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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 15 | Issue 1
Page Nos. 1-98

Online since Tuesday, March 9, 2021

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EDITORIAL  

The journey of COVID-19 vaccine: From despair to hope p. 1
NK Sahoo
DOI:10.4103/0973-4724.276413  
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ORIGINAL ARTICLES Top

Association between oral health and alcoholic liver disease - A cross-sectional analytical study Highly accessed article p. 5
Sreekanth Bose, R Yashoda, Manjunath P Puranik
DOI:10.4103/JODD.JODD_4_20  
Background: Alcoholic liver disease (ALD) is a condition with compromised immunity and dental foci can act as a potential source of infection. Aims and Objectives: This study was conducted to assess and compare the oral health among patients with alcoholic liver disease with healthy individuals and to determine an association between oral health and alcoholic liver disease. Materials and Methods: A cross-sectional analytical study assessed 100 participants with ALD and 100 age and gender matched subjects. Demographic details, laboratory investigation results, medical, dental & family history, oral hygiene practices, information about tobacco and alcohol habits were collected. Caries, periodontal disease, oral mucosal lesions and intervention urgency were assessed using WHO (2013) criteria. Descriptive and inferential statistics were used. A p <0.05 was considered as significant. Results: Mean age of participants in ALD and control groups were 43.71 ± 6.79 and 42.82 ± 6.23 years respectively. Caries experience (DMFT) was higher in ALD group (11.55±12.29) than comparison group (8.2±8.89) (p=0.001) giving an association with age of onset of alcohol abuse. Periodontal health was poor among ALD group with more teeth with gingival bleeding, shallow or deep pockets and loss of attachment giving an association between age of onset, duration of disease since diagnosed and MELD score. Among ALD group 7% had leukoplakia. Association was found between oral mucosal lesion and duration of disease since diagnosed and MELD score. Conclusion: Oral health was poor among ALD group than comparison group. Dental caries was associated with alcohol abuse and oral mucosal lesion was associated with alcoholic liver disease whereas periodontal disease was associated with alcohol abuse and alcoholic liver disease.
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Predicting preformed molar band sizes: Guess to reality p. 11
Sanjeev Datana, Saugat Ray
DOI:10.4103/JODD.JODD_6_20  
Aim: This cross sectional descriptive study aims at finding the sizes of preformed molar bands of five different companies to provide a reference data. Method: Assorted boxes of five different companies were selected randomly based on the easy availability of the brands in the market. The mesiodistal and labiolingual dimensions of the preformed bands were measured and the spreadsheet was created. Statistical evaluation was carried out. One way ANOVA was conducted which revealed overall inner area of bands of a particular size for all the five brands mentioned in the study was almost similar. Results: One way ANOVA was conducted which revealed overall inner area of bands of a particular size for all the five brands mentioned in the study was almost similar. Conclusions: A reference chart had been created for future compliance during banding procedures.
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Impact of occupation on oral health outcomes following third molar surgery p. 15

DOI:10.4103/JODD.JODD_27_20  
Context: The removal of third molar is advised in patients whose occupation precludes ready access to oral health care; however, there is a lack of directly applicable clinical research. Aims: The aim of this study is to assess the outcomes of impacted third molar removal on oral health-related quality of life in these patients. Settings and Design: The prospective study included 178 armed forces personnel who underwent the extraction of symptomatic impacted third molars at Military Dental Center over a 1-year period. Subjects and Methods: Oral health impact profile (OHIP-14) was utilized to analyze the outcomes before surgery and on postsurgical days 1, 7, and 14. Prevalence, extent, and severity scores were calculated. Statistical Analysis Used: The comparison of severity outcomes was analyzed by means of Friedman's test and Wilcoxon signed-rank test. Results: The present study revealed “painful aching in your mouth”, “uncomfortable to eat foods”, “diet been unsatisfactory,” “difficult to relax,” and “difficulty doing usual jobs” were reported “fairly often” or “very often” presurgery by 84%, 25%, 37%, 44%, and 17%, respectively. The median number of all 14 OHIP items reported “fairly often” or “very often” presurgery was 2 (IQ 1, 5.5). Prevalence, extent, and severity scores were the highest on postsurgical day 1 and decreased by postsurgical day 7 and 14. Comparison of severity outcomes revealed a statistically significant increase on postsurgical day 1 followed by significant reduction thereafter. Conclusions: Extraction of symptomatic impacted third molars significantly improve oral health-related quality of life in patients whose occupation dictate that they have to work in conditions isolated from expert treatment.
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Efficacy of platelet-rich fibrin on pain, edema, and healing in mandibular third molar surgery: A split-mouth randomized study Highly accessed article p. 21
ID Roy, Vivek Saxena, BK N Babu, Sadhana Jayanth Perumal
DOI:10.4103/JODD.JODD_48_20  
Context: The postoperative sequelae after third molar surgery include pain, swelling and trismus, distal bone loss along with prolonged sensitivity due to root exposure or increased probing depth. Platelet rich fibrin (PRF) appears to accelerate physiologic healing due to the development of effective neovascularization, accelerated wound closing with fast cicatricial tissue remodelling and reduced incidence of infectious events. The mechanism of action of PRF on pain and edema is not fully understood and it is possible that this effect could be a reflection of better and faster healing of the socket. Aim: The aim is to assess the influence of PRF on pain, edema, and wound healing of the socket after surgical extraction of mandibular third molars. Settings and Design: This randomized controlled study was conducted on 60 patients with bilateral impacted mandibular third molars, reporting to the Department of Oral and Maxillofacial Surgery, Army Dental Centre (Research and Referral). Subjects and Methods: Surgical removal of the impacted mandibular molars of both sides was planned with a gap of 4 weeks between the two sides and appointments were given accordingly. Study side-Surgical extraction followed by placement of PRF in socket and closure and control side-Surgical extraction followed by closure. Statistical Analysis: Preoperative and postoperative measurement of visual analog scale scores for pain, edema, interincisal opening, and gray level histogram values of orthopantomograph was subjected to statistical analysis. The normality of data was analyzed using the Kolmogorov–Smirnov test. The Mann–Whitney U and Wilcoxon Signed-Rank tests were used to check mean differences. Results: We observed a reduction in pain and swelling with improvement in interincisal and greater reduction in pocket depth distal to the second molar on the PRF side. Soft-tissue healing index scores and gray level histogram values for the study side were higher compared to the control side. Conclusions: Further clinical studies to evaluate and assess the applications of PRF in maxillofacial surgery are needed.
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Comparative evaluation of cervical vertebrae maturation index and stages of mandibular second molar calcification: A cross-sectional study p. 31
Ashutosh Bhardwaj, Abhijit A Kadu, B Jayan, Neetu Kadu, Uday R Kamat
DOI:10.4103/JODD.JODD_55_20  
Aim: This study aims to evaluate the relationship between stages of mandibular second molar calcification and cervical vertebrae maturity (CVM) staging for the assessment of pubertal growth spurts in patients. Materials and Methods: Pretreatment panoramic and lateral cephalometric radiographs of 400 patients (200 males and 200 females) were evaluated to ascertain the association of Demirjian index (DI) and CVM method. Results: A highly significant correlation between Cervical vertebrae maturation Index (CVMI) and DI was calculated using Sakoda adjusted Pearson contingency coefficient (r) and a positive correlation was found between CVM and DI in male samples as r = 0.785 and female sample as r = 0.803. Conclusion: A highly significant correlation (r = 0.785 for male subjects and 0.803 for female subjects) was found between DI and CVMI and female subjects showed a higher correlation between skeletal and dental maturity compared to male subjects.
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Knowledge and awareness of prosthodontic treatment requirements among partially edentulous patients of the armed forces: An observational study p. 38
MP Shashidhar, EM Gowda
DOI:10.4103/jodd.jodd_61_20  
Background: Prosthodontic rehabilitation of the partially edentulous patients is one of the important treatment modalities carried out in outpatients departments of Armed Forces Dental Centers. Removable partial dentures, fixed dental prosthesis, and implant-supported prosthesis are the options available for the rehabilitation of the partially edentulous patients. Knowledge and awareness about the prosthetic rehabilitation varies between the individuals and has been largely unobserved and less reported in the literature. The aim of this study was to evaluate the knowledge and awareness of the partially edentulous patients of the armed forces about different options available for prosthetic rehabilitation in general and implant prosthesis in particular. Subjects and Methods: The study included 546 partially edentulous participants who reported to one of the tertiary care dental centers of the armed forces requiring prosthodontic rehabilitation. A self-explanatory questionnaire containing the personal particulars, various options available for the replacement of the missing teeth, and advantages and disadvantages of all the options including dental implants were asked to all the participants. Data were fed into Microsoft Excel® sheet and analyzed using statistical software SPSS. Results: More than half of the participants were unaware of their edentulous state, treatment options available for them, and advantages and disadvantages of available treatment modalities. Conclusion: The results of the study bring about the further requirement of patient education in increasing their knowledge and awareness, which will enable them to make informed decision in choosing appropriate treatment modality in consultation with the treating prosthodontist.
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REVIEW ARTICLES Top

Implication of taurodontism in orthodontic diagnosis and treatment planning: A review and case report p. 43
Sanjeev Datana, Shiv Shankar Agarwal, SK Bhandari, Dhruv Jain
DOI:10.4103/JODD.JODD_7_20  
Taurodontism is defined as lack of usual constriction at the cement-enamel junction, elongated pulp chambers with apical displacement of pulp floor. Affected tooth may not exhibit any characteristic morphologic trait for clinical recognition and require radiologic diagnosis. A special attention is required while planning any treatment for affected tooth. Present article highlights the important of early diagnosis of taurodntism in orthodontic treatment planning. A case report is presented with diagnosis of taurodontism affecting multiple teeth in both maxillary and mandibular arch.
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Forensic odontology: An inseparable aspect of military dentistry p. 47
Sudip Indu, Vineet Singh Cheema, B Jayan, Rajat Mitra, Dinesh Chaudhary
DOI:10.4103/JODD.JODD_47_20  
Forensic odontology is a subdiscipline of dental science which involves a multidisciplinary approach for handling forensic dental evidence and presents it to the Court of Law. Its application to the Armed Forces is also vital, considering the varied role assigned to them. Military personnel are exposed to multiple eventualities such as fatality or captivity where the recognition or confirmation of their identity is absolutely critical. Dental features and their innumerable combinations can be unique to an individual, and the same can be utilized as a postmortem profile to compare to an antemortem dental database if it exists. It is imperative for the Armed Forces to make robust arrangements in terms of infrastructure and technical expertise such that this branch of dentistry can be utilized to its full potential. Establishing a dedicated forensic odontology laboratory will be a step in the right direction.
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Clinical applicability of three-dimensional plates in mandibular angle fractures - A review p. 51
R Arunkumar Shadamarshan, Sanjay Kumar Roy Chowdhury, Vivek Saxena, K Rajkumar
DOI:10.4103/JODD.JODD_8_20  
Fractures involving the angle of the mandible has been a long-term controversy next only to the condylar fractures. Several methods and hardware configurations exist in literature with its attendant advantages and disadvantages. A study was conducted to provide a comprehensive review of existing literature regarding the utility of three-dimensional plates (3DPs) in the management of mandibular angle fractures (MAFs). Electronic database was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines without date and language restrictions. The inclusion criteria were human studies in the form of randomized control trials, non-randomized trials and comparative studies, retrospective studies, prospective studies, and observational studies with at least one of the treatment arms including management of MAF using 3DP. Case reports/case series, technical notes, letters to the editor, studies which do not report the results of MAF management with 3DP separate from other fractures of the mandible, and laboratory/model/computer simulation-based/ animal studies were excluded. The relevant data of the selected articles were tabulated and compiled for review. Twenty-seven articles were included in the review among which 3 were systematic reviews, 12 were found to be observational studies in a prospective or retrospective manner without controls, and 12 were comparative studies with a control group. Based on the review, it can be concluded that 3DP in MAF can be used as an effective alternative to standard miniplates with comparable clinical utility if not superior but with a definite inclination toward less complications.
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CASE REPORTS Top

Intraoperative dislodgement of throat pack into esophagus and its management p. 61
Yuvraj Issar, SK Bhandari, Indranil Deb Roy, Daljinder Singh Bagga
DOI:10.4103/JODD.JODD_5_20  
Throat packs are commonly used in Intra-oral and Maxillofacial surgical procedures to prevent fluids, particulate matter as well as foreign bodies from entering into the aero-digestive tract. The pack is usually placed following endotracheal intubation which involves packing it around the Endotracheal tube (ETT) in the Oropharyngeal region as a reinforcement measure. The need for such a pack arises due to a variety of reasons such as, volumetric change in the airway resulting from a change in the tissue turgor and reducing pressure of the ETT cuff, which may result in the seepage of fluids into the airway, resulting in an emergency. If a throat pack has been inserted but not removed at the end of a procedure, then the obvious danger is that the retained pack may cause airway obstruction. We present an interesting case of a missing pharyngeal throat pack at the end of an operation. The insertion of the throat pack must be documented in the patient safety checklists well as prominently displayed to ensure proper removal at themed of surgery. If the pack is missing its location must be verified before extubating the patient as was in our case where the prudent and prompt action of the Anaesthetic and Surgical team prevented a major complication. This case report represents an interesting case of a missing pharyngeal throat pack at the end of an operation.
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Comprehensive management of severe skeletal Class III malocclusion through a combined surgical and orthodontic approach p. 64
C Thiagu, Ratna Parameshwaran, Selva A Arockiam, Devaki Vijayalakshmi
DOI:10.4103/JODD.JODD_17_20  
Management of skeletal Class III malocclusion requires a comprehensive approach since several factors such as severity of reverse overjet and facial divergence govern the treatment plan. Management of the nongrowing skeletal Class III individual with moderate-to-severe skeletal discrepancy is either by surgical management or orthodontic camouflage. Although various reports emphasize that both the treatment options are equally successful, the degree of correction which can be achieved differs. This report describes the comprehensive management of a case of severe skeletal Class III malocclusion through a combined surgical-orthodontic approach.
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New era of digital impressions and computer-aided designing/computer-aided manufacturing technology in fixed dental prosthetics p. 70
Kirandeep Singh, Poonam Prakash, R Vijaya Kumar, Rahul Bahri
DOI:10.4103/JODD.JODD_28_20  
Rehabilitation of in esthetic zone with fixed dental prosthesis (FDP) is the gold standard in the field of prosthodontic dentistry. Various impression materials have been used for impression making depending upon the type of prosthesis. The fabrication of FDP using conventional technique has been followed since long time. It is an elaborate and laborious procedure involving multiple steps wherein there are the chances of error incorporation in the final prosthesis. It may lead to distortion and misfit of final prosthesis. In the present era of dentistry, digitization in the form of direct metal laser sintering, computer-aided designing (CAD), and computer-aided milling, rapid prototyping has taken over many clinical and laboratory procedures to minimize or avoid the inaccuracies. Digital impressions and CAD/computer-aided manufacturing (CAM) alleviate the use of impression materials which can undergo distortion, fabrication of working models, and various other dental laboratory procedures involved in the fabrication of prosthesis. This case report describes the fabrication of FDP using digital impressions with intraoral scanner and CAD/CAM.
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COVID SPECIAL SECTION: COMMENTARY Top

Coronavirus disease-2019 – Frontline dental care: Experience of government dental establishments p. 74
Sukhbir Singh Chopra, NK Sahoo
DOI:10.4103/JODD.JODD_51_20  
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COVID SPECIAL SECTION: ORIGINAL ARTICLES Top

Changing paradigm of dentistry: Innovations and management in INHS Sanjivani during pandemic crisis p. 77
MM Dempsy Chengappa, AN Anand, Saugat Ray, Dhruv Sharma, A Navin Kumar
DOI:10.4103/jodd.jodd_64_20  
Introduction: March 11, 2020, when the WHO announced the COVID-19 as a pandemic, the whole world went into a panic. This was more so among the health workers and even higher among the dental health-care providers as we are at the highest risk of infection inherently as we are in close proximity with the patients' fluids and have multiple procedures which cause aerosol generation. However, as time passed and more understanding of the disease was obtained, guidelines were devised based on these findings. Objective: To emphasise the protocols and procedures required to be followed to safely carry out the procedures in the background of COVID 19 pandemic. This article looks at how the dental center at INHS Sanjivani has managed to keep the outpatient department (OPD) running and at the same time has successfully prevented patient to patient and patient to health worker spread of COVID-19. Conclusion: The precautionary procedures and procedures instituted resulted in reducing the chances of spread of the pandemic. These protocols may be useful for application in future with an aim to reduce spread through the dental operatory while providing quality care.
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Covid-19 and delivery of dental health care services at Army Dental centre Research & Referral: A holistic assessment p. 83
Dinesh Chander Chaudhary, B Jayan, Manish Mukherjee, Rajat Mitra, Vivek Saxena, Dinesh Kumar, Sudip Indu, Amit Khatak, Mohit Sharma, K Megala, Twinkle Rathore, V Jackson
DOI:10.4103/jodd.jodd_68_20  
Background: The practice of dentistry has been worst affected in Covid-19 pandemic due to its non-emergency nature and fear of rapid spread of disease through aerosol generating procedures. But, multiple dental problems can severely compromise function. This assumes even greater significance when it concerns the health of Armed Forces. ADC (R&R) was always at the forefront providing essential, urgent and scheduled dental care at various stages of pandemic with stringent management protocols. Aims and Objectives: To evaluate challenges, measures and the outcome in delivery of dental services based on observational assessment from 20 Mar-30 Nov 2020. The objectives were to assess patient attendance trends, reason for availing dental services, loss of manhours, antibiotic usage, Covid protection measures and resources, aerosol generating procedures, Knowledge/Attitude/Perception (KAP) studies, Covid-19 casualties, management of quarantine periods. Materials and Methods: Patients and staff data based on attendance, treatment instituted, patient screening procedures, additional expenses on Covid related resources, infrastructural changes etc. Results and Conclusion: The total of 13,046 patients were treated. There has been a considerable loss of manhours and more than 65% of the allocated budget was used in managing patients which otherwise were less than 25-30% of the pre-covid attendance. The manpower requirements tripled and the housekeeping services were heavily taxed. The staff Covid-19 casualties were considerably low and no patient reported acquiring Covid-19 infection post dental treatment at this centre. If the condition persisted, the ability to provide dental health care services will be an uphill administrative and financial challenge.
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COVID SPECIAL SECTION: REVIEW PAPER Top

COVID-19 preparedness and response plan for the dental laboratory workplace in armed forces p. 92
EM Gowda, Prashant Awasthi, NK Sahoo
DOI:10.4103/jodd.jodd_66_20  
Introduction: The outbreak of coronavirus disease (COVID-19) caused by Novel Coronavirus Pneumonia SARS-CoV-2 has necessitated the reinforcement of infection control measures in the dental clinic and prosthetic laboratory setting. These precautions are mandatory to cease any transmission of COVID-19 to the clientele or dental health care workers. Risk assessment is conducted for all steps of dental laboratory processes of prosthesis fabrication viz. preprocessing, processing and postprocessing. Standard precautions must be followed at all times when laboratory staff handles clinical impressions or appliances at various clinical and laboratory stages which may contain infectious microorganisms. Standard precautions must include social distancing and hand hygiene along with the use of personal protective equipment. In the preprocessing phase, all impressions, models and prosthesis should be handled as per Occupational Safety and Health Administration guidelines. They are collected in appropriate containers and are decontaminated by appropriate disinfectant before transporting them for fabrication. There should be the minimal formation of aerosols ensured while undertaking all technical procedures of processing. Adequate decontamination of all the prostheses should be carried out using 1% sodium hypochlorite in the post-processing phase. About 65%–70% ethanol or hydrogen peroxide (0.5%) is used for surface disinfection. All biomedical waste generated should be disposed as per state and national guidelines. Conclusion: The dental prosthetic laboratory biosafety measures are important to minimize the risk of laboratory transmission of COVID-19 to health-care workers.
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LETTER TO EDITOR Top

Well begun is half done! Substantial progress toward whole-tooth regeneration p. 97
Saniya Masood, Deepak Sharma, Nishant Negi
DOI:10.4103/JODD.JODD_57_20  
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