local anesthesia was planned. Inferior alveolar, lingual, and long buccal nerve blocks were administered to achieve local anaesthesia. A crevicular incision was made extending from the distal aspect of the first premolar to the mesial aspect of third molar along with an anterior release incision placed mesial to #34 carefully avoiding injury to mental nerves and vessels. A full-thickness mucoperiosteal flap was elevated, and buccal bone guttering was carefully performed using a rotary surgical bur #701 under continuous sterile saline irrigation to adequately expose the crown. Due to the mesial inclination of the adjacent second molar, surgical access was restricted, increasing the risk of enamel damage during elevation. To avoid this, the crown was sectioned vertically in two parts and horizontally at the cementoenamel junction, thereby separating it from the roots. The mesial and distal roots were separated at the bifurcation and delivered separately thereby reducing risk of injury to the inferior alveolar nerve (Figure 2). Following extraction, the socket was thoroughly debrided and irrigated with sterile saline. Autologous platelet-rich fibrin (PRF) was then placed into the socket to enhance healing and bone regeneration. Primary closure was achieved with 3-0 resorbable polyglactin sutures (VICRYL®, Ethicon). The patient was prescribed amoxicillin-clavulanic acid (625 mg) twice daily for five days, Ibuprofen (400 mg) as analgesic, and 0.12% chlorhexidine gluconate mouth rinse twice daily for one week. Postoperative instructions were given, with emphasis on maintaining oral hygiene. Healing was uneventful, with no evidence of infection, wound dehiscence, or neurosensory deficit. At the two-week follow-up, the patient reported complete resolution of symptoms and restoration of masticatory function. A panoramic radiograph taken at four weeks revealed satisfactory bone regeneration at the extraction site. Discussion Impaction of the mandibular first molar is a rare clinical finding, particularly when diagnosis is delayed until adulthood. Management of such cases requires careful assessment of patient age, angulation and depth of impaction, proximity to adjacent anatomical structures, and structural integrity of the affected tooth. In adult patients, complete root formation and unfavourable angulation frequently limit orthodontic uprighting or surgical repositioning, making extraction the preferred treatment option when the tooth is non-restorable [5,6]. In the present case, panoramic radiography was sufficient to assess the relationship between the impacted tooth and the inferior alveolar canal. Although cone beam computed tomography provides superior three-dimensional visualisation, it was not deemed necessary due to the absence of panoramic features suggestive of intimate neurovascular contact. This approach reduced radiation exposure while still allowing safe surgical planning. Surgical extraction of deeply impacted mandibular molars carries inherent risks, including excessive bone removal and inferior alveolar nerve injury. Controlled sectioning and staged root removal were employed to minimise surgical trauma and preserve the surrounding alveolar bone. The adjunctive use of platelet-rich fibrin was intended to support postoperative healing. While evidence regarding its regenerative efficacy remains variable, satisfactory clinical and radiographic outcomes were observed in this case [7]. The primary limitation of this report is its nature as a single case and reliance on panoramic imaging alone. Nevertheless, this case adds to the limited literature on impacted mandibular first molars diagnosed in adulthood and highlights practical surgical considerations for their management. Conclusion Impaction of the permanent mandibular first molar is an uncommon condition that may remain undiagnosed until adulthood and present with significant clinical challenges when associated with severe carious destruction. In adult patients with deeply impacted and non-restorable mandibular first molars, carefully planned surgical extraction represents a viable management option. Individualised treatment planning remains essential to achieve favourable outcomes in such rare clinical scenarios.
Mandibular first molar, Tooth impaction, Surgical extraction, Platelet-rich fibrin
KNOWLEDGE, ATTITUDE AND PRACTICE OF GREEN DENTISTRY AMONG DENTAL PROFESSIONALS IN CHENNAI: A CROSS-SECTIONAL STUDY
Background: The increasing environmental burden generated by healthcare systems has brought attention to sustainable clinical practices, including dentistry. Single-use plastics, radiographic chemicals, sterilization materials, and mercury disposal contribute significantly to ecological pollution. Green dentistry aims to minimize environmental impact through waste reduction, resource conservation, and the elimination of toxic materials. Understanding the current awareness and practices among dental professionals is essential for integrating sustainability into routine care. Aim: To assess the knowledge, attitude, and practices related to green dentistry among dental practitioners in Chennai and identify gaps and opportunities for sustainable adoption. Materials and Methods: A descriptive, cross-sectional, questionnaire-based study was conducted among 100 dental practitioners in Chennai between July and August 2024. A structured, pre-validated 20-item questionnaire assessing demographic data, awareness, attitudes, and sustainability-related practices was administered online after obtaining informed consent. Data were analyzed using descriptive statistics. Results: Among the 100 participants, most were aged 20–30 years (50%) and engaged in private practice (73%). Awareness of green dentistry was moderate, with 32% somewhat familiar and 30% familiar with the concept. Implementation lagged behind awareness: only 17% used eco-friendly materials exclusively, 46% adopted LED lighting, and 29% followed biomedical waste disposal protocols. Recycling practices were limited (13%), and composting was negligible (1%). Attitudes were positive, with 65% willing to invest in training and 45% willing to pay a premium for eco-friendly products. Preferred future initiatives included renewable energy use (33%) and eco-friendly office design (26%). Conclusion: Although awareness and attitudes toward green dentistry were positive among practitioners, the translation of knowledge into practice remains limited. Strengthening training, integrating sustainability into dental curricula, and providing policy-level support may enhance the adoption of eco-friendly dental practices.
"Minimally Invasive Treatment of a Type II Palatogingival Groove Detected at an Early Stage: A Case Report"`
Background: The palatogingival groove (PGG) is a developmental anomaly that may cause localised periodontal destruction, encourage plaque accumulation and increase risk of dental caries and endodontic involvement. Aims: This case report describes early detection and minimally invasive management of a Type II PGG in a maxillary lateral incisor, highlighting the diagnostic value of cone-beam computed tomography (CBCT). Materials and Methods: A 19-year-old patient presented with gingival bleeding and sensitivity on the maxillary left lateral incisor. CBCT revealed a groove extending from the cingulum into the middle third of the root (depth 1.7 mm). Treatment included flap reflection, saucerisation of the groove, root-surface conditioning with 24% EDTA gel, and sealing with resin-modified glass-ionomer cement. Results: At the 6-month follow-up, gingival inflammation resolved, bleeding ceased and tooth vitality remained intact
Palatogingival groove, Endo-Perio lesion, Saucerization, CBCT
Salivary RANKL/OPG, MIP-1α and Serum Lipids in Periodontitis: Evidence Across Diabetic and Non-Diabetic Populations
Abstract Background: Periodontitis represents a complex inflammatory disease with significant metabolic implications, particularly in type 2 diabetes mellitus patients. Salivary biomarkers offer potential diagnostic insights beyond traditional clinical parameters. Objectives: This review examines the performance of salivary biomarkers and serum lipid associations in periodontal disease, comparing diabetic and non-diabetic populations while evaluating enzymatic marker profiles. Methods: We conducted a narrative review using structured searches of PubMed, Embase, and Cochrane Library through August 2024, focusing on bone remodeling markers, enzymatic profiles, and lipid associations. Results: Macrophage inflammatory protein-1α demonstrated strong diagnostic performance (AUC 0.94, 94.9% sensitivity, 92.7% specificity at 1.12 pg/mL cutoff) with 18-fold elevation in periodontitis patients. RANKL levels and RANKL/osteoprotegerin ratios were significantly elevated in periodontal disease. Meta-analysis of 103,468 participants revealed 15% increased dyslipidemia odds with periodontitis, though with substantial heterogeneity. Matrix metalloproteinases, antioxidant enzymes, and inflammatory proteases demonstrated variable diagnostic utility, accompanied by significant methodological limitations. While small trials demonstrated reductions in inflammatory markers following periodontal therapy, the largest randomized trial, involving 290 type 2 diabetes patients, showed no significant improvements in lipid profiles. Conclusions: Bone remodeling markers, particularly MIP-1α, show promise as adjunctive diagnostic tools, though extensive standardization and validation across diverse populations remain essential. Enzymatic profiles face substantial technical and interpretive challenges, which limit their clinical utility. Population-specific approaches appear necessary given differential responses in diabetic versus non-diabetic patients, with therapeutic lipid benefits remaining questionable in diabetic populations.
Periodontitis; Type 2 diabetes mellitus; MIP-1α
Biologically Enhanced Root Coverage in Gingival Recession Defects Using Modified Zucchelli’s Flap and Platelet-Rich Fibrin: A Case Report
Abstract Gingival recession is a common mucogingival defect that can lead to root hypersensitivity, esthetic concerns, and plaque retention. The coronally advanced flap (CAF) technique, particularly the modified Zucchelli approach, has demonstrated reliable root coverage outcomes. This case report highlights the successful management of a Miller Class I gingival recession defect in the maxillary lateral incisor and canine (teeth 22 & 23) using a biologically enhanced technique involving a modified Zucchelli’s flap in conjunction with Platelet-Rich Fibrin (PRF). Clinical evaluation after one month demonstrated complete root coverage, increased gingival thickness, and satisfactory esthetics without any complications.
Gingival recession, modified Zucchelli technique, platelet-rich fibrin, root coverage, coronally advanced flap
Dental Manifestations and treatment of Vitamin D Dependent Type 2 Rickets - A Case Report
Vitamin D-dependent rickets type 2 (VDDR-II) is a rare autosomal recessive disorder characterized by end-organ resistance to active vitamin D (1,25-dihydroxyvitamin D?), leading to impaired calcium and phosphate metabolism. This condition not only affects skeletal development but also has significant dental implications, often overlooked in clinical practice. This case report presents a 17-year-old female diagnosed with VDDR-II who exhibited characteristic dental manifestations, including delayed eruption, enamel hypoplasia, and widened pulp chambers. A comprehensive dental examination revealed multiple carious lesions and periapical pathologies with supernumerary teeth. Radiographic findings supported clinical features consistent with rickets-related dental anomalies. The patient underwent a multidisciplinary treatment approach involving pediatric dentistry and endodontics. Preventive strategies, restorative interventions, and endodontic treatments were planned with consideration of her systemic condition. Oral hygiene reinforcement and regular follow-ups were emphasized. The coordinated dental and medical management led to improved oral health outcomes and quality of life. Dental professionals play a crucial role in the early diagnosis and comprehensive management of systemic conditions like Vitamin D-Dependent Rickets Type II (VDDR-II). Increased awareness of the diverse oral and dental manifestations associated with this rare disorder can significantly aid in timely diagnosis, minimize complications, and improve long-term outcomes. This underscores the importance of interdisciplinary collaboration between dental and medical teams to ensure holistic patient care and early therapeutic intervention.
The Survival of Single piece basal implants in restoring critically impacted canine - Series of case reports
The prevalence of impacted teeth is a very frequent finding with maxillary canines being the second most common, next to third molars. These teeth pose greater aesthetic deficiencies and are addressed through a variety of treatment modalities. Patients with critically impacted canines, that are not amenable for orthodontic traction are usually opted for extraction. Restoring these teeth with a single piece basal implant aids in immediate loading, and a permanent solution, without using bone grafts. This case series of three patients reports the successful restoration of maxillary canines, after surgically extracting them.
Copyright (c) 2025 Indian Journal of Clinical Research in Dentistry
Assessment of barriers & attitude of pediatric dentist towards the use of inhalation sedation in clinical practice: a mixed method study
Background and aim: Behaviour management is the corner stone of pediatric dentistry. Inhalation Sedation (IS) technique is safe & effective adjuvant in reducing anxiety, and producing analgesia. To assess the attitude of pediatric dentist towards the usage of Inhalation sedation and also to investigate the barriers and obstacles faced by them during usage of IS in their routine clinical practice. Materials and methods: Mixed method study design conducted among 200 pediatric dentist in a metro city. A 18 point questionnaire with 12 closed question & 6 open ended questions was administered to200 pediatric dentist. Quantitative data was presented as percentage, frequency and qualitative data was thematically analysed. Results: Use of IS in pediatric dentistry was beneficial as an effective Behavior Management Technique (BMT). Regarding the safety in the usage of IS in dental setup, 90.9 % respondents agreed that IS is safe enough to be used in clinical setup. Parental acceptance of using IS for their child is a variable strata and has individual perceptions attached to it. Qualitative data was thematically analysed and after an in depth interview with different respondents various themes were generated. Conclusion: Significant gap in the knowledge and practice of inhalation sedation among the study population was found. Through qualitative analysis, major barriers in utilisation of IS was identified.
SOFT TISSUE AUGMENTATION (SUB-EPITHELIAL CONNECTIVE TISSUE GRAFT) AROUND PERI-IMPLANT RECESSION – A CASE REPORT
ABSTRACT Background Peri-implant soft tissue recession poses a significant challenge in dental implantology, impacting both the aesthetic and functional outcomes of implant-supported restorations. This case report details the management of peri-implant recession through soft tissue augmentation, highlighting the procedural approach and outcomes. Case Presentation A 23-year-old female patient presented with peri-implant soft tissue recession around a maxillary implant. Clinical and radiographic assessments indicated insufficient soft tissue volume and improper implant positioning as contributing factors. A connective tissue graft (CTG) was selected to augment the peri-implant mucosa. Results Post-operative follow-up at six months demonstrated significant improvement in the peri-implant soft tissue volume and reduction in recession. The augmented tissue remained stable, and the patient reported high satisfaction with the aesthetic and functional outcomes. No complications were observed, and regular follow-ups ensured continued peri-implant health. Conclusion This case report underscores the effectiveness of connective tissue grafting in managing peri-implant soft tissue recession. Comprehensive assessment, meticulous surgical technique, and diligent post-operative care were critical to the successful outcome. The findings suggest that soft tissue augmentation is a viable solution for enhancing peri-implant aesthetics and function, warranting further research to establish standardized protocols for broader clinical application. Keywords Peri-implant recession, soft tissue augmentation, connective tissue graft, dental implants, aesthetic outcomes.
KNOWLEDGE ON TILT CONCEPT IN IMPLANTOLOGY AMONG DENTISTS OF MAHARASHTRA STATE
Background: Dental implants are widely used for replacing missing teeth. The placement of standard-length dental implants in axial position requires adequate amount of bone to be present. In certain conditions when remaining bone volume is less or the proximity of vital structures (inferior alveolar nerve, mental nerve, and the maxillary sinus) is there, advanced surgical procedures are required to allow the placement of standard-length implants .Such procedures are usually associated with increased morbidity, higher cost, and longer treatment duration. Aim: The aim of the study is to know about the knowledge of the TILT concept in implant among the dentists in Maharashtra Methods: A cross-sectional questionnaire study was conducted among the dentist of Maharashtra. The sample size of 200 dentists. A close-ended questionnaire was used to assess the practitioner’s perspective on tilted implants. Survey software was used to reduce sampling bias. Repeated answers or questioning were avoided. Chi-square tests were applied to find the association between the parameters and the level of significance. Results: Out of 200 practitioners, only 45% of the practitioners had knowledge about the TILT concept in implant and the other 55% were not aware. And only 32.5% of the practitioners were aware of the indications for tilted implants whereas 67.5% of them responded that they don’t know under what conditions tilted implants are used Conclusions: Within the limitation of the study, we can conclude that dental practitioners in the Maharashtra population were not much aware of the tilted implants and their uses and advantages over other techniques.
Tilted implants, Tilt concept , All on 4, All on 6, Dentists of Maharashtra
Copyright (c) 2024 Indian Journal of Clinical Research in Dentistry
Endodontic Management of Maxillary First Molar with Two Palatal canals
An awareness and understanding of the presence of unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. Aberrations in root canal anatomy are commonly occurring phenomena. We report a clinical case of a maxillary left first molar with two palatal root canals. The morphology is atypical because it is characterized by two palatal canals having separated orifices and canals running parallel to each other but joined at the apex. Modifications to the normal access opening and examination of the pulpal floor for additional canals are stressed in such type of cases.
Maxillary first molar, two palatal canals, root canal morphology
A Paradigm of esthetic post and core in primary dentition
Background - Early childhood caries or trauma to anterior primary teeth leads to improper functioning, speech difficulties and poor esthetics. A complete treatment of primary anteriors requires pulpectomy and restoration. To conserve functional and esthetic harmony such patients require post and core systems. This article describes about different posts which can be used in primary dentition which helps in coronal restoration by providing adequate retention. Types of studies reviewed – This review article includes a literature search of different articles from various journals about early childhood caries, post and core system, primary teeth restoration. Search includes the case reports, literature reviews, systemic review which used post and core management of primary anterior teeth. In the search, there were no filters activated and no language restrictions. Included references assessed the use of post and cores used in pediatric dentistry (12 in vivo, 6 reviews, 3 in vitro studies), and the articles were reviewed by two reviewers (both part of the authorship team). Results – Management of early childhood caries and trauma in primary anterior teeth in which crown structure had been lost can be restored by different post and core to conserve functional, biological and esthetic harmony of teeth. Practical Implications – Preformed posts and customized posts, both can be used in restoring the crown structure of primary anteriors for preservation of esthetics and function. Glass fibre, ribbond posts and glass fibre reinforced posts add more esthetic value than metal posts. Key words – post and core, esthetics, pulpectomy, restoration
Copyright (c) 2023 Indian Journal of Clinical Research in Dentistry
Impact of audio-visual 3D animation on students’ depth of knowledge of surgical anatomy of maxillofacial spaces.
Background and Objectives: The study aims to augment conventional teaching of maxillofacial spaces by developing audio-visual animation videos and evaluate its advantages in terms of student satisfaction and depth of knowledge attained by final year dental students. Method: Nine videos on maxillofacial spaces were designed using the Mimics-in-Suite Software. The final year batch of dental students (n=42) were divided in two groups: Group 1 (n=21) and Group 2 (n=21). Group 1 served as the control group, solely receiving instruction through chalkboard and PowerPoint presentation, and the Group 2 served as the experiment group, where the conventional teaching was reinforced with the animation videos. The depth of knowledge gained by both the groups was recorded through a 30 marks multiple choice questionnaire and compared. Group 2 students' satisfaction with the animation module was also noted. Results: Group 2 students outperformed Group 1 students in the depth of knowledge assessment in all levels except for the Level 1. Significantly high scores were achieved in Level 4 questions and the grand total score. Students positively perceived the animation module. They were satisfied with the animation's quality, content, relevancy, utility, and the knowledge obtained. Conclusion: Altogether, the results illustrate that animation was useful to simplify the anatomy of maxillofacial spaces as it deepens their understanding of the material and was intercepted satisfactorily by the students.
Artificial Intelligence In Restorative Dentistry And Endodontics- A Short Review
Artificial intelligence is a branch of computer science that was described by John McCarthy in the year 1956. It has the potential to replicate human intelligence and has been described as the fourth industrial revolution. In health care two types of artificial intelligence methods are used, namely virtual and physical. Different methods have been employed to train the artificial intelligence system. In restorative dentistry they have been used for the detection of dental caries, vertical root fracture, predict restoration failures, locate preparation margins etc. In endodontics they have proved to be helpful in detection of periapical lesion, crown and root fracture, working length determination and also throw light on retreatment predictions and the viability of stem cells etc.So this article provides an overview of the role of artificial intelligence in restorative dentistry and endodontics and its scope for the future.
Novel Remineralizing agents in tooth repair
A new area of dentistry is represented by remineralizing agents. The aim of modern dentistry is to manage non-cavitated caries lesions non-invasively through remineralization in an attempt to prevent disease progression and improve aesthetics, strength, and functionThey can be categorised as fluoride agents, agents made of calcium and phosphate, agents made of herbs, or agents in mixtures. Remineralizing agents can be administered orally by dentifrices, mouthwashes, lozenges, or chewing gum. Fluoride use has been effective in preventing dental caries, but more innovative strategies and exciting new caries prevention products need to be developed and tested. This article provides an overview of various newer reminerlizing agents their role and mechanism of action on tooth. Keywords: caries , remineralizing agents, fluoride, dentistry
Copyright (c) 2022 Indian Journal of Clinical Research in Dentistry
Evaluation of digital text book vs. print text book learning perceptions among dental students during covid-19. A questionnaire study.
Aim: Evaluation of digital text books vs. print text book learning perception levels among the students of Vishnu dental college during COVID 19. A questionnaire study. Objectives: To evaluate the perception levels of E-Book and Text Book learning among students of Vishnu dental college. To assess the mental attitudes of students in E-Book and Text Book learning Key words: E-books, text-books, perception levels, efficacy, dental students, students. Introduction: Textbooks have been a guide since education had stepped into this world. Even if we turn our pages back to ancient-times we come across inscriptions made on leaves, rocks, sculptures, and many more, from there the ideology of writing got started which led to printed books. In the mid-1970s ever since the age of digitalization has started the evolution of textbooks took place which gave birth to e-books. E-learning has transformed into various forms such as tablets, I-pads, kindle and became a fast-growing technology in no time. Considering various factors like cost, accessibility, maintenance, and eco-friendly there was a gradual decline in conventional reading which led to the downfall of many book stores that made them shut their doors and get exhausted. But ultimately it is not only the devices or the technology that evolved, either people have too. So, in this lockdown, many students got introduced to e-reading for their preparation to get done. Taking this as an opportunity our present study is an attempt to find out which type of learning has the better efficiency and intellectuality over the other. Materials and Methodology: A questionnaire study was done on the 1st bds students who have recently completed their university examinations irrespective of gender and age. All the study participants voluntarily completed the questionnaire consisting of 10 questions which was validated by the institutional ethics committee of Vishnu dental college with ref no IEVDC/2021/UGD1/OP/Q/65. The students other than 1st bds were excluded from this study. This questionnaire was based on various aspects related to both text book and e book. test-retest reliability was conducted and the Cronbach’s alpha (?) value was found to be 0.83. for every response the options were ranging from strongly agree to strongly disagree. Data was collected via google forms and statistical analysis for knowledge, awareness were computed and results obtained. Data management was performed by using simple bar and pie charrs with percentage (%). QUESTIONNAIRE: Textbook reading improvises your memory when compared to e books eBooks reading cause s shifting of focus when compared to textbooks (notifications, calls, messages) Increased screen time in reading e books may lead to adverse health effects (eye defects, headache etc.) E-reading helps in quick revision of the content Preparation with e-books consumes more time Content sharing is easy by e-books than text books Textbooks are more economical than e-books (one device many books) E-books have augmented reality experience when compared to textbooks (animated and graphic contents) Textbooks are easily available than e-books What are your opinions/views about the choice of reading in future? Results: 1st Bds students who recently appeared for their university examinations were provided a validated questionnaire and their responses were assessed and displayed in a bar graph: 75% students say that they absorb more information when they read Text Books when compared to E- books. 78% students infer that they get distracted while they use E-Books. 62% students strongly agree that screen time may be health hazardous (headache and eye strain) when compared to Text Book reading. 75% students agree that E-books help in quick revision than the Text Books. Interestingly here the availability of either E-Books or Text Books was equally voted which indicates the advancement of digitalization. 88% of the students prefer E-Books rather than Text Books as their content sharing is fast and easier. Discussion: This comparison of student preferences and use of e books had shown up many important findings. there were no age and gender factors involving in the study [3]. It was also interesting regarding the availability of the E and TEXT books which were equally voted that indicated a greater amount of digitalization going round the world.in regard of the comments given by the study participants previous use of e books doesn’t increase the preference for it.[1] the students were in search of the means through which they could achieve their best output. By grouping all the elements given in the questionnaire it is able to find out that there was no actual difference between e books and text books. perhaps the reason for the low percentage is because of the different ways of getting adapted to either of the means according to their compatibility. Apart from these, the advantages and disadvantages of either the segments were also included in this study. Text books help to increase our memory, they get less distracted, and they’re easy on eyes, No need of current and batteries and it’s great for notes taking. But, on the other side of the coin they’re a bit non ecofriendly, can’t be carried everywhere and their maintenance is a tedious process.[4] E-books are like one device many books, they’re easily accessible, they act as a quick guide, they’re eco-friendly and maintained freely. On the other hand, they’re distracting, health hazardous, can’t be afforded by everyone and require electricity and batteries. Conclusion: In this fast-growing world, the technology is drifting us towards its digitalization but, it doesn’t mean to leave our roots. Obviously, it depends from person’s interest; ultimately the one who makes up the best choice will get the best output. A person should always have a caution in his mind whether the technology codes our mind or we code the technology. We should also give some concern to divide the attention between a pixel and ink. Finally, when it comes to intensively reading long pieces of plain text, paper and ink may still have the advantage. But text is not the only way to read. So, in this study many of the participants were abruptly sent home because of the pandemic and lockdown. This led to the shortage of text books which made them to get adapted to e learning. Considering both their experiences 78% of the students voted for text books and 28% voted for e books. References: Geethika B, Karpagam K. Comparing the choice of Ebooks Vs Textbooks among dental students-A Questionnaire based study. Research Journal of Pharmacy and Technology. 2016 Aug 1;9(8):1077. Zhang Y, Kudva S. E?books versus print books: Readers' choices and preferences across contexts. Journal of the Association for Information Science and Technology. 2014 Aug;65(8):1695-706. Woody WD, Daniel DB, Baker CA. E-books or textbooks: Students prefer textbooks. Computers & education. 2010 Nov 1;55(3):945-8. Engbrecht JR. Digital textbooks versus print textbooks. Jabr F. The reading brain in the digital age: The science of paper versus screens. Scientific American. 2013 Apr 11;11(5).
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Clinical assessment of NTI-tss appliance for TMD’S associated with headache
Temporomandibular joint (TMJ) disorder and bruxism may cause individuals to experience extreme pain in the region of jaw and head. The associated musculature and the joint are placed at a STRAINED position which manifests as unbearable pain. This pain may radiate to face, neck and some may even develop migraine, all of which can have painful and a debilitating effect on an individual. This paper describes the case where a patient who was suffering from TMJ pain from 8 years using multiple occlusal splints over the course of years but showed no signs of relief thus, impairing the quality of life. TMD's constitute a group of disease with overlapping similar sign and symptoms. In this case, the patient was diagnosed and treated with the NTI-tSS appliance, with a 6 month follow up showing almost complete resolution of the symptoms enhancing the quality of life.
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Evaluation of Knowledge and Awareness among dental students about emerging outbreak of COVID-19: A Cross-Sectional study
Background: The ongoing outbreak of Coronavirus disease 2019 (COVID-19), emerged in Wuhan, China, and caused disruption among the health care populace and the rest of the world. As COVID-19 is highly contagious in nature, the front-line health care workers are at a higher risk and dental health care workers are of no exception to this and they are also at high risk than other health care professionals as we expend a lot of time close to the patient's oral cavity and the aerosols generated from dental treatments and the fluids that we came into contact like saliva, blood, etc., increases the risk multifold. Hence our aim was to assess the awareness, knowledge of dental students towards COVID-19. Materials and methods: A total of 350 dental students participated in the study. A structured custom-made questionnaire composed of 16 questions was designed to assess the students level of awareness, knowledge, towards COVID 19. The questionnaire was distributed among 3rd 4th year, interns undergraduate and postgraduate students, and informed consent was obtained before commencing the questionnaire. Results: A total of 350 students participated in a questionnaire study. The majority of the study participants were females (74%) and majority of the students were aware of CoVID-19 (99%) and only 1% were unaware. 79% of students were aware that COVID 19 is highly transmissible and about 76% has knowledge about the incubation period of COVID 19 which is usually between 1-14 days. Inadequate knowledge and awareness make students vulnerable to infections. Adequate training is required to protect students and their patients. Conclusion: Our study concluded that the majority of dental students had knowledge and awareness and its detrimental effects on COVID 19. Few students had a lack of awareness and inadequate knowledge about the mode of transmission, cross-contamination with dental instruments, incubation period and laboratory investigations.
Oral Health Status of Hospitalized Children and Parental Perception about Oral Hygiene during Hospitalization: A Cross Sectional Study
Introduction : Oral health is considered as a gateway for general health. Compromised oral health possibly will have a sizeable bearing on the general health status and quality of life. Underlying medical condition in hospitalized children might prevent the care givers to pay attention towards oral health, which can sometimes lead to life-threatening complications. Hence this study was conducted to know status of oral health during hospitalization and perception of parents toward oral hygiene. Methods: An observational cross sectional study was conducted over a period of one month at in patient ward of dept of pediatrics. All the subjects were examined for oral health status and their parent’s knowledge attitude and practices were assessed through a validated questionnaire. Results: Caries prevalence was high. 42.6 % of children had 1 or more teeth decayed, filled or extracted. The mean dmft score was 3.58 ± 1.75 and DMFT score was 1.43 ± 2.51 overall. There was a significant decrease in the plaque score from the date of admission to date of discharge. Only 42.6% of the parents of hospitalized children were aware about the oral health status of their wards. Conclusions: It was found that the parents of hospitalized children were very much aware of importance of oral health. Hence, preventive strategies involving care givers/guardians, with timely reinforcements would help in reduction of caries experience and improvement in gingival/oral health of these individuals
Oral Health, Hospitalized Children, Caries status & Parental Perception
Prevalence of Hepatitis C virus infection in patients with oral lichen planus in Guntur, Andhrapradesh
Background: The association between oral lichen planus (OLP) and hepatitis C virus (HCV) infection is a matter of controversy. It is heavily influenced by geographical location. It is important to determine the association so that guidelines can be made for HCV testing in patients with OLP. Aims: This study was conducted to determine the possible association between oral lichen planus (OLP) and hepatitis C virus infection (HCV) in Guntur, Andhrapradesh population. Materials and Methods: Blood samples were taken from 50 OLP patients and 50 healthy controls to screen for HCV infection. Moreover, the clinical characteristics of OLP were also observed, such as gender, age, chief complaint, clinical type and the sites involved. Results: In the present study, 50 patients with OLP (30 females and 20 males) with mean age of 42.52 ± 13.04 years, and 50 healthy subjects (30 females and 20 males) with mean age of 40.42 ± 12.38 years were evaluated.HCV antibodies were detected in none of the subjects Conclusion: We could not detect any association between OLP and HCV. This may be due to lower occurrence of hepatitis C virus in comparison to hyper endemic countries for this virus or genotypic discrepancy of the virus or other factors contributing for these patients.
Oral lichen planus, hepatitis C Virus, chronic hepatitis , extra hepatic, liver disease, geographic
Evaluation Of Efficacy Of Arginine Calcium Carbonate Versus Potassium Nitrate Paste In The Treatment Of Dentinal Hypersensitivity
Background and Aim: Dentin hypersensitivity (DH) is a common oral health problem affecting one or more teeth of many adult individuals globally. It is characterized by a sharp pain which arises from exposed dentin in response to an external stimulus, and cannot be explained by any other form of dental pathology. Several agents and treatment modalities have been used in the treatment of this condition. The present study was conducted to compare the efficacy of arginine calcium carbonate paste (Test group) versus potassium nitrate (Control group) in the treatment of dentinal hypersensitivity. Subjects and Methods: A total of 66 cases were randomly divided into two groups based on the toothpaste given: Test group - toothpaste containing 8% arginine and calcium carbonate, Control group - toothpaste containing 5% potassium nitrate. The patients’ DH scores for tactile stimuli was recorded on a visual analog scale and airblast stimuli was recorded on a Schiff Cold Air Sensitivity scale at baseline, immediately post scaling after application of desensitizing paste, 1 month after commencing the use of desensitizing paste, and 1 month following cessation of its use . Statistical Analysis: The data was analyzed using Independent t test (P < 0.05). Results: Both the toothpastes were effective in relieving dentinal hypersensitivity. However, toothpaste containing 8% arginine and calcium carbonate showed a better clinical response at the end of 2 months evaluation. Conclusions: The desensitizing paste containing 8% arginine and calcium carbonate showed instant and long lasting reduction in the symptoms of DH.
Dentin Hypersensitivity, Potassium Nitrate, arginine and calcium carbonate, Proargin Technology.
Ameloblastoma ex COC: An enigma to clinicians and Pathologists
Calcifying odontogenic cyst (COC), though known for more than five decades, is always under constant ambiguity with respect to its nomenclature and classification with extreme diversity in its biologic behavior. It represents a heterogeneous group of lesions that are to be regarded as non-neoplastic, cystic, or solid masses and more frequently found in association with hamartomatous such as odontomas, Adenomatoid odontogenic cyst and other odontogenic tumors such as odontogenic fibroma and Ameloblastoma. Owing to the fewer incidences, uncertain descriptions of the COCs, specific clinical data in the literature is sparse.
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Street dentistry(quack dentistry)-a serious concern
Quackery/street dentistry in dental profession has been an issue for quite a long time. It emerges when there are defi- cient quantities of capable and prepared specialists or when their charges seem restrictive to a portion of the popula- tion. Inadequately instructed individuals frequently become prey to quacks who perform dental treatment, which is destructive to patients and the quality of life is compromised. The time has come to take measures to stop such ex- ploitative practices. Keywords: Quackery, street dentistry, Quacks, complete denture.
Ectodermal Dysplasia-a Case series of two cases
Ectodermal dysplasia is a large hereditary group of disorders which is usually manifested as X-linked recessive Hypohidrotic Ectodermal Dysplasia (HED) and has a full expression in males, whereas females show little to no signs of the disorder. It is a genetic disorder affecting the development or function of the teeth, hair, nails and sweat glands. The two most common types of Ectodermal Dysplasias are the X-linked recessive Hypohidrotic Ectodermal Dysplasia (Christ-Siemens-Touraine syndrome), and Hidrotic Ectodermal Dysplasia (Clouston syndrome). Hypohidrotic ectodermal dysplasia is characterized by hypodontia, hypotrichosis and hypohydrosis. Here in, we report case series of this rare entity of ectodermal dysplasia in a 15year old female and 42 years old male showing characteristic features of hypodontia,hypohidrosis, hypotrichosis.
The Treatment of intrabony defect using silk fibroin as GTR and xenograft – a case report
Background : The most common challenge faced by the clinicians is the management of periodontal disease. Although various treatment strategies have been tried, the use of bone grafts along with a barrier membrane has been the gold standard in intrabony defects. In vivo animal studies and a few in vitro studies have revealed the importance of silk fibroin in bone tissue engineering and has also shown its potential as a scaffold for periodontal ligament cells. The main objective of the case report was to assess the clinical and radiological outcomes of silk fibroin membrane with a xenograft in the treatment of intrabony defects. A male patient reported to the department of Periodontology with the complaint of food lodgement in the lower right back tooth region. Examination revealed a pocket of 5mm. Phase I therapy was followed by open flap debridement. An intrabony defect along with grade II furcation was detected. This was followed by the use of xenograft and silk fibroin membrane. Improvements were noted clinically and bone fill was assessed radiographically and further analysed using AUTOCAD 2017 software at the end of 12 months. Conclusion: The case report has proved the efficacy of silk fibroin with xenograft in treating grade II furcation defects . These results have encouraged the use of silk fibroin in tissue engineering in the field of Periodontology.
Analysis of genetic damage in individuals exposed to Chronic Mechanical Irritation (CMI) in the lateral boarder of the tongue due to Cusp of Carabelli (CoC) – A Cytogenetic study.
Background: Chronic in?ammation is estimated to contribute to approximately 25% of human cancers. In?ammation that is induced by chronic mechanical irritation (CMI) along with carcinogens has a higher chance of leading to oral pre-cancer and oral cancer. Though many studies have been conducted to identify the genetic damage in oral cancer or dysplastic stages, there is no study conducted to find the early detection of genetic damage in healthy individuals associated with CMI. Cusp of Carabelli (CoC) is a small additional cusp at the mesiopalatal line angle of maxillary first molars which can cause chronic irritation to the lateral border of the tongue. Objective: The study is aimed to analyze genetic damage (micronuclei and nuclear buds) in healthy individuals associated with CoC over the lateral border of the tongue causing CMI. Materials and methods: The study comprised of 75 clinically healthy individuals with unilateral/bilateral presence of CoC causing irritation over the lateral border of the tongue as study group. Brush samples of lesional epithelial cells were collected, then spread over clean glass slide and fixed in 100% alcohol, stained with rapid PAP and analyzed under the light microscope. The exfoliated cells were examined to detect the presence of micronuclei (MN). Results: Incidence of MN was found to be more in CoC associated lateral border of the tongue of healthy individuals without habits. Conclusions: Cytogenetic analysis is a simple and scantly invasive technique allowing clinicians in early detection of DNA damage in patients with CoC and preventing the carcinogenesis by proper treatment and follow-up.