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   Table of Contents - Current issue
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April-June 2022
Volume 9 | Issue 2
Page Nos. 85-193

Online since Monday, August 22, 2022

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REVIEW ARTICLES  

A comprehensive review of extraoral maxillofacial material: Part I Highly accessed article p. 85
Darshana Choubisa
DOI:10.4103/jdrr.jdrr_13_22  
Recently, the use of extraoral maxillofacial materials for prosthetic rehabilitation of lost facial structures due to trauma, surgical resection, acquired infection, congenital abnormalities, and burns has heightened dramatically. Extraoral maxillofacial materials have contributed sufficient resolutions in conditions where thorough surgical techniques leave sizable facial defects that jeopardize function and esthetics or situation where surgical reconstruction is contraindicated. At the moment, no ideal extraoral maxillofacial materials have been developed that can mimic human skin. Each material has its own advantages and disadvantages. This article is a comprehensive review done in an attempt to present an overview of the extraoral maxillofacial materials used in the maxillofacial prosthodontics. A computerized exploration was conducted to extract articles using keywords facial defects, extra oral maxillofacial material, maxillofacial rehabilitation, prostheses from PubMed, Scopus, Web of Science and Google Scholar. This article has been divided into four parts. Part I dealt with historical background; Part II dealt with review of some early extraoral maxillofacial materials; part III dealt with majorly with silicone elastomers as an extraoral maxillofacial material; and part IV dealt with recent advances.
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Matrix Metalloproteinase-8 Levels in Peri-Implant Sulcular Fluid in Peri-Implantitis Patients as a Point-of-Care Biomarker: A Systematic Review p. 95
Shukra Paralkar, Amit Benjamin, Pooja Naik
DOI:10.4103/jdrr.jdrr_10_22  
Levels of matrix metalloproteinase-8 (MMP-8) in peri-implant sulcular fluid (PISF) increase to pathologically elevated levels in peri-implant diseases as a result of the destruction of peri-implant tissues. Active (a) and not latent (l) MMP-8 is shown to be truly representative of the disease progression. The objective of the study was therefore to evaluate if aMMP-8 levels in PISF predict the severity of peri-implant diseases in peri-implantitis patients and serve as a possible biomarker. A systematic review of the literature was performed using the PubMed/Medline and EBSCOhost databases. Studies concerning the use of aMMP-8 in the diagnosis of peri-implant disease that evaluated its effectiveness as a biomarker for peri-implant diseases were selected. The search strategy provided a total of 687 studies; only seven studies met the eligibility criteria and were included in the present systematic review. The studies demonstrated significantly higher concentrations of aMMP-8 in PISF of peri-implantitis patients than in healthy controls. aMMP-8 was shown to be a more sensitive biomarker with a questionable correlation to gingival index in assessing peri-implant disease activity and progression. These findings imply the potential adjunctive use of aMMP-8 in the diagnosis of peri-implant disease either alone or along with other pro-inflammatory biomarkers.
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ORIGINAL ARTICLES Top

Evaluation of knowledge, awareness, and perception toward the application of teledentistry on managing early childhood caries during COVID-19 among dental professionals in Kolkata, West Bengal p. 104
Topi Nyodu, PN Nanmaran, Khooshbu Gayen, Subir Sarkar, Somen Roychowdhury
DOI:10.4103/jdrr.jdrr_169_21  
Background: Teledentistry concerns with the utilization of telecommunication technology to provide clinical information, dental consultation, and treatment planning while avoiding direct personal contact with the patients. Its application is already established within the disciplines of oral medicine, orthodontic consultations, and early detection of caries.[1] Objective: The present study aims to evaluate the relevancy of teledentistry on managing early childhood caries (ECC) during the COVID-19 pandemic among dentists residing in Kolkata, West Bengal. Materials and Methods: This descriptive cross-sectional study using a 22-item prestructured, closed-ended questionnaire was conducted among dental professionals in Kolkata, West Bengal, to evaluate their knowledge on their thought that whether teledentistry can be implemented in the effective management of ECC. Results: A total of 108 participants responded to the survey. Knowledge and awareness regarding teledentistry and its use toward managing ECC is found to be high among postgraduates followed by Post Graduate Trainees (PGTs). The majority of the participants think teledentistry can increase the availability of specialists to rural and undeserving communities, where ECC is more prevalent (88%) and 73% of dentists are willing to practice teledentistry to bridge the gap of lack of health-care facilities to rural and undeserving communities for their dental needs. Conclusion: The majority of the BDS graduates and dentists doing private practice surveyed have less knowledge about teledentistry and awareness of ECC is less among dentists doing private practice. Education about teledentistry and ECC should be considered so that dentists can provide better oral health care.
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Evaluation of the effects of distal malocclusion activators on the craniofacial complex p. 111
Zaur Novruzov, Maksut Behruzoglu, Hakan Gurcan Gurel
DOI:10.4103/jdrr.jdrr_196_21  
Introduction: Class II malocclusions are the most commonly seen, and therefore, the most commonly treated type of anomalies. Dental and skeletal factors are involved in the development of Class II malocclusions. The purpose of this study was to investigate whether or not there were any changes in the increased cranial base angle and cranial base dimensions, which have been reported to be among the morphological characteristics of Class II malocclusions, with functional orthopedic treatment and to evaluate effects of these changes on facial structures. Materials and Methods: The study was conducted on hand-wrist radiographs and lateral cephalometric radiographs of 50 patients taken at the beginning and at the end of treatment. The control group comprised 17 patients and the treatment group comprised 17 patients who were treated with a Class II division 1 activator and 16 patients who were treated with a combination of Class II division 1 activator and an Occipital Headgear (Hg). Results: Among the measurements for cranial base dimensions, only the increase in S-N in the treatment group was smaller than that in the control group. No significant differences were found among groups regarding the values of NSBa and NSAr angles, which are known to be cranial base angles. Conclusion: The increase in the S-N dimension being smaller in the treatment group brings about the idea that the activator treatment may influence maxillary development and consequently the nasomaxillary complex.
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Oral health awareness among undergraduate medical students and interns: A cross-sectional study p. 118
G Sree Vijayabala, Aruna Bholenath Patil, S Mohanavalli, VA Janaga rathinam, Himasagar Ellampalli
DOI:10.4103/jdrr.jdrr_179_21  
Introduction: Oral health is an integral component of general health. Many oral systemic diseases manifest orally, and general medical practitioners are the primary health-care providers in society, so understanding oral health and its significance is critical for medical students and practitioners. The present study was conducted to assess the oral health awareness among MBBS students and interns. Materials and Methods: After obtaining institutional ethical committee approval, the present cross-sectional study was conducted among 318 subjects who were second, third, and final year MBBS students and interns of ESIC medical college and PGIMSR. A validated, self-structured questionnaire comprising of 20 questions pertaining to oral health awareness were prepared using Google forms and was sent to the study participants tthrough WhatsApp and the findings were analysed using proper statistical methods. Results: In the present study, 19% of the study population had good oral health awareness, 49% and 32% had fair and poor oral health awareness, respectively. The final year students had a good oral health awareness compared to the other years of students and interns. Oral health awareness scores did not differ significantly between male and female study participants. Conclusion: The present study found a fair oral health awareness amongst the study population. Clinical Significance: A proper knowledge of oral health is very essential among the medical students as they would be approached by the general population for most of the primary health-care needs.
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Immunohistochemical Analysis of Unicystic Ameloblastoma and Dentigerous Cyst: A Comparative Study p. 126
Gargi S Sarode, Meena Kulkarni, Namrata Sengupta, Sachin Sarode, Musarrat Khatri
DOI:10.4103/jdrr.jdrr_63_22  
Background: Diagnosis of odontogenic cystic lesions is challenging because their lining epithelia, which are basically stratified squamous epithelia, resemble each other, especially when they become hyperplastic from an inflammatory reaction. The histological distinction between unicystic ameloblastomas (UAs) and certain non-neoplastic odontogenic cysts can be problematic. Thus, Notch 2 expression has been observed in this immunohistochemical study to discriminate reliably and objectively UA from dentigerous cysts (DCs) in routine practice. Literature search has shown that Notch 2 has not been studied in any of the odontogenic lesions to date, and this study is the first of its kind both nationally and internationally. Thus, the aim of this study is to determine whether Notch 2 can be used to discriminate reliably and objectively cystic jaw lesions in routine practice. Materials and Methods: A total of 26 paraffin-embedded tissues of 13 UA and 13 DC were included, and serial 3 or 4 μm sections were produced from paraffin blocks. One section from each tissue was stained with a routine stain, hematoxylin and eosin to re-evaluate the final histopathologic diagnosis and the other section was expended for immunohistochemistry. Results: The Notch 2 immunoexpression in UA and DC tissue sections demonstrated a mixed result. Four cases of DC showed strong expression, whereas two cases of UA strongly expressed Notch 2. Conclusion: Notch 2 can form a reliable marker in differentiating DC from unicystic ameloblastoma. Thus, the study proved the utility of Notch 2 in differentiating unicystic ameloblastoma from DC.
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Knowledge, Attitude, Practice, and Perception toward Maintenance of Oral Health among Pregnant Women in Eastern Nepal p. 131
Tarakant Bhagat, Ashish Shrestha, Santosh Kumari Agrawal, Pappu Rijal, Manish Aryal, Abanish Singh
DOI:10.4103/jdrr.jdrr_186_21  
Introduction: Oral health maintenance during pregnancy is an important public health issue worldwide. Research has shown that there is an association between gum disease and low birth weight, premature births as well as mothers with untreated dental caries will also pass on cariogenic bacteria to their children. The purpose of the present study was to determine the knowledge, attitude, practice, and perception toward the maintenance of oral health among pregnant women in Eastern Nepal. Methods: It was a descriptive, cross-sectional questionnaire survey of pregnant women. Ethical approval was obtained from the Institutional Ethical Review Committee and written informed consent was obtained from all participants. A convenience sample of 600 pregnant women was obtained. The data were analyzed using the SPSS software. Mean, standard deviation, and percentage were calculated. Results: Although 95% of the pregnant ladies said that oral health is very important or important, 45.4% had one or more dental problems including bleeding gums, tooth decay, loose teeth, and sensitivity. Only 43.8% had visited the dentist. Time, cost, and safety of treatment during pregnancy were the major constraints. Majority (>90%) of them brushed their teeth at least once daily using fluoridated toothpaste. Most of them were aware that they should go for dental checkup, preserve their natural teeth and that gum problems are more during pregnancy. Conclusions: Most of them had good knowledge regarding oral health care but they avoided dental care due to various constraints.
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Youtube as an Information Source for Practitioners on Direct Diastema Closure Procedures p. 136
Mehmet Buldur, Tugba Misilli
DOI:10.4103/jdrr.jdrr_189_21  
Background: The aim of the study was to analyze the content and quality of clinical diastema closure videos related to the direct resin composite restoration technique available on YouTubeTM. Materials and Methods: The videos were determined using the words “diastema closure,” “teeth gap fill,” and “teeth gap close” in the YouTube™ search section. 300 videos were reviewed, and 55 of them were included in the study. Demographics of videos, interaction index, and viewing rates were evaluated. The videos were analyzed in three parameters in terms of content score (CS), technical features (TF), and global quality scale (GQS). Results: The dentist accounts took the first place (51%) in the distribution of those who uploaded the videos. The mean values of the videos from the evaluation criteria were 8.3/15p for CS, 3.1/5p for TF, and 2.7/5p for GQS. There was a statistically significant positive correlation between the viewing rates, TF, and GQS values (P < 0.05). Conclusion: Operational videos of diastema closure with direct composite resin restoration treatments should be uploaded to YouTube™ after approval by experts. In addition, the TF of operational videos needs to be better. Students should be warned about videos which contain insufficient information.
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Pattern of tooth mortality in patients attending a tertiary dental care center: A descriptive study p. 143
A Syed Khaja Hussain, Divya Kallanchira Devaraj, Manoj Joseph Michael, Mohandoss Murugesan, Pravish Vishnudas
DOI:10.4103/jdrr.jdrr_44_22  
Background: Tooth loss is a cumulative index of oral health impairment and an integral part of the decayed, missing, and filled teeth index used to assess oral health status. In spite of the increased awareness of oral hygiene and preventive dental treatments, tooth extraction remains to be the most common procedure in the Indian population following a toothache. The study aims to assess certain demographic characteristics and patterns of tooth loss among patients who underwent extraction from the department of oral and maxillofacial surgery in a dental tertiary care center in Kerala, India. Materials and Methods: A retrospective cross-sectional survey was conducted during 2017–2021 time period in all the patients who underwent permanent teeth extraction from the oral and maxillofacial surgery department. Results: A total of 9673 patients underwent tooth extraction during the study period. Among them, 68.4% were adults (18–59 years) and 27.7% were senior adults (above 60 years). More than half of the patients underwent single-tooth extraction (55%), two (24%), and three in 10%. The most frequent tooth extraction was the first molar (30%), followed by the third molar (27%) and second molar (26%). Among children, the most common pattern of tooth extraction was first molars both in the maxilla and mandible (25%). In adolescent age groups, premolars were extracted frequently along with first molars. In adults and senior adults, the premolar and molar extractions were performed commonly. Conclusion: The mean tooth loss for the cohort was 1.7 ± 1.1 (range 1–12) indicative of good dental hygiene practice. The trends noticed in teeth extraction pattern provide baseline data about the access and availability of dental care in that region.
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Comparative evaluation of regenerative potential of infrabony periodontal defects by using xenograft in combination with 1% alendronate and 1% metformin gels p. 148
Jammula Surya Prasanna, Mannepalli Madhusudhan, Sandeep Nandakumar
DOI:10.4103/jdrr.jdrr_62_22  
Background: Deficiency of the alveolar bone is one of the trademarks of periodontitis. Thus, agents that have osteogenic potential play a meritorious role in disease prevention. There is evidence, that pharmacological agents such as Alendronate (ALN) and Metformin (MF) have such potential in bone regeneration. Objectives: The main aim of this study was to assess the competency of Xenograft (XG) alone and in combination with 1% ALN and 1% MF in the regeneration of periodontal bone defects. Materials and Methods: In this randomized interventional study, total of 36 infrabony defects were randomly assigned to three groups, each group comprised of 12 infrabony defects: Group I with 1% ALN gel + XG (test), II with 1% MF gel + XG (test) and III with only XG (active control). This was a split-mouth study. Clinical criteria such as pocket depth (PD), relative vertical clinical attachment level (RVCAL) were assessed. A radiographic parameter like linear bone growth (LBG) was measured with the help of a grid. The microbial count (MC) was estimated with the plaque sample. All the specifications were calculated before the beginning of the study and at 6 months. Statistical analysis was performed using the Chi-square and paired t-test. Results: The mean reduction of PD, gain in RVCAL, LBG and MC was statistically significant within the groups (P < 0.05) from baseline to 6 months. However, MC was insignificant in Group III (P = 0.294) within the group but was significant on the intergroup comparison. Conclusions: Overall, significant results were found in all three groups. Using XG alone as well as in combination with 1% ALN and 1% MF has given appreciable results.
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Comparative evaluation of 3% Ginkgo biloba gel with 1% chlorhexidine gel as an adjunct to ultrasonic scaling in the treatment of gingivitis p. 155
Malik Abdul Waheed, Rucha Pandya, Neema Shetty, Aditi Mathur, Ashish Bali, Pritish Chandra Pal
DOI:10.4103/jdrr.jdrr_28_22  
Objectives: The aim of this study was to compare and evaluate the efficacy of 3% Ginkgo biloba (Gb) gel with 1% chlorhexidine (CHX) gel as an adjunct to ultrasonic scaling (US) in patients having moderate-to-severe gingivitis. Materials and Methods: Forty subjects with moderate-to-severe gingivitis were selected and randomly divided into two groups: test (Gb) and control (CHX). The test subjects received 3% Gb gel along with US and the control subjects received 1% CHX along with US. Clinical parameters such as plaque index, gingival index, and papillary bleeding index were recorded at baseline (before US), 15th-day, and 30th-day posttreatment. Results: Both the groups presented significant reductions in the clinical parameters at 30th-day post-US when compared within the group. However, Gb gel group showed better results compared to CHX in intergroup comparison on 30th day. Conclusion: Gb gel shows similar results when compared to CHX as an adjunct to US in cases of gingivitis suggesting that it can be used as a herbal alternative to CHX.
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Impact wear stress distribution and total deformation on dental material under chewing cycles: 3D finite element analysis p. 159
Efe «etin Yilmaz
DOI:10.4103/jdrr.jdrr_35_22  
Background: The finite element solution estimates have been improving in recent years in biomedical applications. This method provides many advantages to researchers such as specimen force distribution, total deformation, and strain energy. The data obtained after the experimental methods can be examined for the finite element solutions. Aim: Thus, this study aims to a finite element study of total deformation and strain energy on dental material under chewing impact force simulation after experimental study; prediction of maximum and minimum stress distribution. Materials and Methods: In this study, impact wear stress distribution and total deformation analyses were performed on test samples with different geometries. A cylindrical specimen with a diameter of 12 mm and a square geometry specimen with a size of 8 mm was designed for chewing test procedures. The chewing force was applied to the samples over a while and the effect of this force on the wear surface of the sample was investigated through chewing test procedures. Results: In this study obtained data, the chewing force showed a more homogeneous distribution in the cylindrical sample than in the square sample. Conclusion: In addition, it was observed that the concentration of strength mechanism was present at the time of the maximum chewing force of the sample with square geometry.
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Analysis of youtube videos related to interproximal reduction p. 165
Esra «ifÁi ÷zkan, Sirin Hatipoglu
DOI:10.4103/jdrr.jdrr_60_22  
Objectives: The purpose of this research was to evaluate the quality and accuracy of the information provided by YouTube™ videos on interproximal reduction (IPR). Materials and Methods: A systematic exploration of YouTube™ videos about IPR was collected using the search word “IPR” from the Google Trends application. The first 200 videos were viewed and 131 videos were incorporated in the study. The video content was scored using 12-point score scale, which was used for the classification of low-, moderate-, and high-content video groups. The Kruskal–Wallis test, post hoc Bonferroni test, and multinomial logistic regression analysis were used. Spearman's correlation was used for statistical evaluations. Results: We graded videos as low (59.5%), moderate (37.4%), and high (3.1%) content. Health professionals uploaded most of the videos (52.7%). “Procedure” (87%) was the most mentioned topic, while “oral hygiene instructions” (1.5%) was the least mentioned. The moderate-content scores of “Procedure,” “Duration in minutes,” “Flow of information,” “Quality,” and “Precision” were found to be statistically higher than the low-content scores. The video information and quality index total scores were found to be significantly higher in the moderate-score than the low-score group (P < 0.05). Conclusions: The content of videos with IPR on YouTube™ is insufficient. It is important for the specialist who will perform the IPR procedure to be aware of the available information on the internet to direct their patients to access the correct information.
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CASE REPORTS Top

Comprehensive management of molar–incisor–hypomineralization by preventive, palliative, and restorative treatment modalities in a pediatric patient: A case report and literature review p. 173
Mohammad Kamran Khan
DOI:10.4103/jdrr.jdrr_9_22  
Molar–incisor–hypomineralization (MIH) is a developmental defect of enamel dental tissue caused by the disturbances in the maturation stage of amelogenesis. It usually affects the permanent first molars and incisors. In children, MIH condition clinically appears as the demarcated discolored hypomineralized defects of affected teeth, post-eruptive breakdown (PEB) of affected enamel, dentine exposure, hypersensitivity, increased susceptibility to dental caries and behavioral management challenges owing to dental anxiety/fear and dental esthetic concerns. This case report describes the comprehensive dental management of MIH in an 8-year-old male pediatric patient by conservative and noninvasive treatment approach with preventive, palliative, and restorative treatment modalities under nonpharmacological behavior management techniques.
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Occlusal metal onlays in complete dentures p. 180
Anoopa Nataraj, Rubina Tabassum, Asha M Rathod, Gaurang Mistry
DOI:10.4103/jdrr.jdrr_8_22  
Flabby tissues and enlarged maxillary tuberosities in completely edentulous patients arise as a consequence of combination syndrome which affects complete denture treatment planning. A completely edentulous 70-year-old male denture wearer is presented in this article with flabby tissues and enlarged maxillary tuberosities. Flabby tissues need to be recorded in an undisplaced state to avoid overcompression due to realeff effect. Wear of acrylic teeth and perforation of denture base in the posterior region of his existing denture denotes a lack of interocclusal space. This is due to downward displacement of maxillary tuberosities which affects the posterior interocclusal space and requires special consideration. This article describes the prosthodontic management of the presented challenges with regard to the impression technique used to record flabby tissue and the need to maintain the occlusal vertical dimension to prevent denture base wear using occlusal metal onlays.
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Pyogenic Granuloma in a Thalassemia Minor Patient: Consequence or Coincidence? p. 183
Nishat Sultan, Amina Sultan, Deepika Bablani Popli, Akanksha Juneja
DOI:10.4103/jdrr.jdrr_190_21  
Thalassemia is a blood disorder inherited as an autosomal single gene characterized by a reduced or absent amount of hemoglobin chains. It is considered to be the most common genetic disorder with defect in either alpha or beta chains which produce abnormal blood cells. The present report describes an inflammatory enlargement over gingiva in the region of an erupting maxillary right premolar in a 10-year-old male who had minor thalassemia. The case was surgically handled using LASER, being a conservative management option, especially in such patients. The histopathological examination confirmed it to be a pyogenic granuloma. The paper describes the management of such lesions using LASERS as minimally invasive surgical techniques. It also tries to establish a hypothesis of a possible pathogenic association between intraoral pyogenic granuloma and thalassemia.
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Prosthetic rehabilitation of an extraoral lateral midfacial defect with a silicone prosthesis p. 187
Amanpreet Kaur, Disha Sharma, Rupandeep Kaur Samra, Amit Sharma, Kanav Garg
DOI:10.4103/jdrr.jdrr_39_22  
Midface malignancies result in cosmetic alterations that can affect not only the patient's function and quality of life but also their mental health and social behavior. Maxillofacial prostheses are crucial in restoring damaged structure and function. This case report illustrates a simple and cost-effective prosthetic rehabilitation approach for a patient with an extraoral midfacial deformity where multiple surgical repair attempts to correct the deformity had failed. A heat temperature vulcanized silicone prosthetic, which was easy to produce, was used to rehabilitate the deformity. The patient was pleased with the esthetic results of prosthesis and it helped in restoring her confidence.
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SHORT COMMUNICATION Top

Active involvement in dental education and the way to meaningful knowledge: The viewpoint of a dental educator p. 191
Abubaker Qutieshat
DOI:10.4103/jdrr.jdrr_70_22  
While learning in clinical dental practice is a rich, complex phenomenon with the goal of producing a clinically capable dentist, dental education is based on the premise that students can develop into professionals. This short communication focuses on two of the main principles of learning: meaningful knowledge and active learning, as both are key precursors to other higher-level learning activities and have relatively straightforward and well-understood underpinning theories. This work also makes a number of assumptions to make clinical dental teaching more effective. The present work highlights that the underlying purpose of dental education goes beyond imparting knowledge, skills, and attitudes; it is also about developing a sense of identity. The dental curriculum must prepare students for the roles they will occupy in the future and guide them to become well-rounded clinicians as well as lifelong learners.
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