041761   BAJWA S S, SARNA R, BAWA C, MEHDIRATTA L (Anaesthesiology and Intensive Care Dep, Gian Sagar Medical Coll and Hospital, Banur, Patiala, Punjab, Email: sukhminder_ bajwa2001@yahoo.com) : Peri-operative and critical care concerns in coronavirus pandemic. Indian J Anaesth 2020, 64(4), 267-74.

World Health Organization (WHO) declared novel coronavirus outbreak a “pandemic” on March 11^th, 2020. India has already reached Stage 2 (local transmission) and the Indian Government, in collaboration with the Indian Council of Medical Research (ICMR), is taking all necessary steps to halt the community transmission(Stage 3). Anaesthesiologists and intensivists around the globe are making untiring efforts akin to soldiers at the final frontier during war. All efforts pertaining to adequate staffing, Personal Protective Equipment (PPE) and strict adherence to hand hygiene measures are being stressed upon to prevent in-hospital transmission. In this article, all outbreak response measures including triaging, preparation of isolation rooms, decontamination and disinfection protocols as well as fundamental principles of critical care and anaesthetic management in Covid-19 cases is being discussed. All the recommendations have been derived from the past experiences of SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) outbreak as well as upcoming guidelines from the international health fraternity and Indian Health Services.

2 tables, 32 ref

041760   MATHEW R R, RAJU K, NAIR B R, MARIAPPAN R (Neuroanaesthesia Dep, Christian Medical Coll, Vellore - 632 002, Tamil Nadu, Email: ramamani@cmcvellore.ac.in) : An observational case‑control study comparing the recovery profile in patients receiving additional dose of anticonvulsant vs. regular dose during supratentorial craniotomy. Indian J Anaesth 2020, 64(3), 222-9.

Anticonvulsants are used routinely for seizure prophylaxis in patients with supratentorial tumour who present with/without seizures. Excessive use of prophylactic anticonvulsant may delay the recovery from anaesthesia. We have studied the recovery profiles of patients who received an additional dose of anticonvulsant in comparison with those who received only the regular dose. In this prospective observational study, patients were anaesthetised using standard anaesthesia protocol. An additional dose of anticonvulsant was administered in one group, while the other group received only the regular dose. Time taken for extubation, eye opening, obeying commands and orientation were compared between the two groups. Haemodynamics, depth of anaesthesia, the plasma anticonvulsant levels and the incidence of seizures were compared between the two groups. A total of 36 patients were studied, of which 19 received regular dose and 17 received an additional dose. There was no significant difference in recovery time between the two groups. Subgroup analysis was performed for phenytoin and sodium valproate. There was a clinically significant delay in recovery in patients who received an additional phenytoin compared to those who received regular dose (time to obey commands >15 min and orientation time >1hour) but, it was not statistically significant. Administration of an additional dose of valproate did not prolong the recovery time. An additional dose of sodium valproate did not cause a delay in recovery both, clinically and statistically. However, the administration of an additional dose of phenytoin caused a clinically significant delay in recovery but was not statistically significant.

2 illus, 4 tables, 9 ref

041759   UDHAYACHANDHAR R, OTOKWALA J, KORULA P J, RYMBAI M, CHANDY T T, JOSEPH P (Critical Care Div, CMC Hospital, Vellore - 632 004, Tamil Nadu, Email: pritishkorula@gmail.com) : Perioperative factors impacting intensive care outcomes following Whipple procedure: A retrospective study. Indian J Anaesth 2020, 64(3), 216-21.

Whipple procedure is associated with perhaps the most perioperative morbidity and mortality amongst surgical procedures. Current data regarding their ICU profile and outcomes are lacking. Thus, in the present study, we aimed to determine perioperative factors affecting patient‑centred outcomes following the Whipple procedure. In a cohort of patients undergoing pylorus‑sparing pancreaticoduodenectomies, we strove to determine perioperative variables that may impact outcomes. Unfavourable outcomes (composite of mortality, prolonged ICU stay of more than 14 days or ICU readmission) of patients who underwent the procedure were recorded and logistic regressions analysis of significant variables conducted. Around 68 patients recruited over a 20‑month period which included 57 males (83.8 %); mean age was 53.4(±11.2) with mean acute physiology and chronic health evaluation (APACHE) II score12.5 (±6.1). Nineteen patients remained intubated at the end of procedures (27.9 %). Median ICU stay was 2 days (IQR 2–3). Unfavourable ICU outcomes were 14 in number (20.6 %) and 2 (2.9 %) hospital deaths occurred. Pulmonary complications occurred in 12 patients (17.7 %) and non‑pulmonary complications occurred in 41 patients (60.3 %). In a multiple logistic regression analysis, the APACHE score 1.34 (1.09–1.64) and pulmonary complications 17.3 (2.1–145) were variables that were identified as predictors of unfavourable outcomes. The APACHE II score may reliably predict adverse outcomes following Whipple procedure. Although non‑pulmonary complications are common, pulmonary complications in these patients adversely impact patient outcomes.

4 tables, 25 ref

041758   SINGLA K, BALA I, JAIN D, BHARTI N, SAMUJH R (Anaesthesia and Intensive Care Dep, Postgraduate Institute of Medical Education and Research, Chandigarh ? 160 012, Email: jaindivya77@rediffmail.com) : Parents’ perception and factors affecting compliance with preoperative fasting instructions in children undergoing day care surgery: A prospective observational study. Indian J Anaesth 2020, 64(3), 210-5.

Fasting guidelines have been recommended in the paediatric population to minimise the risk of pulmonary aspiration. The present study was planned to assess the compliance with fasting instructions in children undergoing ambulatory surgery and identify the factors affecting it. A total of 1,050 ASA I and II children aged 1–12 years, scheduled for day care surgery were enrolled. Parents of these children were given a questionnaire with specific questions like fasting instructions, source of instructions, actual fasting times and reasons for not following instructions. Only 90 (8.5 %) parents followed fasting instructions as advised. Of the 960 non‑compliant patients, 31 (2.9) inadequately fasted while 929 (88.4 %) fasted more than advised. While only 5.2 % mentioned aspiration, 25 % cited vomiting as the reason for fasting. Younger parents (OR = 0.853, 95 % CI‑0.796 to 0.915), fasting instructions in writing (OR = 10.808, 95 % CI‑1.459 to 80.059) and separate instruction for solids and liquids (OR = 6.016, 95 % CI‑ 3.663 to 9.883) were found to affect compliance with fasting instructions. To avoid risks of prolonged or inadequate fasting in day care surgical patients, good coordination between the anaesthetist and the surgeon and an updated knowledge about the preoperative fasting instructions among the health‑care providers is essential. Separate written fasting instructions for liquids and solids should be given to the parents according to their order in the operating list to ensure better compliance with fasting instructions.

4 tables, 16 ref

041757   AMMAR M A, ABDOU A M H (Anesthesia and Intensive Care Dep, Ain Shams Univ, Cairo, Egypt, Email: Mona_3mmar@hotmail.com) : Benefits of N‑acetylcysteine on liver functions in living donor hepatectomy. Indian J Anaesth 2020, 64(3), 204-9.

The proportion of patients undergoing living donor liver transplantation is high especially in countries without or with limited cadaver organ sharing programs. The aim of this study was to evaluate the post‑hepatectomy effect of using N‑Acetylcysteine (NAC) infusion in living donors undergoing donor hepatectomy. In a prospective randomised non‑blinded study, 50 healthy donors were enrolled; following hepatectomy patients were randomised into 2 groups: Group NC receiving NAC 150 mg/kg diluted in 100 ml glucose 5 % over 40 minutes, followed by NAC 12.5 mg/kg in 500 ml glucose 5 % over 4 hours. This was followed by NAC 6.25 mg/kg for 2 post‑operative days, Group C (Control group) received ringer acetate infusion at same rate for 2 days. The primary outcome was serum lactate levels. Secondary outcomes were liver function tests, serum creatinine and urine output on intensive care unit (ICU) admission (0 hr.), after 24 hours and 48 hours, length of ICU stay. Our study revealed significant reduction in serum lactate in Group NC at 0, 24 and 48 hours compared to C group (P = 0.017, 0.002, 0.014). INR values showed significant reduction after 48 hours in Group NC compared to Group C (P = 0.049). Total Bilirubin, ALT, and Creatinine, urine output and ICU stay showed no statistical difference between the 2 groups. The NAC protocol is a safe, cost‑effective tool for improvement of post hepatectomy liver function and early stabilisation of the metabolic profile.

2 illus, 3 tables, 26 ref

041756   PUTHENVEETTIL N, SANDHYA S, JOSEPH N, NAIR S, PAUL J (Anaesthesiology and Critical Care Dep, Amrita Institute of Medical Sciences, Vidyapeetham, Kochi, Kerala, Email: nituveesundeep@gmail.com) : Comparison of cross‑legged sitting position with the traditional sitting position for the ease of insertion of an epidural catheter in parturient for providing labour analgesia: A randomised control trial. Indian J Anaesth 2020, 64(3), 199-203.

The patient’s position during the insertion of the epidural catheter plays a major role in the success of labour analgesia. In our study, we compared the ease of insertion of the epidural catheter in either traditional sitting position (TSP) or crossed‑legged sitting position (CLSP). The primary objective was to compare the number of successful first attempts at epidural placement between the groups. Secondary objective included patient comfort, ease of landmark palpation and the number of needle‑bone contacts. The prospective non‑blinded randomised control study was conducted on 50 parturient with uncomplicated pregnancy during active labour. Patients were randomly assigned into two groups using a computer‑generated random sequence of numbers by closed envelope technique. Group TSP received epidural in a traditional sitting position and group CLSP received an epidural in a crossed‑legged sitting position with knee and hip flexed. The parturient in both groups were comparable with respect to the distribution of age, height, weight and parity. The baseline visual analogue score (VAS) and VAS scores at 15 min were comparable between groups. Percentage of a parturient with successful epidural placement in the first attempt was higher in CLSP group than in TSP group (88 % versus 44 %, P = 0.004). The landmark, needle‑bone contact and comfort during positioning were comparable between the two groups. Cross‑legged sitting position is a better position than the traditional sitting position for the ease of insertion of labour epidural catheter.

2 illus, 3 tables, 19 ref

041755   LAL J, BHARDWAJ M, VERMA M, BANSAL T (Anaesthesiology and Critical Care Dep, Pt. BD Sharma Univ of Health Sciences, Rohtak, Haryana - 124 001, Email: drbmamta@gmail.com) : A prospective, randomised, comparative study to evaluate long axis, short axis and medial oblique axis approach for ultrasound‑guided internal jugular vein cannulation. Indian J Anaesth 2020, 64(3), 193-8.

The Ultrasound (USG)-guided internal jugular vein (IJV) cannulation can be performed using different approaches like short axis (SAX), long axis (LAX), oblique axis (OAX) or medial oblique axis (M-OAX). We aimed to determine which view was optimal for IJV cannulation. After ethical committee approval and written informed consent, this prospective, randomised, controlled trial was conducted on 108 patients. Patients were allocated into one of the three groups: A (SAX), B (LAX) and C (M‑OAX approach) for USG‑guided IJV cannulation. The number of needle passes, the success of IJV cannulation and its diameter, venous access time, guidewire time, catheterisation time and complications if any were recorded. Statistical analysis was performed by SPSS version 17.0. First needle pass success rate was highest in M‑OAX (97.2 %) followed by SAX (88.9 %) and then LAX (77.8 %) but it was statistically insignificant among the groups. Mean venous access, guidewire insertion and catheterisation time were shortest in M‑OAX followed by SAX and then LAX approach. It was statistically significant between LAX and SAX and between LAX and M‑OAX group. (P < 0.001). The carotid puncture was noticed in two patients in the LAX group. The overall success rate and the number of needle passes were comparable among the groups. The M‑OAX approach is a safe and effective technique for USG‑guided IJV cannulation when compared to SAX and LAX approaches.

3 illus, 3 tables, 16 ref

041754   DAGGUPATI H, MAURYA I, SINGH R D, RAVISHANKAR M (Anaesthesiology Dep, Super Speciality Cancer Institute and Hospital, Lucknow - 226 002, Uttar Pradesh, Email: indubala.maurya@ gmail.com) : Development of a scoring system for predicting difficult intubation using ultrasonography. Indian J Anaesth 2020, 64(3), 187-92.

Ultrasound measurement of anterior neck soft tissue thickness by skin to epiglottis distance (SED) has been shown to predict difficult laryngoscopy. In this study, we developed an airway scoring system incorporating SED into three clinical predictors and assessed whether it would improve accuracy in prediction of difficult intubation. Mentohyoid distance, mandibular subluxation, head extension and ultrasound measurement of skin to epiglottis distance were measured a day before surgery in 310 adult patients. During direct laryngoscopy, Cormack–Lehane grading was noted (Grade 1 and 2 = Easy, Grade 3 and 4 = Difficult). We constructed a score named MSH, which included mentohyoid distance, mandibular subluxation and head extension. Then, SED was added to the MSH score to form another new score named U_SED‑MSH. Student’s t‑test, Mann‑Whitney U test and Chi‑square test or Fisher exact tests were used. Both scoring systems were compared under the receiver‑operating characteristic curve and area under the curve (AUC) were calculated. Difficult intubation was observed in 62/310 patients (20 %). The AUC for U_SED‑MSH score was greater than the MSH score (0.93, 95 % CI [0.89–0.97] vs 0.76, 95 % CI [0.69–0.84], P value <0.001). U_SED‑MSH score had higher sensitivity (93.6 % vs 59.7 %) and lower specificity (85.9 % vs 91.1 %) with similar positive predictive value (62.7 % vs 62.4 %) in comparison with MSH score. An airway scoring system using the ultrasound measurements of skin‑to‑epiglottis distance along with the clinical predictors would be helpful in the prediction of difficult intubation.

4 illus, 2 tables, 16 ref

041753   SHASTRI P S, GUPTA P, KUMAR R (Critical Care and Emergency Medicine Dep, Sir Gangaram Hospital, New Delhi, Delhi - 110 060, Email: prakashshastri@live.in) : A prospective 3 year study of clinical spectrum and outcome of dengue fever in ICU from a tertiary care hospital in North India. Indian J Anaesth 2020, 64(3), 181-6.

The incidence of specific complications and adverse outcomes in dengue patients needing admission to intensive care units (ICU) may be quite variable in different regions of India presumably because of different strains of dengue virus or due to re infection. Patients admitted with acute febrile illness (AFI) with either positive IgM antibody or NS1 antigen for dengue were enrolled. Data were collected for 3 years (2015-2017). A total of 313 patients with acute febrile illness were admitted in the study period (2252 total ICU admissions). A total of 137 (43.76 %) cases were serologically proven as dengue fever. Median age (IQR) of study population was 36.0 (26.0–52.0) years. Liver (65.7 %) was the main organ involved followed by acute kidney Injury (AKI) (18.6 %). Dengue Shock Syndrome (DSS) was found in 18.6 % of cases. Fifty‑two patients died and the crude mortality was 38.0 %. On multivariate analysis APACHE Score >10, thrombocytopenia, hepatic dysfunction, AKI and dengue shock syndrome (DSS) were associated with the risk of mortality. This study in ICU patients showed high mortality in relatively younger patients. Liver (in the form of raised Bilirubin) was the most common organ dysfunction. The need to recognise early warning signs for ICU admission is highlighted.

1 illus, 5 tables, 21 ref

041752   KUNDRA P, GOSWAMI S, PARAMESWARI A (Anaesthesiology and Critical Care Dep, Jawaharlal Institute of Medical Education and Research, Puducherry - 605 006, Email: p_kundra@hotmail.com) : Advances in vaporisation: A narrative review. Indian J Anaesth 2020, 64(3), 171-80.

The output of inhalational agents from modern vaporisers are both electronically and pneumatically controlled. They are designed to deliver set agent concentrations accurately with low fresh gas flows and possess enhanced safety features. The purpose of this review article is to give an overview of three modern vaporisers, namely, the Aladin cassette vaporiser, injection vaporisers and AnaConDa™. The Aladin cassette is integrated with Datex Ohmeda S/5 ADU and GE Aisys anaesthesia machines. The electronic vapour control unit is incorporated within the anaesthesia machine. The agent specific cassettes act as a detachable vaporising chamber. The system can work as a variable bypass and measured flow vaporiser but requires a power supply to function. Injection vaporisers can achieve the set end‑tidal agent concentration very rapidly with even metabolic flow rates. Hence, anaesthetic depth can be rapidly altered with minimal wastage and theatre pollution. The two types of injection vaporisers, namely, Maquet and DIVA™ are customised to function with Maquet FLOW‑i and the Drager Zeus anaesthesia machine, respectively. AnaConDa™ is a combination of vaporiser and humidity and moisture exchange filter which can be fitted in the ventilatory circuit. It is primarily designed for use in intensive care for sedation and out of operating room use.

8 illus, 14 ref

045335   RAMASWAMY P, KIRAN C S, RAJU B M, KIRANMAI M S ( Oral Medicine and Radiology Dep, St. Joseph Dental Coll, Eluru, Andhra Pradesh, Email: munipatiswathi@gmail.com) : Malignant transformation rate of oral leukoplakia: A meta analysis. J Indian Acad Oral Med Radiol 2020, 32(4), 399-404.

Oral squamous cell carcinoma is the most common form of head and neck cancer which is sometimes preceded by potentially malignant disorders such as leukoplakia. Oral leukoplakia is a potentially malignant lesion that has been considered to confer increased risk for the development of oral cancer. Tobacco smoking and alcohol intake have been attributed as major risk factors. Many articles were published connecting the malignant transformation rate to lifestyle modifications. As contemporary sources of information regarding malignant transformation rate of oral leukoplakia are lacking, there is a need to have a comprehensive evaluation of leukoplakia and its malignant transformation potential. Aim: This study aims to provide a systematic review of research on the current malignant transformation rate of oral leukoplakia. To find association between malignant transformation rate and other parameters in oral leukoplakia. The malignant transformation rate of oral leukoplakia was observed to be 5.7 % from the year 1963 and has increased by two-fold from year 1996 to 10.9 %. Malignant transformation rate of verrucous leukoplakia was 28.2 %. Dysplastic malignant transformation rate of leukoplakia was 53.7 % [95 % Confidential interval: 32.9 %, 74.5 %] overall malignant transformation rate of oral leukoplakia was 10.9 %. The two-fold increase in the malignant transformation rate since 1990s should be considered as an alarming issue, and necessary steps have to be taken in this regard.

1 table, 50 ref

045334   PARIHAR A P S, SINGAR S, GEHI S, SAXENA A, JAIN A (Oral Medicine and Radiology Dep, Government Coll of Dentistry, Indore, Madhya Pradesh, Email: ajaycbct@gmail.com) : Unilateral agenesis of the mental foramen. J Indian Acad Oral Med Radiol 2020, 32(4), 396-8.

The inferior alveolar nerve canal opening in the anterior labial aspect called mental foramen (MF) is a vital anatomic landmark of the mandible, through which the mental nerve and blood vessels emerge. The importance of MF is particularly associated with dental implant placement and various surgical procedures within this region. It is elementary to use caution in and around the MF region during surgical procedures and implant placement to avoid nerves and vessel injury. Anatomic variations of the MF are often found, like the prevalence of multiple foramina and unusual locations in the mandible. On rare occasions, the absence of MF is often detected. The modern imaging-resource cone-beam computed tomography (CBCT) permits correct three‑dimensional assessment of MF and identification of its variations. This article aims to report the unilateral absence of MF detected in CBCT images of a 70 years-old male patient.

5 illus, 10 ref

045333   RAINA A, SUNIL M K, PRADHAN L, YELURI G, RAVINDRA S V, HANDA R (Oral Medicine and Radiology Dep, Teerthanker Mahaveer Dental Coll and Research Centre, Moradabad, Uttar Pradesh, Email: anudeepraina0885@gmail.com) : Characteristics and prevalence of underwood’s septae on digital panoramic radiographs. J Indian Acad Oral Med Radiol 2020, 32(4), 371-5.

The term Underwood’s septae is eponymously used for maxillary sinus septae. Septae may be defined as cortical bony partitions found in the form of inverted gothic arches that protrude from the sinus walls, dividing the sinus into two or more cavities.This study was aimed to determine the prevalence of maxillary sinus septae on digital panoramic radiographs. This retrospective radiographic study was carried out in the Department of Oral Medicine and Radiology at Teerthanker Mahaveer Dental College and Research Centre, Moradabad. This retrospective study comprised of panoramic radiographs of 100 subjects of either gender, aged between 16 and 80 years. Bony projections having a minimum height of 2.5mm were considered as septae according to the criteria suggested by Velasquez Plata D et al. The location of maxillary sinus septae was defined by Underwood classification as anterior, middle, and posterior. The data were analyzed using the SPSS statistical software 21.0 Version. Maxillary sinus septae were seen in 18 out of 100 radiographs, out of which unilateral maxillary sinus septae were noted in 08 cases (right-sided in 3, left-sided in 5) while bilateral septae were seen in 10 cases. The prevalence of maxillary sinus septae was found to be 18 % on digital panoramic radiographs. Oral radiologists should thus report maxillary sinus septae and the possibility of surgical complications that may arise during maxillary sinus surgeries.

4 illus, 4 tables, 10 ref

045332   SINGH H, KUMAR A, GUPTA A, REDHU A, SINGH A (Oral Medicine and Radiology Dep, PGIDS, Rohtak, Haryana, Email: drharneetomdr@gmail.com) : Impact of covid-19 on Indian dentists: A cross sectional survey. J Indian Acad Oral Med Radiol 2020, 32(4), 360-5.

COVID-19 and associated lockdown have had some detrimental effects on the health care professionals. With the maximum fear of getting infected and further transmitting the infection, dentists are suffering from the psychological meltdown along with the physical changes due to altered lifestyle. To evaluate the psychological and physical effects of COVID-19 and consequential lockdown on dentists and to understand the possible reasons for the problems they were facing amidst lockdown due to the changes in their lifestyle.  A questionnaire-based survey to evaluate disaster mental health and analysis of musculoskeletal symptoms was designed and sent to the various groups of dentists. A total of 453 respondents completed the survey. Cluster sampling method was used and the dentists were segregated into four groups. The responses were evaluated for Post-traumatic stress disorder, Depression, Anxiety and Pain or discomfort. Chi Square test was applied to statistically assess the association of responses. Out of 453 respondents 65.1 % were females and 34.9 % were males. Based on profession, 23 % were academicians, 18.8 % private practitioners, 16.8 post‑graduate students and 41.5 % undergraduates. Females were significantly affected and showed a tendency towards Post traumatic stress disease (PTSD) and potential depression along with pain and discomfort. All the three groups except undergraduate students showed potential symptoms. COVID‑19 and the lockdown exhibited significant psychological and physical effects on the dentists. Counselling centers or helplines/portals need to be set up to avoid any grave consequences and untoward losses.

2 illus, 2 tables, 24 ref

045331   GOYAL G, GUPTA D, PALLAGATTI S (Oral Medicine and Radiology Dep, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, Email: dr.gaurav867@gmail.com) : Salivary cortisol could be a promising tool in the diagnosis of temporomandibular disorders associated with psychological factors. J Indian Acad Oral Med Radiol 2020, 32(4), 354-9.

Biopsychosocial models emphasize the multifactorial nature of temporomandibular disorders (TMDs). The role of cognitive, social, and biological factors in the etiology of TMDs has been reported.  To test the salivary cortisol levels in young adults with the temporomandibular joint disorder and having positive depression level and with TMD but with negative depression level and compared with the control group. The correlation between cortisol levels and depression levels according to axis-II of Research Diagnostic Criteria (RDC) was assessed. Settings and Design: The study was a randomized, prospective, and double-blinded study. The total sample comprised 60 subjects. The study comprised 20 subjects with TMD and depression, 20 subjects with TMDs and without depression, and 20 subjects were taken as the control group. To measure these variables, research diagnostic criteria (RDC/TMJ) were used for the study. Salivary cortisol levels were determined by Enzyme-linked immunosorbent assay (ELISA). A paired t-test, ANOVA, and linear multi regression tests applied to compare the TMD groups with the control group.  The results showed that there was a positive correlation between morning and evening salivary cortisol levels in all the groups and the correlation coefficient was 0.729. There was a significantly higher value of salivary cortisol in TMD patients with depression than TMD patients without depression and the control group. Salivary cortisol could be a promising tool in identifying underlying psychological factors that could be associated with TMD

7 tables, 18 ref

045330   AGRAWAL Y, NAIDU G S, NAGI R, JAIN S, CHOUDHARY M, CHOUDHARY V (Oral Medicine and Radiology Dep, New Horizon Dental Coll and Research Institute, Chhattisgarh, Email: yashagrawalinfo1989@gmail.com) : Digital cephalometric analysis of pharyngeal airway space changes in oral submucous fibrosis patients: A cross sectional observational study. J Indian Acad Oral Med Radiol 2020, 32(4), 341-6.

Oral submucous fibrosis (OSMF) causes changes over the pharynx that may cause changes in airway dimensions. Cephalometry could be a reliable diagnostic tool for evaluation of the changes happening in the pharyngeal structures, so that preventive measures such as areca nut habit cessation could be initiated at an earlier stage. Aim: To test pharyngeal changes and airway dimensions in OSMF patients using digital lateral cephalograms. This was a crossectional observational study done in the Department of Oral Medicine and Radiology. Twenty-two subjects with clinically diagnosed OSMF formed the study group A, and 30 healthy subjects formed the control group B. OSMF subjects were further divided into stage I, II, III according to Nagesh And Bailoor (1993) criteria. We tested all study subjects for velopharyngeal and upper airway dimensions as measured on Digital Lateral Cephalographs using Sirona Sidexis software. The findings were compiled to arrive at data in the study population. Statistically significant difference was observed for mouth opening tongue between different stages of OSMF (p = 0.000) and significant difference was also observed for hyoid position to vertical, AH‑FH (p = 0.023), tongue length (VT) (p = 0.002), mid airway width (p = 0.031), soft palate width (p = 0.012) between the groups. There was a significant change in the pharyngeal airway with the advancing stage of OSMF. Lateral cephalometric radiographs are a useful, non-invasive diagnostic tool to analyze pharyngeal airway changes in OSMF patient’s to prevent the development of complications associated with advanced stages.

1 illus, 5 tables, 15 ref

045329   JEEVITHA G, ANURADHA G (Oral Medicine and Radiology Dep, Madha Dental Coll and Hospital, Chennai- 600 020, Tamil Nadu, Email: drjeevithagauthaman@gmail.com) : Effect of hand-held mobile phones on the parotid gland: A cross sectional study. J Indian Acad Oral Med Radiol 2020, 32(4), 335-40.

The mobile phones widely used today uses electromagnetic radiations for signal transmission. These radiations have been speculated to cause pathological changes, especially in the salivary glands. The aim of the present study was to compare the salivary flow rate, pH, total protein concentration, Immunoglobulin A, total antioxidant capacity and salivary amylase levels of the parotid saliva between the dominant and non-dominant sides of mobile phone usage. Settings and Design: A total of 40 participants who used hand-held mobile phones were selected for the study. Group A comprised of participants who used mobile phones for 0-2 hours a day, group B comprised of participants who used mobile phones for 2-4 hours a day and group C comprised of participants who used mobile phones for more than 4 hours a day. The parotid salivary pH, total protein concentrations, immunoglobulin A (IgA), salivary amylase, and total antioxidant capacity were estimated. Statistical Analysis: One-way ANOVA, Tukey HSD test and Pearson’s correlation were used. There was an increase in the mean salivary flow rate, pH and salivary IgA levels on the dominant side of participants. The mean total protein levels and IgA levels in the dominant sides of group A, B and C was 22.56 ± 9.35, 20.10 ± 4.95, 17.44 ± 4.52 and 3.39 ± 0.62, 5.03 ± 0.72, 7.51 ± 1.17, respectively. There was a decrease in the mean total protein, amylase and total antioxidant capacity in the dominant side. Our study has shown an increase in the levels of salivary flow rate, pH and IgA in the dominant side of usage.

5 illus, 4 tables, 24 ref

045328   BAGGA M, BHATNAGAR D, KUMAR N (Oral Medicine Diagnosis and Radiology Dep, MN DAV Dental Coll and Hospital, Solan, Himachal Pradesh, Email: munbhawni@gmail.com) : Elongated styloid process evaluation on digital panoramic radiographs: A retrospective study. J Indian Acad Oral Med Radiol 2020, 32(4), 330-4.

The precise knowledge about anatomy of both normal and abnormal styloid process is important for clinicians, surgeons, and radiologists. Thus, the present study highlighted the prevalence of anatomic-radiological features of elongated Styloid process on panoramic radiography. Aim: The aim of the study was to evaluate and classify the radiographic appearance of the Styloid process (SP) along with morphologic characteristics and patterns of calcification according to the subject gender and site predilection.  A random sample of 1706 good quality digital panoramic radiographs were included in present study. Elongated SPs were classified with the radiographic appearance based on morphology and calcification pattern. The data were analyzed by using student t test and Chi‑squared with significance set at P = 0.05. Results: Bilateral elongation having “Elongated” Type SP with “partially calcified” pattern was the most frequent SP. No correlation was found between SP type and calcification pattern and subject gender, although elongated Styloid was more prevalent among male population (P < 0.001). Dentists should recognize the existence of morphological variation in elongated Styloid process apparent on panoramic radiographs. According to our knowledge, this is the first study conducted in Solan region to evaluate Styloid process elongation (SPE) and also had recorded highest prevalence of SPE in comparison with other studies conducted in Indian population. We found calcification of the Styloid process is common in older age groups with no correlation to gender and site predilection. “Type I” with “partially calcified” of the Styloid process was observed most frequently in the population studied.

4 illus, 4 tables, 32 ref

045327   MAHESWARI T N U, CHAUDHARY M (Oral Medicine and Radiology Dep, Saveetha Dental Coll and Hospitals, Chennai, Email: umasamsi@gmail.com) : Management of oral lichen planus based on the existing clinical practice guidelines. J Indian Acad Oral Med Radiol 2020, 32(3), 284-92.

Lichen planus is a chronic inflammatory mucocutaneous disorder that affects oral and genital mucous membranes, skin, nails, and scalp. Oral lichen planus (OLP) is the mucosal counterpart of cutaneous Lichen planus. Clinical practice guidelines (CPG) are statements that include recommendations intended to optimize patient care. These guidelines are formulated by using a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Diagnosis and management of patients with OLP continue to challenge even the most experienced clinician. To provide optimum care to the patients a decision tree algorithm needs to be formulated. This article compares the existing clinical practice guidelines available in the literature and a formulated decision tree algorithm.

3 illus, 6 tables, 53 ref

041751   THAKUR A, SIWACH P, AGRAWAL R R (Oral Pathology and Microbiology Dep, Government Dental Coll and Hospital, Mumbai - 400 001, Maharashtra, Email: arushthakur.medico@ gmail.com) : Hard tissue formation in odontogenic lesions associated with impacted tooth: Plausible pathogenesis. Indian J Dent Res 2020, 31(5), 782-3.

Odontogenesis is a complex process, which involves the molecular interaction between the epithelium and ectomesenchyme called as epithelium mesenchymal interaction (EMI). Reduced enamel epithelium (REE) after tooth formation protects enamel from coming in contact with adjacent ectomesenchyme. Also, REE acts as a source of origin for odontogenic lesions, during the process of development of a lesion, disruption in REE may occur and lead to formed enamel coming in contact with adjacent ectomesenchyme leading to the formation of cementum like calcifications. REE may play a role in pathogenesis of hard tissue formation in odontogenic lesions.

5 ref

041750   SREEVIDYA G, ARCHANA D, PRITHIKA U, SIVAPRIYA E, TEJASWI B, PRADEEPKUMAR A R (Conservative Dentistry and Endodontics Dep, Thai Moogambigai Dental Coll & Hospital, Chennai - 600095, Tamil Nadu, Email: arpradeependo@gmail. com) : Esterase like activity of Enterococcus faecalis and Lactobacillus casei on microhardness and weight loss of resin luting cements. Indian J Dent Res 2020, 31(5), 768-73.

Gap‑free/continuous cement margins have been considered important for the longevity of indirect dental restorations. Bacterial species have demonstrated esterase‑like activity that can cause biodegradation of resin composites. The aim of this study was to evaluate the effect of the esterase‑like activity of E. faecalis and L. casei on three resin luting cements. In-vitro study materials and three resin luting cements tested were: Variolink N, Rely X U200 and Panavia F2.0. E. faecalis and L. casei suspensions and supernatants were assessed for enzymatic activity by bacterial esterase activity assay. Circular samples of resin luting cements were exposed to suspensions of E. faecalis and L. casei for 7 and 28 days followed by testing for solubility, microhardness and bishydroxy propoxy phenyl propane (BisHPPP) release. E. faecalis and L. casei both demonstrated esterase‑like activity. Bacterial suspensions had significantly increased enzymatic activity than supernatant solutions (P < 0.05). There was no significant reduction in microhardness or increased weight loss in all three cements after incubation in E. faecalis and L. casei for 7 and 28 days. BisHPPP release signifying resin degradation was seen after 7 and 28 days of incubation in E. faecalis and L. casei. Within the limitations of this in vitro study, E. faecalis and L. casei demonstrated esterase‑like activity. BisHPPP release was evident in all three cements after 7 and 28 days. However, the bacterial strains did not significantly reduce the microhardness or cause weight loss of the tested resin luting cements (Variolink N, Panavia F2.0 and Rely X U200) after 7 and 28 days of incubation.

2 illus, 3 tables, 35 ref

041749   FERNANDES R C, DAMASCENO M L, PIMENTEL G, MENDONÇA J S, GELFUSO M V, PEREIRA S L D S, PASSOS V F (Federal Univ of Ceara, Fortaleza-CE 60430-170, Brazil, Email: vanarapassos@hotmail.com) : Development of a membrane for guided tissue regeneration: An in vitro study. Indian J Dent Res 2020, 31(5), 763-7.

The aim of this study was to develop an alternative low‑cost membrane for use in guided tissue regeneration (GTR). In vitro study. In this study, a membrane prepared from a 335 mm sized opening nylon substrate, covered in aqueous resin derived from chitosan, was compared with a commercial material, a non‑degradable expanded poly (tetrafluoroethylene). Nylon substrate samples 2.0 × 2.0 cm were covered by aqueous resin based on diluted chitosan solution into 1:05 or 1:10 by spin coating technique to produce from 06, 10, and 15 layers. The surfaces of these membranes were observed using optical microscopy. The physical properties were measured by hydration superficial energy measurements (∆G) and a tensile test machine. Statistical analysis was performed using the Student’s t test at a significance level of 5 %, using the BioEstat 2.0 program. The ∆ G values of the nylon membrane covered by the 1:05 of chitosan with 15 layers were close to the commercial membrane’s ∆ G values. The tensile strength values of the nylon membrane covered by the 1:05 of chitosan with 15 layers were higher than the commercial membrane’s (115.826 MPa, P < 0.05). Therefore, the membrane developed shows some favorable physical properties that could qualify it as a material candidate for use in guided tissue regeneration.

5 illus, 2 tables, 21 ref

041748   ATIF M, TEWARI N, MATHUR V P, BANSAL K, GANGADHARRAO M R (Pedodontics and Preventive Dentistry Div, All India Institute of Medical Sciences, New Delhi - 110 029, Email: dr.nitesht@gmail.com) : Effect of inciso cervical position of wire composite splint on the mobility of an avulsed permanent tooth: A cadaveric model study. Indian J Dent Res 2020, 31(5), 758-62.

The wire composite splint as a general rule is placed on the middle third of labial surface of the tooth. This is due to ease of application, better isolation, and fewer chances of contamination. However, these assumptions are opinion‑based, with no scientific evidence to support them. In addition, to best of our knowledge no research has been carried out to evaluate the effect of position of wire splints on the mobility of the affected tooth and anchor teeth. The aim of this study was to evaluate the effect of the cervico‑incisal position of splinting wire on the mobility of a replanted tooth and anchor teeth in a cadaveric model. Three cadavers (one female, 45 years old and two males, each 40 years old) were included in the study. periotest S was used to assess physiologic‑tooth‑mobility in three cadavers at baseline and after “extraction‑replantation‑wire‑composite” splinting‑protocol. Greatest splint effect for horizontal‑mobility was found to be 9.33 ± 0.57 for Cadaver‑I (incisal‑third), whereas it was highest (3.66 ± 2.51) for vertical‑mobility in Cadaver‑II (cervical third). Middle third position of wire composite splint have lowest splint effect on both horizontal and vertical mobility of replanted teeth, thus rendering the most favorable position for the establishment of physiologic mobility.

3 illus, 2 tables, 23 ref

041747   GANESH A S (Conservative Dentistry and Endodontics Dep, Tagore Dental Coll and Hospital, Chennai - 600127, Tamil Nadu, Email: sriganeshanguswamy@ gmail.com) : Comparative evaluation of shear bond strength between fifth, sixth, seventh, and eighth generation bonding agents: An in vitro study. Indian J Dent Res 2020, 31(5), 752-7.

To evaluate and compare the shear bond strength of composite resin to dentin using eighth generation dental adhesive (G‑Premio Bond) with fifth, sixth, and seventh generation dentin adhesives. A total of 64 freshly extracted non‑carious, intact human premolar teeth were selected. Class V cavity was prepared by using high speed hand piece. The prepared samples were randomly divided into four experimental groups (n = 16). Group I: Adper single Bond 2 [fifth generation] (ASB‑5), Group 2: Clearfil SE [sixth generation] (CSE‑6), Group 3: Single Bond Universal [seventh generation] (SBU‑7), Group 4: G‑Premio Bond [eighth generation] (GPB‑8). Bonding agents were applied according to the manufacturer’s instructions and light cured. Then, the Nano composite Filtek Z350 was placed in a two layer increment using Teflon Jig (2 × 2 × 2 mm) and was light‑cured for 40 s. Shear bond strength was tested by a universal testing machine. This study was carried out by using Tukey HSD post‑hoc test where P ≤ 0.05 was considered as a statistical significant. The highest value of shear bond strength was obtained from G‑Premio Bond (eighth generation) showed statistically significant difference when compared to seventh generation bonding agent. However, there is no statistical significant difference between eighth and fifth, sixth generation. The study concluded the G‑Premio Bond (eighth generation) showed effective shear bond strength than other bonding agents. This bonding agent is compatible with self‑etch without use of primer which gives highly long lasting esthetic, wear resistant, and it is ideal for hypersensitive tooth.

6 illus, 2 tables, 22 ref

041746   LOITONGBAM M, MOHAN R, CHOWDHARY Z, MEHROTRA S (Periodontology Dep, Indira Gandhi Government Dental Coll, Jammu and Kashmir - 180 012, Email: Dr.zoya1988@gmail. com) : Comparative evaluation of tooth surface roughness caused by three different powered toothbrushes and a novel manual toothbrush –an sem and afm study. Indian J Dent Res 2020, 31(5), 743-51.

Toothbrush is the most frequently used tool for mechanical plaque control. Variety of manual and powered toothbrushes are available in the market, and it is often a dilemma for a common man that which one to choose among the wide range. Thus, the purpose of the present study was to evaluate and compare the tooth surface roughness caused by three different powered toothbrushes. In total, 160 samples comprising of 80 enamel and cementum each were equally and randomly divided into four groups: Group 1 multi‑directional powered toothbrushing; Group 2 oscillating/rotating/pulsating powered tooth brushing; Group 3 sonic powered tooth brushing; and Group 4 manual tooth brushing. They were further sub‑divided equally into Control and Test. The Test samples were brushed for 2 min every day for a period of 1 month. The prepared samples were evaluated for surface roughness using scanning electron microscope at 1000 × magnification and atomic force microscope at the nanoscale. A statistically significant difference was seen in the enamel and cementum roughness between multi‑directional tooth brush group and sonic (P = 0.00); multi‑directional tooth brush group and manual tooth brush group (P = 0.00); oscillating tooth brush group and sonic group (P = 0.00); oscillating tooth brush group and manual tooth brush group (P = 0.00); and sonic group and manual tooth brush group (P = 0.00). The surface microroughness caused by tooth brushing was found to be least using multi‑directional and oscillating/rotational/pulsating powered toothbrush, followed by sonic powered toothbrush and maximum in manual toothbrush.

9 illus, 3 tables, 41 ref

041745   SRICHINTHU K K, KUMAR G S, PRASAD H, RAJMOHAN M, ANUTHAMA K, YOITHAPPRABHUNATH T R (Oral and Maxillofacial Pathology Dep, KSR Institute of Dental Science and Research, Thiruchengodu - 637 215, Tamil Nadu, Email: chintuchnth@gmail.com) : Expression of epithelial glycoprotein (EGP40) in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). Indian J Dent Res 2020, 31(5), 738-42.

To study the expression of Epithelial Glycoprotein (EGP40) in various grades of Oral Epithelial Dysplasia namely mild, moderate and severe epithelial dysplasia and in various grades of Oral Squamous Cell Carcinoma (OSCC) namely well, moderate & in poorly differentiated squamous cell carcinoma. This laboratory study comprised of 47 samples in which 27 samples were of three different grades of OSCC, Well (n=10), Moderate (n=10) and Poorly differentiated (n=7) and remaining 20 samples were of three different grades of dysplasia [Mild (n=7), Moderate (n=8), Severe dysplasia (n=5)]. All the 47 cases were subjected to immunohistochemical staining to evaluate the expression of EGP40. Chi square was used to analyze the significance of differences in different grades of oral epithelial dysplasia & in different grades of OSCC. The percentage of EGP40 immuno positivity was increased from mild to severe dysplasia and the percentage of EGP40 immuno positivity was increased from well to poorly differentiated carcinoma No statistical significance was observed in the immunoreactivity and in the intensity of expression between various grades of oral epithelial dysplasia and oral squamous cell carcinoma. The epithelial cell adhesion molecule can be considered as an early marker for predicting malignant transformation of dysplastic epithelial lesions and used as a marker in predicting the OSCC prognosis.

2 illus, 3 tables, 30 ref

041744   RASHMI B, CHINNA S K, RODRIGUES C, ANJALY D, BANKUR P K, KANNAIYAN K (Public Health Dentistry Dep, K.L.E Dental Coll and Hospital, Bangalore, Karnataka, Email: dr.sschinna@rediffmail.com) : Occurrence of micronuclei in exfoliated buccal mucosal cells in mobile phone users: A case control study. Indian J Dent Res 2020, 31(5), 734-7.

The use of mobile phones has increased enormously all over the world especially among young people. This technology is based upon electromagnetic radiation in the microwave frequency range [radiofrequency (RF) waves and microwaves]. The radiation frequency and modulation standards vary in the range of 300–2100 MHz, depending on the region in the world. To detect the presence of micronuclei in exfoliated buccal mucosal cells of mobile phone users as well as to carry out a quantitative analysis of micronuclei in exfoliated buccal mucosal cells of mobile phone users. A cross‑sectional study was carried out in 100 individuals, out of which 50 were included under the test group and 50 under the control group. Buccal mucosal smears were obtained from each subject. Staining was done using papanicuolau (PAP) stain and the slides were examined for the presence of micronuclei. The mean duration of mobile phone usage in years was 5.32 years for the exposed and 2.42 years for the control. Mean duration of mobile phone usage per day in the test group was 94.8 min and 12.4 min in the control group. The frequency of micronucleated cells (MNC) in test and control groups ranged from 0 to 16 and 0 to 2 respectively. The data obtained were statistically analyzed using Student t‑test and significant results were obtained at 0.0001 level. Our study concluded that there is an increased frequency of micronuclei in mobile phone users which is related to carcinogenesis.

1 illus, 2 tables, 7 ref

041743   SISODIA M, BOMMANAVAR S, BAAD R, VIBHUTE N, BELGAUMI U, KADASHETTI V (Oral Pathology & Microbiology Dep, KIMS “Deemed to be Univ”, Karad - 415 539, Maharashtra, Email: drsushopath@gmail.com) : Correlation and comparison of dactyloscopy and palatoscopy with blood groups – an institutional study. Indian J Dent Res 2020, 31(5), 728-33.

The most crucial evidence that is left behind at the crime scenarios that might narrow down the suspect pool are lip prints and fingerprints. These are undoubtedly the most reliable and valuable evidence till date in the court of law. One more biological record that remains unchanged throughout the lifespan of a person is the blood group. To study, correlate and compare cheiloscopy and dactyloscopy with blood group among dental students in the Western Maharashtra population. A total of 200 dental students with age groups ranging between 18–25 years were included in the study. Lip print pattern, fingerprint pattern and ABO blood groups were collected and compared. SPSS version 20.0 was used to analyse the data. There was a statistically significant correlation between lip prints and ABO – Rh (χ2 37.56, P < 0.05) as well as between fingerprints and ABO‑Rh blood groups (χ² 30.6, P < 0.05). Hence, this study concluded that fingerprints–ABO blood group and lip prints–ABO blood groups are valuable evidence that can be relied upon in forensic investigations for the identification of the suspect in crime.

6 illus,2 tables, 22 ref

041742   SHAH S, RATH H, SHARMA G, SENAPATI S N, MISHRA E (Public Health Dentistry Dep, SCB Dental Coll, Cuttack - 753 007, Odisha, Email: basicgaurav@gmail.com) : Effectiveness of curcumin mouthwash on radiation induced oral mucositis among head and neck cancer patients: A triple-blind, pilot randomised controlled trial. Indian J Dent Res 2020, 31(5), 718-27.

Radiation‑induced oral mucositis (RIOM) is considered the most severe non‑haematological complication affecting almost every head and neck cancer patient during the course of radiotherapy (RT). Curcumin, a herbal agent present in Indian spice ‘Turmeric’ has anti‑inflammatory, immunomodulation and wound healing properties. The objective of this pilot randomised controlled clinical trial was to compare the effectiveness and safety of 0.1 % curcumin (freshly prepared using nanoparticles) and 0.15 % benzydamine mouthwash on RIOM among 74 head and neck cancer patients scheduled to receive RT. Assessment of RIOM was carried out using WHO criteria once in a week for 6 weeks. Both modified intention to treat (MIT) and per protocol (PP) analysis were carried out to test the null hypothesis of equal effectiveness on prevention and severity of RIOM. As far as the onset of RIOM is concerned, MIT analysis showed that the instantaneous risk of getting the onset of RIOM was 50 % lower (hazard ratio 0.5) in curcumin. Onset of RIOM was also significantly delayed (mean = 19.56, median = 21) in the test group by 2 weeks. But in ‘PP’ analysis, no significant difference was observed between two preparations and almost all patients experienced the onset. Both the mouthwashes were equally effective in preventing the occurrence of severe form of RIOM in PP analysis after dichotomisation of severity score (≥3 and ≤2). Though both the mouthwashes were not able to completely prevent the onset of RIOM and reduce the severity of RIOM, use of 0.1 % curcumin mouthwash was able to significantly delay the onset of RIOM (Clinical trial registration no. CTRI/2018/04/013362).

1 illus, 12 tables, 28 ref

041741   KELKAR K C, DOGRA E S, BHAT V, PRASAD D K, HEGDE C (Prosthodontics Dep, A B Shetty Memorial Institute of Dental Sciences, Mangalore - 575 018, Karnataka, Email: drvinayabhat@gmail.com) : A comparison between visual, digital photography and polarizing filter photography for shade selection. Indian J Dent Res 2020, 31(5), 712-7.

There is an increased awareness for aesthetically pleasing restorations among patients in current practice. Due to variability in the natural tooth colour, shade selection becomes an intricate procedure. The aim of this study is to determine which of the three named methods is more accurate for shade selection in aesthetic dentistry. Two VITAPAN classical shade guides were used for this study. Nine shades were selected from the first shade guide (A1, A2, A3.5, B1, B2, B3, C1, C2, C3) and the number was concealed. Ten selected participants were asked to identify each concealed shade with the second shade guide. Canon 5D camera with ISO 200, shutter speed 1/100 sec, F22 was used for capturing images of the second shade guide. Photoshop CS3 Software was used for developing the digital shade guide. The participants were asked to match the shades from the first shade guide with the prepared digital shade guide. The third photographic shade guide was prepared using a polarised filter on the Canon 5D camera with the same settings. The participants were asked to match shades with the prepared photographic shade guide. Total observations made during the study were 270. Cross table statistical analysis (Chi‑square test) done using SPSS 20.0 showed statistically significant difference between conventional and digital photography (P = 0.049). Analysis between digital photography and polarizing filter photography did not reveal a significant association (P = 0.181). Digital photographic method was most accurate among the three shade selection methods. It can be used to obtain aesthetic results.

6 illus, 3 tables, 12 ref

045326   KANAPARTHI A, MEUNDI M A, DAVID C M, MAHESH D R, KRISHNAPPA S L, KASTALA R K (Oral Medicine and Radiology Dep, MNR Dental Coll and Hospital, Sangareddy- 502 001, Telangana, Email: kanaparthialekhya@gmail.com) : Precision of 3D optical scanner in assimilation of experimental bite marks in chocolate. J Indian Acad Oral Med Radiol 2020, 32(3), 259-65.

To analyze the accuracy of a three‑dimensional (3D) optical scanner‑GOM® (Gesellschaft für Optische; Messtechnik, Braunschweig Germany) model‑ATOS triple II optical Scanner  (Advanced topometric Sensor) in examination and identification of experimental bite marks  (BM) in chocolate using Styrofoam exemplar  (SE).  The study was conducted with 25 volunteers from whom the dental cast exemplar  (CE), SE, and experimental BMs in chocolate, were made. These were then digitized using the GOM® ATOS optical scanner and 3D models were generated using GOM® ATOS software. Data analysis was performed using independent t‑test for inferential statistics.  On 3D analysis, the experimental BM matched with the presumed biters correctly using both SE and CE. The mean percentage matching of BM vs SE was found to be 92.55 ± 1.757, and in BM vs CE, the mean matching percentage was found to be 96.09 ± 1.311. Statistical analysis of the data was obtained using independent t‑test, and the mean difference in percentage matching was significant (P < 0.05) Three‑dimensional BM analysis using 3D optical scanner proved to be a reliable, accurate, and permanent method of documentation compared to the conventional two‑dimensional methods.

7 illus, 3 tables, 18 ref

045325   THIRUNAVUKARASU S, MATHEW P, AUSTIN R D, SRIVASTAVA K C, RAMASAMY S, USHA V (Oral Medicine and Radiology Dep, Indira Gandhi Institute of Dental Sciences, Puducherry, Email: sankarisenthil1984@gmail.com) : Efficacy of toluidine blue, lugol’s iodine and acetic acid for detecting oral lesions of leukoplakia and erosive lichen planus – A cross sectional study. J Indian Acad Oral Med Radiol 2020, 32(3), 253-8.

Early detection and treatment of oral cancer will significantly improve the survival rate and prognosis of the patients. Adjunctive diagnostic aids such as vital staining have been developed to supplement clinical examination and improve the diagnosis. The current study was conducted to evaluate the diagnostic efficacy of acetic acid (2 %) (AA), lugol’s iodine (3 % dilution) (LIS), and toluidine blue (1 %) (TBS) in oral leukoplakia (OL) and erosive variant of oral lichen planus (OLP). A hospital-based, cross-sectional study was conducted with 30 randomly selected subjects having clinically proven cases of OL and erosive OLP. Every patient underwent AA, LIS, and TBS application to their oral lesions in a sequential manner. Subsequently, clinical and histopathologic diagnosis was compared with staining results of each. Cases which were diagnosed as epithelial hyperplasia were considered as a control group. Data are presented in numbers and percentages. Chi‑square test was used to compare between TBS, LIS and AA. Diagnostic efficiency and reliability was calculated by sensitivity and specificity test in terms of its utility in predicting the dysplastic nature of the lesion.  Sensitivity of both TBS and LIS staining was calculated as 90.48% whereas the specificity of the former test was 22.22 % and latter was 11.11 %. AA test showed a sensitivity of 57.14 % and specificity of 33.33 %. Multiple comparisons of staining with three agents and the histopathologic variants did not show any statistically significant difference. TBS and LIS staining showed high sensitivity in diagnosing OL and erosive OLP compared to AA. The specificity of all three modalities used was low.

3 illus, 7 tables, 27 ref

045324   RAMASAMY S, PAVITHRAN V K, ANJALIN J R (Oral Medicine and Radiology Dep, Annamalai Univ, Chidambaram- 608002, Tamil Nadu, Email: reni.anjalin3@gmail.com) : An insight on innovative teaching strategies: a cross sectional survey among the oral medicine and radiology faculties in Tamil Nadu and Pondicherry, India. J Indian Acad Oral Med Radiol 2020, 32(3), 247-52.

Education in recent years has evolved in leaps and bounds. Traditional pedagogical methods may still be useful, but education today revolves more around encouraging the students to awaken their curiosity and desire to learn. Many new methods have emerged using technology in the classroom, giving education a new lease of life allowing us to approach ideas in new ways. This survey was conducted to assess the awareness of new teaching methods among the Oral Medicine and Radiology (OMR) faculties in Tamil Nadu and Pondicherry and their perception towards practice of new teaching methods in dental curriculum.  Purposive sampling was done and self-administered, online questionnaire was sent to the faculties of Oral Medicine and Radiology in Tamil Nadu and Pondicherry to collect data regarding the interest and practice of new teaching methods and their perception of new teaching methods towards enhancement of students skills. A response rate of 94.56 % was obtained. About 92 % of faculty members found that new methods will be effective in dental education but only 56 % of teaching faculty felt that it would replace the conventional methods. The faculties agreed that various skills of the students will improve with new teaching methods. Statistically significant difference (P < 0.05) was found among the various designations of OMR teaching faculties and their perception towards enhancing the students skills. Thus, the faculties were aware and accepted that the new teaching methods were the need of the hour to improve students skills, independent learning and engage them in continuous learning.

4 illus, 2 tables, 31 ref

045323   SINGH B, DESAI V, SHARMA R, KAUR K, NARANG R S, KAHLON S (Oral Medicine Dep, SGRD Institute of Dental Sciences and Research, Amritsar- 143 001, Punjab, Email: dr.balwindersingh@rediffmail.Com) : Qualitative analysis of serum estrogen, parathyroid and calcium levels in postmenopausal women with oral dryness A case control study. J Indian Acad Oral Med Radiol 2020, 32(3), 241-6.

The emergence of oral dryness unrelated to salivary flow volume has always raised many questions over the hypothesis of oral dryness in postmenopausal women. The current research article tries to focus on qualitative changes in saliva in the postmenopausal women suffering from oral dryness. To correlate the severity of oral dryness with qualitative changes in serum estrogen, serum parathyroid (PTH), serum calcium levels in postmenopausal women. This case-control study was carried out on 60 postmenopausal women with 30 forming the case groups as having oral dryness and 30 forming control group without oral dryness. The severity of oral dryness was assessed through the Xerostomia Inventory Score (XI Score). Serum estrogen and serum parathyroid levels were assessed by the ELISA method and serum calcium levels were assessed by Arsenazo III reaction using a semi-autoanalyzer in all participants. Statistical analysis was done by student’s t- test and Pearson correlation. Significant differences were observed in the mean values of serum estrogen levels, serum parathyroid levels, and XI score between the case and control groups. (P < 0.001). Serum calcium levels did not show significant variation (P= 0.385) between the groups. The correlation proved that there was an inverse correlation between estrogen levels and XI scores (r-value -0.777). The severity of oral dryness was associated with decreased levels of estrogen and increased levels of parathyroid hormones in postmenopausal women. Fall in estrogen levels is associated with an increase in oral dryness.

5 tables, 29 ref

045322   YENDLURU M S, MANNE R K, KANNAN N, BEPARI A S, ANUMULA A, PULIMI S (Oral Medicine and Radiology Dep, C.K.S.Theja Dental Coll, Tirupathi, Andhra Pradesh, Email: mercysravanthi@gmail.com) : Probiotics an adjuvant in the management of recurrent aphthous ulcer: A randomized clinical trial. J Indian Acad Oral Med Radiol 2020, 32(3), 235-40.

Recurrent Aphthous Stomatitis (RAS) is benign ulcerated lesions in the oral cavity. RAS is one of the most common ulcers and known to affect 20 % of the population Aim: To assess the efficacy of probiotics as an adjuvant to tetracyclines in the management of RAS. The study was a randomized clinical trial. Forty participants were assigned to two groups. Group 1, 20 patients received Bacillus. coagulants (Sporolac) & Tetracycline capsules 250 mg (Resteclin) twice daily for 7 days. Group 2, 20 patients received only Tetracycline capsules 250 mg (Resteclin) twice daily for 7 days. Assessment of pain, size, and average duration of the ulcer was carried out at baseline, 4th and 7th day. Comparison of the parameters between the two groups was performed using the Mann Whitney U test. The Probiotic group achieved a significant reduction in all the parameters in 4 days. Conclusion: Probiotics acts as adjuvant therapy for the treatment and management of RAS.

6 illus, 3 tables, 16 ref

045321   PATEL P S, SHAH J S, DUDHIA B B, BUTALA P B (Gujarat Univ, Ahmedabad, Gujarat, Email: purv57@gmail.com) : Presurgical assessment of alveolar ridge dimensions before dental implant procedures by opg&cbct – A comparative study based on fryback & thornbury model. J Indian Acad Oral Med Radiol 2020, 32(3), 229-34.

Replacing missing teeth is one of the most common challenges faced by the dental surgeon. The invention of dental implants has brought about a great change in successfully delivering a fixed prosthesis to the patient. Precise radiographic assessment of available alveolar bone is of prime importance for dental implant placement. Panoramic radiograph provides an overview of the jaw bones and is considered adequate in the initial evaluation of the implant site; however, they do not provide the buccolingual dimension of the implant site. CBCT provides volumetric imaging with the ability to visualize the imaged region in virtually any plane. The objective of this study was to compare panoramic radiography (OPG) with cone‑beam computed tomography (CBCT) for pre‑surgical implant site evaluation.  A total of 150 potential implant sites in 94 patients who were subjected to OPG and CBCT imaging previously were selected for the study. The height, width, and length of the available bone were measured for all the implant sites (except bone width which was measured on CBCT alone). Out of these, OPG & CBCT findings of 60 potential implant sites were evaluated by comparison with the surgical gold standard dimensions of actual dental implant placed. A comparison of all the values obtained with the two imaging modalities was done and the data was tabulated for statistical analysis. The mean value of bone height using OPG and CBCT were found to be 12.15 mm and 11.99 mm, respectively. The mean value of the length of the edentulous jaw segment using OPG and CBCT was found to be 8.10 mm and 8.98 mm respectively. The mean value of the width of the crestal bone below the height of the crest using CBCT was found to be 5.46 mm. The overall results suggested that CBCT is better in depicting the bone height and bone width as compared to OPG; however, the length of the edentulous jaw segment is better depicted by OPG as compared to CBCT.

4 tables, 24 ref

045320   VERMA P, MAHAJAN P, FARAZ S A, SRIKANTH K, RAVICHANDRA B, BATHLA N (Oral Medicine and Radiology Dep, Surendera Dental Coll and Research Institute, Srigangangar- 335 001, Rajasthan, Email: pradhuman_verma@rediffmail.com) : Evaluation of condyle fossa position and articular eminence angulation in dentate and edentate patients – A cephalometric pilot study. J Indian Acad Oral Med Radiol 2020, 32(3), 222-8.

Temporomandibular joint is a mobile synovial joint where articulated bones are separated by a joint cavity. Its functional harmony is disrupted by a long standing period of edentulousness which could be analyzed using lateral Cephalograph. To evaluate the condyle–fossa position and articular eminence angulation in dentate and edentate patients using a lateral cephalogram along a different axis. Cross‑sectional study consisted of randomly selected 40 patients with 20 dentulous patients (Group I), and age‑ matched 20 completely edentulous patients (Group II), within an age group 45–65 years. Lateral cephalograms were performed for all selected patients using single Kodak 8000C digital OPG/Ceph machine, (Rochester, New York, United States). All the radiographs were digitally traced and evaluated twice for condyle- fossa position along X and Y axis and articular eminence angulation by an Oral & maxillofacial radiologist at an interval of two days. The collected data was tabulated and analyzed using SPSS Software version 20 using unpaired t-test and tests of normality. Significant difference in condyle ‑ fossa distances along the X and Y axis in two study groups was suggestive of more upwards and forwardly placed condyles and more anteriorly placed glenoid fossae in Group II patients. Also, articular eminence angulation was noted more in edentulous patients but the difference was statistically insignificant. A great variation in condylar– fossa position was observed in the edentulous patient when compared to the dentulous patient due to remodeling or degenerative changes that occur during the period of edentulousness.

4 llus, 7 tables, 21 ref

045320   VERMA P, MAHAJAN P, FARAZ S A, SRIKANTH K, RAVICHANDRA B, BATHLA N (Oral Medicine and Radiology Dep, Surendera Dental Coll and Research Institute, Srigangangar- 335 001, Rajasthan, Email: pradhuman_verma@rediffmail.com) : Evaluation of condyle fossa position and articular eminence angulation in dentate and edentate patients – A cephalometric pilot study. J Indian Acad Oral Med Radiol 2020, 32(3), 222-8.

Temporomandibular joint is a mobile synovial joint where articulated bones are separated by a joint cavity. Its functional harmony is disrupted by a long standing period of edentulousness which could be analyzed using lateral Cephalograph. To evaluate the condyle–fossa position and articular eminence angulation in dentate and edentate patients using a lateral cephalogram along a different axis. Cross‑sectional study consisted of randomly selected 40 patients with 20 dentulous patients (Group I), and age‑ matched 20 completely edentulous patients (Group II), within an age group 45–65 years. Lateral cephalograms were performed for all selected patients using single Kodak 8000C digital OPG/Ceph machine, (Rochester, New York, United States). All the radiographs were digitally traced and evaluated twice for condyle- fossa position along X and Y axis and articular eminence angulation by an Oral & maxillofacial radiologist at an interval of two days. The collected data was tabulated and analyzed using SPSS Software version 20 using unpaired t-test and tests of normality. Significant difference in condyle ‑ fossa distances along the X and Y axis in two study groups was suggestive of more upwards and forwardly placed condyles and more anteriorly placed glenoid fossae in Group II patients. Also, articular eminence angulation was noted more in edentulous patients but the difference was statistically insignificant. A great variation in condylar– fossa position was observed in the edentulous patient when compared to the dentulous patient due to remodeling or degenerative changes that occur during the period of edentulousness.

4 llus, 7 tables, 21 ref

041740   KHAN S I R, RAO D, RAMACHANDRAN A, ASHOK B V (PAHER Univ, Udaipur, Rajasthan - 313 003, Email: dr.sulthankhan@gmail.com) : Influence of personality traits on the intensity of maximum voluntary bite force in adults. Indian J Dent Res 2020, 31(5), 706-11.

To determine the Maximum voluntary bite force among patients having different personality traits. In total, 323 patients were given the big‑five inventory (BFI) questionnaire to fill and allotted to the various personality traits. The patients in the Agreeableness (n = 62) and Neuroticism traits (n = 62) were included in the study. They were categorized into groups as Group 1a – Neuroticism male (41 patients) and Group 1b – Neuroticism Female (21 patients) and Group 2a – Agreeableness male (26 patients) and Group 2b – Agreeableness female (36 patients). Highest value of the maximal voluntary bite force (MVBF) was recorded using FlexiForce sensor (B 201) (Tekscan, USA). The statistical data were analyzed by independent t‑test (P < 0.05). The mean bite force values for Neuroticism male was 778.66 N, Agreeableness male was 699 N, Neuroticism female was 686.24 N, and for Agreeableness female was 565.47 N. Statistically significant differences in the bite forces between the male and female groups of both the groups with the males showing significantly higher bite force values in both groups was seen. Also, the bite force in Neuroticism male was significantly higher than Agreeableness male and bite force in Neuroticism female was higher than Agreeableness female. In this study, the highest bite force was seen in Neuroticism males. Additionally, this study infers that personality has significant influence on the quantum of bite force. Thus, personality assessment of the patient can assist the clinician in planning the appropriate treatment.

1 table, 19 ref

041739   AIDASANI G L, MULAY S, BORKAR A (Conservative Dentistry and Endodontics Dep, Dr. D. Y. Patil Dental Coll and Hospital, Pune, Maharashtra - 411 018, Email: gauravaidasani20@gmail.com) : Comparative evaluation of flexural fracture resistance of mandibular premolars after instrumentation with four different endodontic file systems: An in vitro study. Indian J Dent Res 2020, 31(5), 701-5.

Under axial loading, there is stress concentration around the cervical areas especially in the premolars because of their location in the arch. To evaluate and compare flexural fracture resistance of mandibular premolars after instrumentation with ProTaper®Universal, ProTaper Next®, OneShape®, and WaveOne® endodontic file systems. Seventy‑five mandibular premolar teeth with single straight canals were divided into five different groups (n = 15): Group A: Control, Group B: ProTaper Universal (PTU), Group C: ProTaper Next (PTN), Group D: OneShape, Group E: WaveOne. The teeth were instrumented as per the manufacturer’s instructions. After obturation and core placement, the teeth were placed in a customized jig mounted on a universal testing machine where force was applied at 45° on the buccal cusp and the force required to fracture the teeth was noted. Amongst all the instrumented groups, WaveOne showed the highest resistance to fracture (1065.56 ± 175.05) and the control group was 1104.13 ± 188.42. All groups showed a significant difference in the fracture load values with the control group. However, there was a statistically significant (P < 0.05) difference seen with WaveOne vs PTU and WaveOne vs OneShape. Root canals instrumented with reciprocating motion have better flexural fracture resistance than continuous rotary motion. Mandibular premolars when instrumented with ProTaper Universal and OneShape endodontic files showed similar fracture resistance, proving that dentin removal does not depend on the number of files used.

5 illus, 2 tables, 18 ref

045320   GUPTA P, NAIK S R, ASHOK L, POORNIMA R, SHETTY R (Oral Medicine and Radiology Dep, Dental Institute, Ranchi- 834 009, Jharkhand, Email: shantala_naik@rediffmail.com) : Combination of trypsin, rutoside, bromelain and diclofenac sodium in the management of internal derangement of temporomandibular joint: A randomized clinical trial. J Indian Acad Oral Med Radiol 2020, 32(3), 216-21.

Internal derangement of temporomandibular joint (TMJ) is a chronic disease which causes a considerable amount of pain and reduced chewing ability and thus compromising patients eating ability and lifestyle. This study was carried out to evaluate the clinical effectiveness of enzymes like trypsin, rutoside, bromelain, and diclofenac combination against the use of diclofenac alone in the treatment of internal derangement (ID) of TMJ. This study was done in the OPD of Oral Medicine and Radiology department at dental institute and is a randomized case-controlled clinical trial. 30 subjects were enrolled in the study by simple random sampling and were diagnosed clinically as ID and radiographically screened. They were divided into 2 groups of 15 each. Group I was given oral diclofenac sodium and group II was given an oral combination of trypsin, rutoside, bromelain, and diclofenac sodium for a span of 14 days. It was done by comparing the mean, median, and standard deviation of each variable. Comparative analysis was done using the Mann–Whitney U test, Friedman’s test, Chi-square test, Student’s t‑test, and ANOVA to find the P‑ value and confidence interval. Both the groups had reduced pain, improved chewing ability and mouth opening, and reduction in joint noise and jerky mandibular movements. Group I, patients had better results when compared to group I and the differences were highly significant. We recommend the use of a combination of enzymes and diclofenac for the management of ID of TMJ.

2 illus, 5 tables, 15 ref

041738   IYER R R, SETHURAMAN R, WADHWA M (Public Health Dentistry Dep, K. M. Shah Dental Coll and Hospital, Vadodara, Gujarat - 391 760, Email: ramya83_r@rediffmail.com) : A qualitative research analysis of gender-based parities and disparities at work place experienced by female dentists of Vadodara, India. Indian J Dent Res 2020, 31(5), 694-700.

To assess the gender‑based parities and disparities at work place experienced by female dentists of Vadodara, India. In‑depth face‑to‑face qualitative semi‑structured interviews in English were conducted among 12 female dentists of Vadodara. Female dentists working with one/more male colleague or auxiliary were selected through purposive sampling. Interviews were conducted as per Kvale’s principles and recorded using a digital voice recorder. Transcribed data was analyzed using Giorgi’s phenomenological analysis. The recurring themes identified were: (a) Striking work–family balance (b) Dependence on male authority for instating work discipline (c) Male dentists’ hostility to “woman in power” concept (d) Male dentists’ superiority in technical skills (e) privileges for women dentists. There is a need to improve the work environment of women dentists. Social support, sensitivity among male colleagues, and generous institutional policies will enable increased contribution from women to the profession.

3 illus, 2 tables, 16 ref

045319   SITARAMAN P, SHANMUGASUNDARAM K, MUTHUKRISHNAN A (Oral Medicine and Radiology Dep, Saveetha Dental Coll, Chennai- 600 077, Tamil Nadu, Email: arvindmuthukrishnan@yahoo.com) : Assessment of service quality in special care dentistry department using servqual model. J Indian Acad Oral Med Radiol 2020, 32(3), 209-15.

Special care dentistry, also known as special needs dentistry includes treating patients who are physically disabled (congenital, traumatic, and/or physiological), medically compromised (systemic, genetic, and/or acquired), and cognitive deficit (mental, sensory, emotional, and/or behavioral) who experience barriers to preventive and routine dental care. The purpose of this study was to assess the quality of treatment received by the patients in the special care dentistry department using SERVQUAL model. Setting and Design: This descriptive, cross-sectional study was conducted at the special care dentistry department, Unit of Oral Medicine and Radiology department. The study population consisted of 384 patients treated in the Special care dentistry department from December 2017 – December 2019. Each participant’s demographic data and reason for referral was recorded. Participant or the participant’s caregiver was asked to fill the expectation questionnaire of the SERVQUAL model and required dental treatment was provided. Post treatment, the participant was asked to fill up the perception questionnaire. Each question was assessed using a 5-point Likert scale. Multiple statistical analyses was done to calculate the discrepancy between perception and expectation scores which is denoted by the statistical term “Gap value.” Results: Most patients belonged to the age range of 51–60 years. The commonest reason for referral was being medically compromised. All five domains of the SERVQUAL model showed high expectation, perception scores, and positive gap values. The SERVQUAL model has been validated as an effective service assessment tool. In our study, this SERVQUAL model which was employed in the special care dentistry, Unit of Oral Medicine Department for patients with special needs showed positive expectation and perception scores in all five domains which denotes effective patient care.

4 tables, 26 ref

041737   DESAI V C, SHIRSAND S B, MALPANI A, HIREMATH S (Pharmaceutical Techonology Dep, HKES's Matoshree Taradevi Rampure Institute of Pharmaceutical Sciences, Kalburgi - 585 105, Karnatak, Email: vijaybdesai_97@yahoo.co.in) : Evaluation of mucoadhesive dexamethasone sodium phosphate gel in the treatment of arecoline-induced oral submucous fibrosis in wister albino rats: A cross-sectional study. Indian J Dent Res 2020, 31(5), 685-93.

The present work aimed to prepare an oral mucoadhesive gel of dexamethasone sodium phosphate to serve the purpose of treating oral submucous fibrosis by incorporating the drug in a polymeric matrix to facilitate the localisation of the drug at the absorption site, to prolong drug delivery and to provide patient convenience. The formulations F₁ , F₂ and F₃ were prepared using 2, 2.5 and 3 % of carboxymethyl cellulose sodium, formulations F₄ , F₅ and F₆ were prepared using 2, 2.5 and 3 % of hydroxypropyl methylcellulose, respectively, and formulations F₇ , F₈ and F₉ were prepared using equal mixtures of carboxymethyl cellulose sodium and hydroxypropyl methylcellulose in the concentrations of 1, 1.25 and 1.50 %, respectively. The prepared formulations were subjected for screening of physicochemical parameters, viz, homogeneity, grittiness, viscosity studies, spreadability, extrudability, mucoadhesive strength, pH, drug content uniformity, in vitro drug diffusion, Fourier transform infrared spectroscopy spectral analysis and stability studies. Among the nine formulations prepared, the formulation F8 containing 1.25 % carboxymethyl cellulose sodium, 1.25 % hydroxypropyl methylcellulose having a mucoadhesive strength of 12.600 ± 0.01 g and drug release of 88.473 ± 0.457 % was considered as the promising one and was further used for in vivo study. Oral application of the gel for 4 months in arecoline‑induced oral submucous fibrosis rats showed more than 80 % reduction in fibrosis. The histopathological results supported these findings.

8 illus, 7 tables, 25 ref

041736   VIGNESH R, PRIYADARSHNI I, SUKANYA T (Pediatric and Preventive Dentistry Dep, Saveetha Univ, Chennai, Tamil Nadu, Email: dhanam61@yahoo.co.in) : Efficacy and feasibility of usage of hand signals during dental procedure among students in a dental institute in Maduravoyal, Chennai: A cross-sectional study. Indian J Dent Res 2020, 31(5), 678-84.

To assess the efficacy of the usage of hand signals during a dental procedure among students in a dental institute. 268 students and their allotted patients from a dental institute were taught about hand signals (DentiSign) that can be used for communication during dental procedures. During the first dental visit, a pretested questionnaire was provided to students, before and after the treatment procedure, to assess the change in fear and anxiety in their patients. This protocol was followed for the second consecutive visit. The questionnaires were collected and subjected to statistical analysis. McNemar’s test was used to analyze the responses for the questionnaire before and after treatment during the first and second visits. By the end of the first visit, 45.75 % students felt that using hand signals can make patients feel comfortable and 35.68 % students felt that the practitioner will be able to understand patients’ fear and anxiety, which were statistically significant. By the end of second visit, the response increased significantly to 92.17 % and 94.66 %, respectively. A reduction in treatment time was also perceived by the students but was not statistically significant. Use of hand signals during dental treatment can be an option in reducing anxiety and fear for the patients. They can also help in effective communication during the treatment procedure and may help in reducing treatment time.

1 illus, 6 tables, 12 ref

041735   SURYANI H, GEHLOT P M, MANJUNATH M K (Conservative Dentistry and Endodontics Dep, JSS Dental Coll and Hospital, Mysuru - 570 015, Karnataka, Email: dr.parasmullj@jssuni.edu.in) : Evaluation of the remineralisation potential of bioactive glass, nanohydroxyapatite and casein phosphopeptide-amorphous calcium phosphate fluoride-based toothpastes on enamel erosion lesion –an ex vivo study. Indian J Dent Res 2020, 31(5), 670-7.

Erosion, a dynamic process with periods of demineralisation and remineralisation, has become a common problem in modern societies, owing to changes in life style and dietary habits. Although fluorides have been included in toothpastes that claim to prevent demineralisation and aid remineralisation, their ability to remineralise is limited by low concentration of calcium and phosphate ions available in saliva. Hence, a new paste based on casein phosphopeptide‑amorphous calcium phosphate fluoride (CPP‑ACPF), nanohydroxyapatite and bioactive glass (BAG) were introduced. To evaluate and compare the effects of BAG, nanohydroxyapatite and CPP‑ACPF pastes on surface microhardness of demineralised enamel. 48 enamel specimens were randomly divided into five groups: Group I positive control ‑ intact specimens and Group II ‑  demineralised specimens. The test groups, Group III, IV and V, comprised CPP‑ACPF, nanohydroxyapatite and BAG, respectively. The test specimens were demineralised with 0.1 % citric acid followed by remineralisation using either of the three prepared slurries. The specimens were subjected to pH cycling regime for 15 times. The remineralisation potential of the specimens was studied by evaluating the surface microhardness. One specimen from each group was analysed under SEM. Data was tabulated and analysis performed by one way ANOVA and post hoc Scheffe test. Statistically significant difference was found between the negative control and three test groups based on microhardness evaluation. Nanohydroxyapatite had the least remineralising potential as compared to CPP‑ACPF and BAG. Comparatively, BAG and CCP‑ACPF paste showed better remineralising potential.

1 illus, 2 tables, 46 ref

041734   BALAGOPAL S, CHANDRASEKARAN C (Conservative Dentistry and Endodontics Dep, Tagore Dental Coll and Hospital, Chennai - 600 127, Tamil Nadu, Email: sbalagopal@hotmail.com) : Structure bound guide to access cavity preparation for molar root canal treatment. Indian J Dent Res 2020, 31(4), 621-4.

A good access cavity preparation is the gateway to success in endodontic treatment. This article presents occlusal landmarks that can be used as the boundary for the endodontic access at the occlusal surfaces of maxillary and mandibular molars. Further this article gives a structure or landmark guided three simple stages of preparation to reach the pulp chamber. This assures an ideal access cavity reducing the risk of dentin gouging and eliminating iatrogenic deleterious events. All canal orifices will be within this boundary and can often be located easily.

4 illus, 8 ref

041732   KRISHNAN V G, KAILASAM V, CHITHARANJAN A B (Orthodontics Dep, Sri Ramachandra Univ, Porur - 600 116, Chennai, Email: drvgkrishnan@gmail.com) : Effects of haemostatic agents on bond strength – an in vitro study. Indian J Dent Res 2020, 31(4), 585-8.

To evaluate and compare the effect of contamination with haemostatic agents like Tranexamic Acid (TA) and Ethamsylate, on the shear bond strength. There are about 100 extracted human premolars randomly segregated into four groups each consisting of 25 samples. Group I was bonded with Transbond, Group II was bonded with Transbond after blood contamination, while groups III and IV were bonded with Transbond after contamination with Tranexamic acid and the shear bond strength was measured. The data were compared by One‑ way ANOVA and Tukey (HSD) tests. Group I had the highest shear bond strength (SBS) while Group II, where the teeth were contaminated with blood showed the least SBS values ANOVA indicated significant differences between the four groups (P <.05). Tukey HSD revealed that contamination with TA (Group III) had a statistically higher SBS that contamination with Ethamsylate (Group IV) (P <.05). Since tranexamic acid and ethamsylate reduces the bleeding when used during surgery, these haemostatic agents may be considered in bonding situations where blood contamination is anticipated.

3 tables, 21 ref

041731   NASIRI K, WRBAS K-T (Endodontics Dep, Danube Private Univ (DPU), Krems, Austria, Email: dds.nasiri@web.de) : Comparison of the efficacy of different Ni Ti instruments in the removal of gutta-percha and sealer in root canal retreatment. Indian J Dent Res 2020, 31(4), 579-84.

To evaluate and compare the efficacy of four rotary instrumentation systems in root canal retreatment and to determine retreatment time. To achieve the purpose of this study, canals of 60 distal roots in mandibular molar teeth were selected and randomly divided into four groups A, B, C and D (n = 15). Using step‑back technique, the canals were prepared and filled with gutta‑percha and AH Plus employing cold lateral compaction technique. The root filling material was removed with the following retreatment systems: Group A: Mtwo R, group B: D‑RaCe, group C: ProTaper R and group D: R‑Endo. In order to record retreatment time, a stopwatch was used. The samples were split longitudinally, examined under a stereomicroscope, photographed and assessed with AutoCAD software. Finally, the percentages of remaining filling material were calculated and the extracted data were analyzed using one‑way ANOVA and Tukey HSD test. All examined groups showed traces of remaining filling material within the canals. No statistically significant difference was found among the four groups in the coronal, middle, and apical thirds. The same result was obtained with regard to retreatment time (P > 0.05). However, within each one of the groups, significant difference was observed in the three regions (P < 0.05). Based on the findings of this study, none of the examined systems could completely remove root filling material from the root canals. However, they were all found to be effective in this regard. The most amount of remaining filling material was found in the apical third.

3 illus, 2 tables, 30 ref

041730   ANUSHA K, SRIDEVI E, SANKAR A J S, SRIDHAR M, SANKAR K S, CHOWDARY K H (Pedodontics and Preventive Dentistry Dep, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, Email: saisamata@gmail.com) : An in vitro evaluation of biodegradability of stainless steel crowns at various salivary pH. Indian J Dent Res 2020, 31(4), 569-73.

To evaluate the biodegradability of preformed stainless steel crowns at varying salivary pH and the cytotoxic effect of leached out elements on fibroblasts. A total of 243 stainless steel crowns were selected and were divided into 3 groups (I, II, III) based on Ph of immersion media. The pH of samples in group I, II, III were 4.3, 5.5 and 6.3 with 81 crowns in each group. Each group has 9 samples with 8 crowns in each sample. All samples were immersed in polyethylene bottles containing 10ml of artificial saliva and incubated at 37°C for 4 weeks. All the samples were analyzed on 1,7,14 and 21 days by atomic absorption spectrophotometer for the quantitative assement of Ni, Cr and Fe. Fibroblast tissue culture was used to assess the cytotoxicity of the samples. Analysis of variance. Maximum release of Ni, Cr, Fe ions were observed at pH 4.3 followed by pH 5.5 and least release of ions were observed at pH 6.3 from SS crowns. The cytotoxic results showed that the least cell viability of cells was seen at pH 4.3. With decrease in pH, there is an increase in ion release from stainless steel crowns and the mean release of nickel, chromium and iron were very much below the average dietary intake. But the allergic manifestations of ions like nickel can’t be ruled out.

1 illus, 1 table, 19 ref