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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 8 | Issue 3
Page Nos. 143-232

Online since Tuesday, August 24, 2021

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ORIGINAL ARTICLES  

Evaluation of maxillary anterior tooth proportion using the novel TR proportion Highly accessed article p. 143
Tarulatha R Shyagali, Ruchi Jha, Deepak Bhayya, Abhishek Gupta, Anil Tiwari, Rahul Patidar
DOI:10.4103/jdrr.jdrr_6_21  
Aim: The aim is to evaluate the maxillary anterior tooth proportion relationship using different calculations. Materials and Methods: Forty pleasing smile photographs were evaluated for the different calculations. Mesiodistal width of all the maxillary anterior teeth were measured and were subjected to different calculations like individual tooth width divided by the combined width of all the anterior teeth of one side and individual tooth width divided by the combined width of the remaining two teeth of one side. Calculated results were tabulated and were subjected to descriptive statistics. Results: Among the various formulas, the mesiodistal width of canine divided by the sum of mesiodistal width of central, lateral incisors, and canine showed the consistent quotient of 0.3 for all the subjects. Mesiodistal width individual teeth like central incisors when divided by the combined width of central incisor, lateral incisor and canine, also showed the constant quotient of 0.3 for all the patients. The sum of Mesiodistal width of central and lateral incisor when divided by combined width of central, lateral incisor and canine gave the constant value of 0.6. Conclusion: The consistent quotients obtained by the formulas like width of central incisors and the canine divided by the combined width of central-lateral incisors-canine and the other formulas can be used for building up of the missing teeth and the smile designing.
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Dentist preparedness regarding novel coronavirus disease: An insight Highly accessed article p. 149
Aniket Gid, Roshani Thakur, Motilal Jangid, Vini Mehta, Shreya Bagwe, Ankita Mathur
DOI:10.4103/jdrr.jdrr_167_20  
Objective: This study aimed to assess the level of preparedness exhibited by Indian dentists regarding the novel coronavirus. Materials and Methods: The study included Indian dentists who worked in private clinics or hospitals, public healthcare centers, and government hospitals. The online questionnaire consisted of demographic details and questions on awareness of coronavirus disease 2019 (COVID-19) and the dentists' preparedness against it. Results: A total of 300 dentists participated in this study, with males in majority compared to females. The majority of the dentists were aware of the incubation period and symptoms of COVID-19. Ninety percent of dentists had received knowledge about COVID-19 from various health bodies. Most of the dentists were aware of the precautions to be taken in dental practice, and they enquired about the travel history of all the patients. Conclusion: There is a mounting need for protocols made by health bodies to reach every dentist to take the correct precautions.
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Effectiveness of online E-teaching among dental students during COVID-19: A study from North India p. 156
Avijit Avasthi, Prashansa Sharma, Avninder Kaur, Geeta Kalra
DOI:10.4103/jdrr.jdrr_11_21  
Objective: The purpose of the study was to evaluate the effectiveness of instructor in conducting online e-teaching during COVID-19 among dental students across North India. Materials and Methods: A questionnaire consisting of an online teaching effectiveness scale comprising 12 items was shared among dental students pursuing undergraduation from various dental colleges across North India. Virtual sampling was used for inclusion of students and students shared an online questionnaire among their peers via WhatsApp and e-mail. Anonymity of students' responses was maintained. Data obtained were subjected to statistical analysis by SPSS Version 21.0 Armonk, NY: IBM Corp. Descriptive statistics was generated in frequency and percentage. The mean scores were obtained and comparison of students response was done using one-way analysis of variance. Results: About 96.4% responded to the online questionnaire. Students from 3rd year and 4th year perceived online e-teaching more effective when compared to mean scores obtained from 2nd year students with a significant difference. Students rated high with significant differences in teacher's ability to clear their expectation (P < 0.01), explanation of teaching content with meaningful examples (P < 0.02), and teaching seamlessly with planned schedule (P < 0.00). Conclusion: Therefore, preplanning and thorough training could further accelerate the efficiency and effectiveness of online e teaching.
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Surgical difficulty assessment in patients undergoing impacted mandibular third molar extraction. A single center evaluation in Najran, Kingdom of Saudi Arabia p. 163
Ramat Oyebunmi Braimah, Dawood Ali-Alsuliman, Abdulrazaq Olanrewaju Taiwo, Adebayo Aremu Ibikunle, Reham Mohammed Hassan Makarami, Abdullah Saleh Al-walah, Saeed Turki Al-Sagoor
DOI:10.4103/jdrr.jdrr_37_21  
Introduction: The evaluation of surgical difficulty preoperatively is important during mandibular third molar (MTM) extraction. This study aimed to evaluate the difficulty index for the removal of impacted MTM using Pederson difficulty index (PDI), Parant Scale (PS), and total operation time (TOT). Materials and Methods: This was a prospective study of patients referred for the extraction of impacted MTM between April, 2019 and July, 2020. Estimated level of difficulty was done before a standardized surgery using the PDI and classified as: Minimally difficult (I), moderately difficult (II), and very difficult (III). Intraoperatively, it was classified as extraction requiring ostectomy only (II); extraction requiring ostectomy and coronal section (III); and complex extraction requiring coronal and root sectioning (IV) using the Modified PS. TOT was recorded by a resident with stopwatch. Results: A total of 502 patients (203 [40.4%] males and 299 [59.6%] females) with an M:F of 1:1.5. The age ranged from 17 to 69 years with a mean age ± standard deviation (SD) (31.6 ± 9.6) years. The majority of the patients were in the age group of 21–40 years. TOT ranged from 10 to 35 min with mean TOT ± SD (15.35 ± 7.02) min. The mean TOT according to PDI was 11.30 ± 2.22, 12.74 ± 4.14, and 26.44 ± 4.39 min in I, II, and III, respectively, while according to PS were 10.91 ± 0.9, 19.60 ± 4.5, 28.82 ± 3.5 min in II, III, and IV, respectively. The observed correlation coefficients® for PDI and PS were 0.716 and 0.870, respectively. Conclusion: Analysis of the surgical difficulty of impacted MTM extraction is essential for treatment planning and patient satisfaction. PS has been found to be significantly associated with TOT.
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Assessment of challenges faced by dental interns and their psychological health during the COVID-19 pandemic in South Indian State of Kerala p. 168
Thayyil Sivaraman Hrishi, Puliyulla Paramba Sanara, Rosamma Joseph Vadakkekuttical, TV Soumya Mohanan
DOI:10.4103/jdrr.jdrr_54_21  
Context: The dental universities were shut or partially operating amidst the lockdown imposed by the coronavirus disease 2019 (COVID-19) pandemic. Dental interns because of reduced opportunities for clinical training and recruitment for COVID-19 containment activities can be faced with many challenges. Aims: To assess the various challenges faced by the dental interns during the COVID-19 pandemic and to evaluate their psychological health. Materials and Methods: A cross-sectional study was conducted using an online questionnaire among dental interns of ten randomly selected dental colleges in Kerala. The questionnaire comprised of questions about demographic information, questions to assess various challenges the interns faced during the COVID-19 pandemic, and a Patient Health Questionnaire-4 tool to screen for anxiety and depression. Statistical Analysis Used: The data were analyzed using SPSS 21 software; descriptive statistics were used to describe the demographic characteristics and challenges faced by interns. The Chi-square test was used to analyze the association of psychological health with different parameters. Results: A total of 283 interns, 154 (54.4%) from private colleges and 129 (45.6%) from government colleges completed the questionnaire. About 86% of the interns opined that they did not receive the expected clinical training and 71.7% of interns were not confident to practice with the training they received. Almost 58% of the respondents were frontline workers in managing the pandemic with a majority of them being from government colleges. A high prevalence of psychological distress (73.1%), depression (36%), and anxiety (28%) was observed among interns. The lack of adequate training influenced the psychological health of interns significantly. Conclusions: The dental interns did not receive adequate clinical training during the pandemic; this had severely affected their confidence to practice and mental health. Measures should be implemented by institutions and governing bodies to address these problems immediately.
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Comparison of frictional resistance of different esthetic archwires in different esthetic brackets in dry and wet fields: An in vitro study p. 176
Jinsa Nakasseril Joseph, Pavithranand Ammayappan, Hanumanth Sankar, V Aniruddh Yashwant, Lidhiya Alexander
DOI:10.4103/jdrr.jdrr_50_21  
Introduction: The patient's desire toward achieving an esthetically pleasing face has not only increased the demand for orthodontic therapy but also necessitates the need for an esthetic appearance during the treatment period which led to the introduction of tooth-colored ceramic brackets and archwires. Materials and Methods: The experimental research was done using esthetic brackets (polycrystalline ceramic brackets with and without metal slot and monocrystalline brackets) and stainless steel archwires (uncoated, Teflon coated, epoxy coated, and rhodium coated) in both dry and wet fields. Two typhodont models were selected onto which the above-mentioned brackets were bonded and frictional resistance was evaluated using Instron machine for each of the archwire-bracket combinations in dry and wet fields. Results: The uncoated stainless steel (SS) wires showed less friction when compared to esthetic-coated SS wires. The frictional resistance was least for wet field when compared with dry field for all the groups and subgroups. It was also found that frictional resistance was minimum for Teflon-coated wires in polycrystalline ceramic bracket with metal slot (wet field) and maximum for rhodium-coated wires in monocrystalline brackets (dry field). Conclusion: Polytetrafluorethylene/Teflon-coated archwire and ceramic bracket with metal slot could be preferred as the esthetic archwire and bracket material of choice, respectively, due to their low frictional properties.
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A cross-sectional study on knowledge, attitude, and perception toward COVID-19 pandemic among dental students of India p. 182
Ichita Joshi, Mamta Kaushik, Akansha Rajawat, Harshvardhan S Jois, Neha Mehra
DOI:10.4103/jdrr.jdrr_43_21  
Context: The rapid spread of COVID-19 globally continues to be a threat for healthcare professionals. Dental students and practitioners remain at the risk of having this disease. Aim: The aim of this survey was to assess the knowledge, attitude, and perception of dental students across India toward COVID-19. Settings and Design: A survey with 51 questions to obtain knowledge, attitude, and perception of dental students toward COVID-19 was formulated, pretested via a pilot study and then validated. Subjects and Methods: The final questionnaire was circulated through a link to Google forms, making participation voluntary. Statistical Analysis Used: Statistical analysis was carried out using one-way analysis of variance (ANOVA) test and independent t-test. Results: A total of 610 undergraduate dental students (3rd year, 4th year and students undergoing internship) from various dental colleges across the country responded. On intergroup comparison using One-way ANOVA test, between knowledge, attitude, and perception of dental undergraduate students, attitude toward COVID-19 was found be of statistical significance with P = 0.008. Conclusion: Knowledge, awareness, and perception toward COVID-19 will help contain the spread of this infectious disease that can be caused during dental procedures. There lies a strong call to conduct educational programs on COVID-19 regarding the infection control practices for all healthcare professions, especially dental school students.
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Assessment of anchorage loss with conventional versus contemporary method of intraoral anchorage: A prospective clinical study p. 188
Oonit Nakra, Sanjeev Datana, BS Walia, Priyavrat Soni, Rajneesh Kumar Joshi
DOI:10.4103/jdrr.jdrr_55_21  
Background: Anchorage control is a major concern in the design of orthodontic treatment planning. Even the best known methods to reinforce the anchorage result in taxing of the anchor unit. Control of anchorage is primarily important in “critical anchorage” situations where no anchor loss is acceptable. Temporary anchorage devices (TADs) offer to solve one of our greatest dilemmas of “anchorage control” and have been compared in this study with conventional intraoral anchorage in situ. Materials and Methods: The study involved a total of 60 subjects; 26 males and 34 females with a mean age of 16.7 years having Angle's Class I malocclusion with severe crowding who were divided randomly into two groups; Group A - TADs and Group B - Nance palatal button (NPB) for anchorage preparation. Amount of anchor loss was determined at maxillary first molar using the pre- and post-treatment lateral cephalograms. Results: The mean range of difference between pre- and post-values of the maxillary molar position in Group A was 0.02–0.09 mm (P = 0.005) and in Group B was 1.18–1.26 mm (P = 0.0001). Hence, the anchorage loss during the initial phase of leveling and alignment was approximately 1.22 mm with the use of NPB and minimal when TADs were placed and engaged before leveling and alignment. Conclusion: Minimal mesial movement of the maxillary first molars was observed when TADs were placed and engaged before leveling and alignment, thus proving their efficacy in maximum anchorage situations.
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Assessment of attitude and awareness of oral health changes in females during menstrual cycle: A questionnaire-based survey p. 194
Swetha Kardalkar, Shruti B Kardalkar, Harsha Bhayya
DOI:10.4103/jdrr.jdrr_82_21  
Background: Menstrual cycle is one of the phases in a woman's life wherein there are multiple physiological changes in the body. Various phases of menstrual cycle show a different physiological behavioral pattern of the body as well as hormonal changes which can lead to multiple changes in the oral cavity. Aims: The aim of this study is to assess the attitude and awareness of oral health changes in females during menstrual cycle. Materials and Methods: The present study was conducted as a cross-sectional study among the general population of Karnataka, India. A self-administered semi-structured questionnaire consisting of 19 questions was used to assess the attitude and awareness of oral health changes in females during menstruation. Data were entered in Excel and analyzed using IBM SPSS statistics version 22. Results: In the present study, a total of 300 females participated comprising different age groups, of which maximum participants were in the age group of 18–24 years. 57.7% of population had a duration of 28–30 days' menstrual cycle. About 44.3% of participants had experienced an overall health change. 18.3% of participants experienced oral changes, of which 15% of participants had developed aphthous ulcers. 7.3% of participants experienced bleeding gums. 81.3% of participants believed that the use of antimicrobial mouthwash reduces bad breath and 55.7% believed that brushing twice can reduce swelling of gums. Conclusion: This study gives an inference that participants were though aware of menstruation and related complaints, but they were not aware of oral changes occurring during the cycle.
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CASE REPORTS Top

Laser ablation of blandin and nuhn mucocele: A rare case report p. 200
Henpu Kamki, Ritesh Kalaskar, Shruti Balasubramanian
DOI:10.4103/jdrr.jdrr_40_21  
Blandin and Nuhn glands are the mixed type of minor salivary glands located on the anterior ventral surface of the tongue. Mucoceles are rarely associated with Blandin and Nuhn gland. Out of 400 mucoceles reviewed by Harrison, only 9 arose on the tongue. Its differential diagnosis ranges from soft-tissue abscess to pyogenic granuloma, oral hemangioma, lymphangioma, lipoma, and squamous papilloma. This is a rare case report emphasizing the laser ablation of Blandin and Nuhn mucocele. The diagnosis of Blandin and Nuhn mucocele was made based on its anatomical site, size, flaccid nature, and frequent change in size characteristically increasing after consumption of food. Laser ablation was opted for the excision because it enables minimal bleeding, scarring, postoperative discomfort, and low recurrence compared to the conventional surgical excision. Histopathological examination revealed extravasation type of mucocele, suggesting that trauma may be the initiating factor.
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An unusual case of molar incisor hypomineralization with a rare combination of fusion, hypodontia, and ankyloglossia in 11-year-old male p. 203
Khooshbu Gayen, Supreet Shirolkar, Raju Biswas, Avik Narayan Chatterjee, Subir Sarkar
DOI:10.4103/jdrr.jdrr_91_21  
Molar-incisor hypomineralization (MIH) is a developmentally acquired dental defect that directly affects the enamel and dentin of one to four first molars, frequently associated with affected incisors. Due to alteration in matrix production, crystal arrangement and formation, enamel matrix secretion a compromised enamel structure may be seen. This condition can also be called a idiopathic enamel hypomineralization. In the article, we report a case of 11-year-old male presenting with typical features of MIH affecting all four permanent molars in combination with fusion of mandibular right permanent central and lateral incisor, hypodontia of mandibular left central incisor and ankyloglossia, and a possible management of the clinical condition.
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Apert's syndrome: A rare congenital disorder p. 208
Rajib Sikdar, Khooshbu Gayen, Supreet Shirolkar, Anisha Bag, Santanu Mukhopadhyay, Subir Sarkar
DOI:10.4103/jdrr.jdrr_90_21  
Apert's syndrome (acrocephalosyndactyly) is a developmental malformation characterized by craniosynostosis, syndactyly, and dysmorphic facial features. The purpose of this paper is to report a case of an 8-year-old child affected with Apert's syndrome with emphasis on the craniofacial and oral features. It demonstrates autosomal dominant inheritance and occurs due to point mutation of fibroblast growth factor receptor-2 gene in chromosome 10q25 and 10q26. The patient presented with brachydactyly, syndactyly, polydactyly, hypoplastic maxilla, and malalignment of teeth. The cases of Apert's syndrome can only be treated by multidisciplinary approach. Early diagnosis and proper counseling of families can help in better management.
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A rare malignant transformation in pleomorphic adenoma p. 213
Sunayana Misra, Priyadarshna Mudgal, Shivani Kundal, Arvind Ahuja, Nitin Agarwal, Nirajan Kansakar
DOI:10.4103/jdrr.jdrr_104_21  
Carcinoma ex pleomorphic adenoma (Ca ex PA) is a rare type of malignant salivary gland tumor. Myoepithelial carcinoma (MEC) as the malignant component in Ca ex PA is an even rarer occurrence. Preoperative pathological diagnosis of Ca ex PA often goes unnoticed in many cases as they may be clinically indolent and the malignant component may not be picked up on fine-needle aspiration cytology. However, features such as rapid growth, recurrent tumor, and pain point toward a malignant transformation. We present a case of a 40-year-old female who presented with a history of recurrent swelling over parotid region with cytological diagnosis of pleomorphic adenoma, which on excision was reported as Ca ex PA with MEC being the malignant constituent. Till date, few cases of MEC arising from PA have been reported. It presents as a diagnostic challenge to both clinicians and pathologists alike; prognosis is still not clear due to few number of cases and lack of follow-up in most of them.
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Managing a facial talon: A rare morphological variation on maxillary permanent central incisor p. 217
Supreet Shirolkar, Monalisa Das, Khooshbu Gayen, Santanu Mukhopadhayay, Subir Sarkar, Somen Roychowdhury
DOI:10.4103/jdrr.jdrr_115_21  
Talon cusp or Eagle's Talon is a developmental anomalous structure that is thought to arise due to evagination of the coronal surface of a tooth before the commencement of calcification. The facial form of talon cusp is a rare morphological variation occurred on the facial surface of incisors that are often associated with clinical problems such as poor esthetic, soft tissue irritation, and caries susceptibility. We report a case of facial talon cusp on permanent maxillary right central incisor in a 9-year-old girl who visited our department with esthetic concern. The patient was managed with a minimally invasive approach by selective grinding followed by the application of fluoride varnish at a regular interval. Direct resin-based composite restoration performed to achieve esthetic rehabilitation, demonstrated satisfactory clinical and radiographic treatment outcomes.
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REVIEW ARTICLES Top

Treatment of anterior mandibular fractures by lag screw - A systematic review p. 221
A F. M Shakilur Rahman, Ismat Ara Haider
DOI:10.4103/jdrr.jdrr_26_21  
Different techniques that meet the basic principles of open reduction and internal fixation with either plates and screws or lag screws may treat anterior mandibular fractures (AMFs).This review article aims at assessing the effectiveness of lag screw fixation in the treatment of AMFs. Using the following electronic databases, a systematic electronic search was carried out: PubMed, Elsevier, Google Scholar, and Wolters Kluwer. The following search words were used in single or in combination: AMFs, fixation, and lag screw. Any randomized or quasi-randomized controlled trials, controlled clinical trials, or retrospective studies regarding the lag screw fixation in the management of AMFs were included. Studies of more than 10 years were not included in this study. This study was reviewed in compliance with the PRISMA guidelines. A total of 13 articles were included in the qualitative synthesis of this review. The majority of the studies were comparative studies between the lag screw and the mini plate. In lag screw groups, the duration of surgery, postoperative radiographic distance, and biting ability reported better outcomes than in miniplate groups. A sensitive, simplistic, accurate, and relatively inexpensive approach to internal fixation for AMFs is the lag screw fixation. The Lag screw provides an effective and rapid rigid internal fixation in the treatment of AMFs. Although it is a technique-sensitive procedure for fixation of AMFs, it permits the skilled surgeon to achieve the most favorable stability and functional rehabilitation with the minimum amount of materials.
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Changing trends and clinical recommendations of denture adhesive in complete denture: A review p. 228
E Nagaraj, Rony Tomy Kondody, Aravind Kalambettu, Dileep Nag Vinnakota, Jangala Hari
DOI:10.4103/jdrr.jdrr_97_21  
Over the past decade, the specialty of prosthodontics has witnessed a great deal of advancement in its treatment mechanics to improve the quality of complete dentures. Along with proper fabrication, various approaches such as retention by overdentures and the use of implants were widely used. Along with these, many patients use adhesive materials to increase the perceived sense of satisfaction. Whereas for patient well-being, long-term use of adhesives materials is not advocated or recommended in clinical practice. This review discusses various features, trends, and the need for clinical consideration for the application of denture adhesives in prosthodontic practice.
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