Unraveling the Molecular Mechanisms of Activated Protein C (APC) in Mitigating Reperfusion Injury and Cardiac Ischemia: a Promising Avenue for Novel Therapeutic Interventions

Ischemic heart disease, which results from plaque formation in the coronary arteries, hinders the flow of oxygenated blood to the heart, leading to ischemia. Reperfusion injury remains a significant challenge for researchers, and the mechanisms underlying myocardial ischemia-reperfusion injury (MIRI) are not entirely understood. The review directs future research into potential targets in clinical treatment based on our present understanding of the pathophysiological mechanisms of MIRI. The study provides insights into the mechanisms underlying MIRI and offers direction for future research in this area. The use of targeted therapies may hold promise in improving cardiac function in the elderly and minimizing the adverse effects of revascularization therapies. The purpose of this review is to analyze the role of activated protein C (APC) in the pathogenesis of ischemic heart disease, heart failure, and myocardial ischemia-reperfusion injury, and discuss the potential of APC-based therapeutics.

Mandibular guiding flange prosthesis to guide mandibular deviation following partial mandibulectomy and partial maxillectomy for squamous cell carcinoma: A case report

ABSTRACT

Squamous cell carcinoma is one of the most prevalent cancers affecting the oral cavity. Rehabilitation following surgical treatment requires a multidisciplinary approach and care. Multiple disabilities such as dysarthria, dysphagia, unesthetic appearance, and psychosocial disorders following the surgery for carcinoma can greatly impact the quality of life of such patients, thereby necessitating multidisciplinary intervention. The clinician has to wait for the healing of the lesion and the effects of radiotherapy to be dwindled in case a secondary osseous grafting is planned. During this time lag until a more definitive prosthesis is planned, an interim prosthesis is must to correct the mandibular deviation due to the unilateral muscular pull. This case presentation describes the utilization of guiding flange prosthesis (GFP) as an interim modality for the establishment of a stable and functional maxillomandibular relationship following combined ipsilateral partial mandibulectomy and maxillectomy.

A comprehensive review on the risks assessment and treatment options for Sarcopenia in people with diabetes

Objectives

This comprehensive review aims to examine the reciprocal interplay between Type 2 diabetes mellitus (T2DM) and sarcopenia, identify prevailing research gaps, and discuss therapeutic approaches and measures to enhance healthcare practices within hospital settings.

Methods

A thorough literature review was conducted to gather relevant studies and articles on the relationship between T2DM and sarcopenia. Various databases were searched, including Google Scholar, PubMed, Scopus, and Science Direct databases. The search terms included T2DM, sarcopenia, inflammation, insulin resistance, advanced glycation end products, oxidative stress, muscle dimensions, muscle strength, muscle performance, aging, nutrition, hormone levels, and physical activity. The collected articles were critically analysed to extract key findings and identify gaps in current research.

Results

The prevalence and incidence of metabolic and musculoskeletal disorders, notably T2DM and sarcopenia, have surged in recent years. T2DM is marked by inflammation, insulin resistance, accumulation of advanced glycation end products, and oxidative stress, while sarcopenia involves a progressive decline in skeletal muscle mass and function. The review underscores the age-related correlation between sarcopenia and adverse outcomes like fractures, falls, and mortality. Research gaps regarding optimal nutritional interventions for individuals with T2DM and sarcopenia are identified, emphasizing the necessity for further investigation in this area.

Conclusions

The reciprocal interplay between T2DM and sarcopenia holds significant importance. Further research is warranted to address knowledge gaps, particularly in utilizing precise measurement tools during clinical trials. Lifestyle modifications appear beneficial for individuals with T2DM and sarcopenia. Additionally, practical nutritional interventions require investigation to optimize healthcare practices in hospital settings.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01262-w.

Knowledge, Attitude, and Perception of Undergraduate Dental Students on Information and Communication Technology and Computer-assisted Learning

Introduction

The use of information and communication technology (ICT) in education and clinical purposes is growing immensely. The usage skill, attitude of dental students, and difficulties faced by students are important concerns to be addressed.

Objective

The study was designed to investigate the knowledge, attitude, and skills of ICT of undergraduate dental students via assessing the ease of computer and internet use among students, the level of computer skills and training of the students, and usage pattern of computer activities.

Materials and methods

A cross-sectional survey was conducted among students of three dental colleges in Haryana using a self-designed questionnaire having sections related to demographics, devices, softwares and search engine usage, ICT skills, ICT attitude, and educational and social use.

Results

The response rate was 81.96%. A total of 99.1% of the individuals responded affirmatively to the usage of mobile phones, 48.4 and 13.1% for laptops and tablets, respectively. The average duration of use of smartphones per day was 4.2121 ± 2.834 hours. Google was opted as the most popular search engine used and PubMed the least popular. Only 12.9% of participants showed a negative attitude toward the use of ICT in studies. More social use than academic use was observed. Attitude scores showed a significant correlation with the educational use of ICT (r = 0.89, p = 0.003).

Conclusion

Most of the participants were well acquainted with the usage and had a positive attitude toward ICT for educational purposes. Sensitization and training in scientific literature search and basics of ICT and their practical utilization in dental education, research, and practice should be included in the curriculum.

How to cite this article

Sikka N, Arya L, Bala S, et al. Knowledge, Attitude, and Perception of Undergraduate Dental Students on Information and Communication Technology and Computer-assisted Learning. Int J Clin Pediatr Dent 2023;16(5):711-715.

Effect of Liquorice Candies on Remineralization of Initial Enamel Carious Lesion

Background

Glycyrrhiza glabra (G. glabra), known as liquorice root is one such herbal remedy that has been shown to have immense potential in the treatment of orofacial diseases.

Aim

To evaluate the remineralizing potential of liquorice extract on initial enamel carious lesions.

Materials and methods

An in vitro and in vivo study was conducted, wherein the sound-extracted human premolars were sectioned longitudinally and into enamel blocks of size 4 × 4 mm. Enamel blocks were demineralized to produce artificial carious lesions. In vitro study, the demineralized enamel block was exposed to artificial saliva for 5 minutes and artificial saliva containing liquorice for 4 minutes 14 times in a sequential manner. An in vivo study was carried out on six volunteers aged between 6 and 12 years. The demineralized enamel block was inserted into the 5 × 5 mm window created on the full palatal coverage appliance. Patients were given commercially available liquorice candies (Ricola) to consume for 7 days twice daily. The remineralization potential of liquorice on demineralized enamel block was assessed using confocal microscopy analysis.

Results

Liquorice extract containing candies showed visual remineralization of the demineralized area on the enamel surface through confocal images.

Conclusion

Liquorice extract possesses remineralizing potential with its other medicinal properties.  .

How to cite this article

Pooja HR, Nagar P, Mascarenhas AN, et al. Effect of Liquorice Candies on Remineralization of Initial Enamel Carious Lesion. Int J Clin Pediatr Dent 2023;16(S-1):S33-S38.

Survival and Complications of Single Dental Implants in the Edentulous Mandible following Immediate or Delayed Loading: A Randomized Controlled Clinical Trial

Introduction

The lifespan of an edentulous mandible with one median implant to hold a full denture for 24 months was evaluated to see if the early loading had any impact on it. Single-implant denture retention for the mandibular region was proposed by "Cordioli et al. in the 1990s.

Objectives

Whether rapid loading and placement of a "single median implant" may result in the implant survival rate comparable to rehabilitation with a single implant and second-stage surgery.

Methods

It was found that 81 of the 158 implant recipients had quick loading, whereas the rest had delayed loading (77 patients). Patients in the context of "delayed loading group" had follow-up appointments at 1 month, 4 months, 12 months, and 24 months. In addition, the nine implants failed in the 3 months after loading in a quick loading group, while just one implant failed before loading. Median implant survival at 2 years was the study's main goal. Direct loading had a 7% fatality rate advantage over traditional loading because of the alleged advantages of immediate loading, including the avoidance of second-stage surgery. Prosthetic problems were evaluated using Fisher's exact test.

Results

A higher rate of implant survival was not seen when implants were loaded more quickly (P = 0.81). A statistically significant difference (P = 0.019) was seen in implant survival between the therapy groups.

Conclusion

Single implant loading in an edentulous mandible has a worse survival rate than delayed loading, according to all available research.

"Comparative Evaluation of Three Different Microabrasion Techniques in Esthetic Management of Fluorosis": An In Vivo Study

Aim

"Comparative evaluation of three different microabrasion techniques in esthetic management of fluorosis"-an in vivo study.

Materials and methods

A total of 48 permanent incisors in children between the age-groups of 8-12 years with Dean's fluorosis index modified criteria 1, 2, and 3 were included. The patients were randomly divided into three groups; each group included 16 samples. Group I-phosphoric acid and pumice microabrasion (37% phosphoric acid and pumice as abrasive), group II-opalustre microabrasion [6.6% hydrochloric (HCL) acid and silicon dicarbide (SiC2)], and group III-icon etch microabrasion (15% HCL acid gel as icon etch, pumice, and resin infiltrate). Preoperative sensitivity and pulp vitality of each tooth were evaluated. Standardized preoperative photographs were captured for the evaluation of color parameters L1, a1, and b1 by Adobe Photoshop 7 software and an assessment of color enhancement was carried out. Preoperative surface roughness was evaluated with two methods like, cellulose acetate replicating tape and confocal microscope, and Epoxy resin replica obtained from the preoperative impression of teeth using additional silicone and contact profilometer. Microabrasion was done accordingly. Postoperative values of all the parameters were evaluated.

Results

Phosphoric acid and pumice showed the best color change, followed by icon etch resin infiltrate. Opalustre (6.6% HCL acid and SiC2) and was unsuccessful as it had less concentration and was more abrasive.

Conclusion

Phosphoric acid and pumice showed the best color enhancement, followed by icon etch resin infiltrate and opalustre. Icon etch resin infiltrate showed minimal surface roughness followed by phosphoric acid and pumice and opaluster group.

How to cite this article

Reddy VN, Nagar P, Lakhotia R, et al. "Comparative Evaluation of Three Different Microabrasion Techniques in Esthetic Management of Fluorosis": An In Vivo Study. Int J Clin Pediatr Dent 2023;16(4):572-581.

Assessment of Dental Crowding Occurring in Mixed Dentition in Maxillary and Mandibular Arches Based on Tooth Size-Arch Length Relationships and Certain Cephalometric Parameters

Aim

The aim of the study is to find indicators of crowding in primary and mixed dentition that may lead to occurrence of dental crowding in future dentition using dental measurements.

Materials and methods

A sample of 300 children was selected and divided into two groups based on their age primary dentition and mixed dentition. Dental arch impressions were made and casts were poured. The study was then divided into two phases for assessment of degree of crowding by Little's irregularity index (LII) and by measurement of tooth size-arch length discrepancies. Appropriate statistical analysis was used to assess the correlation of measurements in crowded and noncrowded groups.

Results

It was found that Little's index is less dependable as an indicator of anterior crowding. In the primary dentition, there is significant difference in inter-canine width between lower noncrowded and crowded dentition. In the mixed dentition, there is significant difference in Intermolar width between upper noncrowded and crowded dentition and in sum of incisors between noncrowded and crowded dentition in both the arches.

Conclusion

Little's index is not a reliable indicator of crowding in both primary and mixed dentition. Inter-canine width of lower arch can be considered as an indicator of crowding in primary dentition. The intermolar width of upper arch, sum of incisors in upper and lower arch and the intercanine width of upper and lower arch can be considered indicators of crowding in the mixed dentition.

How to cite this article

Kandakkeel FN, Nagar P, Saseendran A, et al. Assessment of Dental Crowding occurring in Mixed Dentition in Maxillary and Mandibular Arches based on Tooth Size-Arch Length Relationships and Certain Cephalometric Parameters. Int J Clin Pediatr Dent 2023;16(2):357-362.

Clinical manifestations of human monkeypox infection and implications for outbreak strategy

Monkeypox is an orthopoxvirus-based zoonotic illness that causes symptoms similar to smallpox in humans. Health care workers around the world are making it a priority to educate themselves on the many clinical manifestations and treatment options for this virus as public health agencies strive to stop the current outbreak. The infected do not have access to any treatment at this time. However, information obtained from the smallpox pandemic has led researchers to examine vaccinia immune globulin (IVG), tecovirimat, and cidofovir as viable treatments for monkeypox. Moreover, medication like tecovirimat may be given in extreme circumstances, and supportive therapy can help with symptom relief. The European Medicines Agency (EMA) certified tecovirimat as safe and effective against monkeypox in 2022, per the World Health Organization (WHO). As there are now no established guidelines for alleviating these symptoms, the efficacy of these treatments is highly questionable. Some high-profile cases in recent years have cast doubt on the long-held belief that this illness is rare and always resolves itself without treatment. We aimed to conduct this review to get a deeper comprehension of the evolving epidemiology of monkeypox by analysing such factors as the number of confirmed, probable, and potential cases, the median age at presentation, the mortality rate, and the geographic distribution of the disease. This study offers an updated review of monkeypox and the clinical treatments that are currently available as a result of the worldwide epidemics.

Evaluating the shortest and most efficacious decontaminating method for endodontic files in Pediatric dentistry

Aim: To compare and evaluate the effectiveness of various pre-sterilizing techniques used for the sterilization of endodontic files used intermittently in between patients in the dental operatory. Materials and Methods: The current study involved investigating the effectiveness of 4 methods of pre-sterilizing endodontic files: Control group: no sterilization procedure was performed; Group A- chemical sterilization (with Glutaraldehyde), Group B- Autoclave, Group C- Ultraviolet Chamber and Group D- Ethanol. A total of 50 endodontic files for 10 patients indicated for pulp therapy in primary deciduous molars with 4 root canals each were selected for the study. After access opening, pulp was extirpated by 5 files each per patient. After access opening, 40 root canals in 10 patients were cleaned and shaped using conventional techniques. Each file was then allotted to each group and sterilized by the above mentioned methods and assessed for sterility by putting it in eppendorf tubes containing Brain Heart Infusion (BHI) broth and incubating it at 37oC for 24 hours. The bacterial cultures were then measured for their optical densities using the spectrophotometer.  Results: Maximum decrease in microbial cultures was noted in the Autoclave group followed by the Glutaraldehyde group with a non-significant difference. Ethanol and UV sterilization had non- significant results among them but were significantly different from Autoclave and Glutaraldehyde. Conclusion: Pre sterilization of files is an important step especially in these times and can be easily achieved by various methods.

The effects of corticotomy and piezocision in orthodontic canine retraction: A randomized controlled clinical trial

Background:

There have been many studies and experiments to evaluate the effectiveness of different types of dental treatment. Maxillary canine extraction is such a dental treatment which can be performed through either alveolar corticotomy (AC) or piezocision (PZ). The current study aims to compare the effectiveness of these two types of dental procedures. It is based on a randomized clinical trial (RCT) through the split-mouth technique supported by a parallel group design. The participants in the trial were selected on the basis of a medical criterion. The clinical trial involved extraction of both the first maxillary premolar teeth through use of orthodontic instruments. This study aims to evaluate the comparative effectiveness of alveolar corticotomy and piezocision corticotomy in acceleration of maxillary canine retraction and how it can be used for expression of multiple bone remodeling gingival crevicular fluid (GCF). As part of this study, a RCT was performed on the basis of split-mouth technique at the Department of Orthodontics of Pontifical Catholic University at Minas Gerais in Brazil. The sample size for the clinical trial consisted of people who required extraction of maxillary premolar teeth after canine extraction. After digital intraoral scans, the cumulative distal movement of canines was measured on the basis of superimposition of digital model and the results were considered as the primary outcome of the study. The GCF bone remodeling samples were considered as the secondary outcomes.

Results:

50 patients, involving 22 males and 28 females were analyzed in this particular clinical trial. The age range that was considered for this clinical trial was 19–33 years. In case of understanding the distal movement between control and AC, no statistical significance was observed in Group1 (G1). Lower cumulative cervical and incisal measurements in case of PZ was lower than the measurement in the control state. In all the groups, the expression of the biomarkers had occurred in specific timepoints (P < 0.05) but no distinct pattern was observed.

Conclusions:

In order to accelerate the maxillary canine retraction, PZ and AC were ineffective. No distinct induction pattern of biomarker expression was noted as well.

Changes in the Sequence of Eruption of Permanent Teeth; Correlation between Chronological and Dental Age and Effects of Body Mass Index of 5&ndash;15-year-old Schoolchildren

Aim

To determine the changes in the sequence and age of eruption of permanent teeth in 5–15-year-old schoolchildren, correlating their dental and chronological age.

Materials and methods

A total of 1,477 schoolchildren aged between 5 years and 15 years were examined for the eruption timing, body mass index (BMI), and other oral findings. Dental age was calculated for 10% of the total sample using the Willem's method from their ortho-pento graphs (OPGs) and correlated with their chronological age.

Results

The maxillary teeth erupted earlier than mandibular teeth. Males were found to mature earlier than females. The sequence of eruption observed was: males (maxilla) 1-6-2-4-3-5-7 and (mandible) 1-6-2-3-4-5-7; females (maxilla) 6-1-2-4-3-5-7 and (mandible) 1-6-2-3-4-5-7. The chronological age and the dental age were found to be different in the age range of 9–10 years female; 10–11 years male; and in 13–14 years both male and female. Also when the dental age was correlated with the BMI, the dental age of obese children in 5–6 years and underweight children in 10–11 years were found to be far ahead of their actual chronological age.

Conclusion

This study opens an expected door for a large sample size to be tested in various local populations with different ethnicity and race as there can be changing trend in the eruption pattern.

Clinical significance

Changing trends in the sequence and age of eruption of the permanent teeth definitely need to be looked into. As this change, if firmly established in future, can help pedodontist in better planning of space management, interceptive as well as full-mouth orthodontic treatment which largely depends on this sequence being true in most of the cases.

How to cite this article

Khan AS, Nagar P, Singh P, et al. Changes in the Sequence of Eruption of Permanent Teeth; Correlation between Chronological and Dental Age and Effects of Body Mass Index of 5–15-year-old Schoolchildren. Int J Clin Pediatr Dent 2020;13(4):368–380.

Antimicrobial Efficacy of Triphala and Propolis-modified Glass Ionomer Cement: An In Vitro Study

Background

The antimicrobial activity of restorative materials has a major role in preventing recurrent caries.

Aim

To assess the antimicrobial activity of triphala and propolis-modified glass ionomer cement (GIC) against Streptococcus mutans and Lactobacillus.

Materials and methods

The samples were prepared using cylindrical molds (6 mm in diameter and 2 mm in thickness). A total of 30 samples were prepared containing 10 samples in each group. Group I, 10 samples of glass ionomer with aqueous extract of triphala were prepared; group II, 10 samples of glass ionomer with 50% of ethanolic extract of propolis (EEP); and group III as control consisting of 10 samples of glass ionomer. The samples were placed in to agar plates containing inoculum of S. mutans and Lactobacillus and incubated at 37°C for 48 hours and using a digital caliper, zones of inhibition formed around specimens were measured.

Results

Data obtained were analyzed using nonparametric Kruskal-Wallis test followed by pairwise comparison was done using Dunn-Bonferroni test. Group I and group II showed highest antimicrobial efficacy against S. mutans and Lactobacillus with no statistical significant difference, i.e., (p value > 0.05) but in both groups I and II, there was a statistical significant difference when comparing with group III i.e., (p < 0.05).

Conclusion

Thus, triphala and propolis-modified GIC provided higher antibacterial effect with increased level of inhibition against the S. mutans and Lactobacillus; hence, it can be used as a choice of restorative material to treat dental caries. Further studies are required to determine the physical and mechanical characteristics of the material.

How to cite this article

Paulraj J, Nagar P. Antimicrobial Efficacy of Triphala and Propolis-modified Glass Ionomer Cement: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(5):457-462.

Comparison of Antimicrobial Efficacy of Natural Extracts as a Disinfectant for Removable Orthodontic Appliances: An Ex Vivo Study

Aim

The purpose of the study is to formulate a standard protocol for cleaning and disinfecting removable appliances by evaluating the antimicrobial efficacy of three natural extracts.

Materials and methods

Fifty patients with removable orthodontic appliances were selected and divided into five groups [chlorhexidine 0.2% (positive control), extracts of neem, katha, cinnamon, and normal saline (negative control)] with 10 samples each. Saliva sample from the appliance was collected using a sterile cotton swab and cultured. Agar diffusion method was used and zones of inhibition were measured.

Statistical analysis

The obtained data were subjected to statistical analysis by the Kruskal–Wallis ANOVA test and the Mann–Whitney U test.

Results

The neem extract had the highest zone of inhibition measuring 14.95 mm (mean) followed by katha extract with the value of 13.85 mm which was found to be comparable to chlorhexidine with 15.85 mm.

Conclusion

Thus, neem and katha extracts can be used to disinfect removable appliances because of their good antimicrobial activity.

Clinical significance

By following these simple cleaning protocols, it is possible to avoid numerous health hazards caused by unclean removable appliances in children.

How to cite this article

Janani J, Nagar P, Kaniappan AS, et al. Comparison of Antimicrobial Efficacy of Natural Extracts as a Disinfectant for Removable Orthodontic Appliances: An Ex Vivo Study. Int J Clin Pediatr Dent 2020;13(6):640–643.

Comparing the Arch Forms between Mongoloid Race and Dravidian Race in 11-14-year-old Children

Aim and objective

To compare arch forms between Mongoloid race and Dravidian race in 11–14-year-old children.

Materials and methods

Total 10 subjects from each study group were selected. Impression of both maxillary and mandibular arches were taken of all the subjects. Dental casts were poured. Intercanine measurement can be termed as the distance across two canine cusp tips, and intermolar measurement can be termed as the distance across two mesiobuccal cusp tips. This distance was recorded for maxillary and mandibular casts by making use of digital Vernier caliper. Data were tabulated.

Statistical analysis

To note the statistical impact, a Chi-square test was applied.

Results

The difference across the two groups was found to be statistically significantly noteworthy (independent t test p < 0.001).

Conclusion

Group I (Mongoloid race) showed significantly larger intercanine to intermolar width compared to Dravidian race with wide flaring arches.

Clinical significance

The size and forms of dental arches exhibit considerable variability within and among human groups. This research demonstrated that while considering Mongoloid patients, we must make use of prior formed orthodontic wires for ovoid shaped arches in a trivial fraction of patients.

How to cite this article

Smitha S, Nagar P, Abinaya R, et al. Comparing the Arch Forms between Mongoloid Race and Dravidian Race in 11–14-year-old Children. Int J Clin Pediatr Dent 2020;13(S-1):S26–S28.

Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study

Aim

This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test.

Materials and methods

Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted.

Statistical analysis

Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test.

Results

Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained.

Conclusion

In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups.

Clinical significance

Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups.

How to cite this article

Abinaya R, Nagar P, Urs Pallavi, et al. Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(6):585–589.

Bromelain vs Papain Gel for Caries Removal in Primary Teeth

AIM

The aim of the study was to evaluate and compare bromelain with papain as the chemomechanical caries removal agent in relation to their efficacy.

MATERIALS AND METHODS

Thirty extracted primary molars with active carious lesion extending into dentin were selected. The samples were randomly divided into groups by sectioning the samples into two halves. Group I-cavity prepared using papain gel; group II-cavity prepared using bromelain gel. Time taken for caries removal in both the groups (I and II) was recorded with the help of a stopwatch. Following caries removal, the amount of remaining demineralized dentin was measured with the help of stereomicroscope and weld check (biological image analysis) software.

RESULTS

t test is used to evaluate the significance of study parameters on continuous scale between two groups on metric parameters. The mean of residual carious dentin thickness obtained from the group II (bromelain) was 36.74 μm, which was much lower than that obtained from group I (papain) with a mean of 73.84 μm. The mean time taken in the group II (bromelain) was 335.30 seconds which was nearly equal to the mean time of group I (papain) of 352.33 seconds.

CONCLUSION

The amount of remaining demineralized dentin was found to be lower in bromelain group than the papain group and time taken for the carious dentin removal was almost found similar in both bromelain and papain groups. It may be concluded that bromelain was more effective in amount of caries removal than papain.

CLINICAL SIGNIFICANCE

Chemomechanical caries removal with the organic gels pose a great benefit as they are less invasive and has low side effects and cost-effective. How to cite this article: Reddy VK, Nagar P, Reddy S, et al. Bromelain vs Papain Gel for Caries Removal in Primary Teeth. J Contemp Dent Pract 2019;20(11):1345-1349.

A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study

Objectives

The objective of this in vitro study was to assess the surface hardness through Vickers hardness (VH) test of one conventional hybrid resin composites (Filtek Z350), compared with that of two bulk cure resin composites (SDR™, Tetric N Ceram®).

Materials and methods

Twenty specimens of each material were prepared in cylindrical aluminum molds with an internal diameter of 5 mm and depth of 4 mm, 10 (incremental curing) and 10 (bulk curing).

The surface of each specimen was covered with a transparent plastic matrix strip before light curing with conventional visible light for 40 seconds. The specimens thus obtained were stored in deionized water and transferred to an incubator at 37°C for 24 hours to simulate clinical conditions. After 24 hours, the microhardness of each specimen was measured using a Vickers indenter, with a load of 100 gm and dwell time of 15 seconds (HV 0.2/40).

The specimens were further subjected to VH test in an interval of 7, 30, and 90 days. The data were subjected to statistical analysis—Student’s t test, analysis of variance, and post hoc Tukey’s test.

Results

The present study showed that SDR™ in bulk curing showed consistently greater value of hardness and was comparable to traditional incremental cured Filtek Z350, highlighting the advantages of the new SDR technology.

How to cite this article: Sarma A, Nagar P. A Comparative Evaluation of Time-dependent Changes on the Surface Hardness of Bulk Cure Composites: An in vitro Study. Int J Clin Pediatr Dent 2018;11(3):183-187.

Aggressive bougie dilatation and intralesional steroids is effective in refractory benign esophageal strictures secondary to corrosive ingestion

Endoscopic dilatation of corrosive esophageal strictures is effective, but some patients are refractory to it and require long-term repeated dilatations. The present study was carried out to analyze whether rigorous schedule of endoscopic bougie dilatation along with intralesional injection of triamcinolone in patients refractory to endoscopic dilatation alone could decrease the number and frequency of endoscopic dilatations. The inclusion criterion for this prospective study was patients with refractory corrosive esophageal stricture of any age group. Refractory benign esophageal stricture is defined as an anatomic fibrotic esophageal restriction with inability to achieve dilatation of ≥14 mm or to maintain dilatation for 4 weeks once ≥14 mm diameter is achieved. The patients were followed up prospectively for 1 year. Patients with refractory strictures were subjected to weekly bougie dilatation (Savary-Gilliard) of the strictures along with injections of intralesional triamcinolone (40 mg/mL, 1 mL diluted in 1 mL of saline, 0.5 mL injected per quadrant of stricture) for consecutive 5 weeks, referred to as rigorous schedule. Further dilatation was done on an 'on-demand' basis. Eleven patients were enrolled for the study. Dysphagia score improved from pre-intervention score of 3.54 ± 0.52 to 0.45 ± 0.52 post-intervention (P < 0.001). The maximum dilatation achieved pre-intervention was 9.90+1.04 mm Savary-Gilliard and post-intervention significantly improved to 14.7 + 0.7 mm Savary-Gilliard (P < 0.001). The periodic dilatation index defined as number of dilatations per month also significantly improved from pre-intervention score of 2.54 ± 1.06 to post-intervention score of 0.19 + 0.13 (P < 0.001). No adverse effects were reported by the patients. Rigorous weekly schedule of bougie dilatation and intralesional triamcinolone in combination is safe and effective in achieving significant dilatation, reducing the frequency dilatations, maintaining dilatation and improving dysphagia till 1 year of follow-up.

Unstable Angina: A Serious Adverse Event following Gemcitabine-Cisplatin Based Chemotherapy

A 29 year male, with an inoperable adenocarcinoma of gall bladder was initiated on gemcitabine and a platinum compound based chemotherapy. During 4th cycle of chemotherapy, patient complained of chest pain following cisplatin and gemcitabine infusion. ECG was suggestive of acute coronary syndrome, which was successfully managed by antianginal therapy. Fifth cycle of chemotherapy was uneventful. Patient died of cardiovascular collapse before receiving the 6th cycle of chemotherapy. As per Naranjo adverse drug reaction probability scale, causal association of the event with cisplatin and gemcitabine was probable and possible respectively. It is advised to routinely assess the cardiovascular status of patients before and during cisplatin and/or gemcitabine based chemotherapy.

Hyperactive Dental Lamina in a 24-Year-old Female - A Case Report and Review of Literature

An extra tooth to the normal formula of teeth sequence in any region of dental arch is regarded as Supernumerary teeth (ST). The reasons are still not clearly known, one of them being dichotomy of tooth bud, but the more accepted reason is the hyperactivity theory. Supernumerary teeth are present more in permanent dentition than in primary dentition and can present as a single entity or multiple, unilaterally or bilaterally, impacted or erupted, in either or both the dental arches. This article discusses the supernumerary teeth in detail with a case discussion of a non-syndromic 24-year-old girl, with six ST (bicuspids) present in all the four quadrants. In the mandible, ST's showed a classical clustered flower like presentation. The interesting feature in the presented case was the sequential orthopantomographs taken at various ages of the patient that showed continuous development of STs in all four quadrants, thus pointing to the theory of hyperactive dental lamina or atavism. An electronic search was conceded in PubMed, Cochrane Library and google scholar databases, and articles dated between December 1932 and December 2012 were selected to review the occurrence patterns of supernumerary teeth in non-syndromic cases.

24% Indigenously Prepared Ethylene Diamine Tetra Acetic Acid Compared to Self-Etching Adhesives and their Effect on Shear Bond Strength of Composites in Primary Teeth: An In-vitro Study

BACKGROUND

Over the years, it has been known that 34% phosphoric acid is the benchmark in etchants with the best shear bond strength shown with composites in primary teeth. However, with latest technological advancements and innovations, in order to reduce the number of steps and less damage to the tooth structure, non-rinse conditioner (NRC) & Single-Etch and various other etchants have been tried and tested. These etchants have been found to have shear bond strength comparable to phosphoric acid. In this study, indigenously prepared 24% ethylenediaminetetraacetic acid (EDTA) has been compared with established etchants, as to prove if their shear bond strength was closely related. As it is a well-known fact that EDTA could be less damaging to the enamel during etching and hence can be an alternative for etching of primary teeth.

MATERIALS AND METHODS

For the study 60 caries-free primary molars were used, they were sectioned in the middle, after making area for bonding; the marked area was then etched using different etchants for 30 s. Each of the teeth was then rinsed and bonded with composite resin and thermocycling was done. Shear bond strength testing was done on the composite using Universal Testing Machine.

RESULTS

Results of the study showed that phosphoric acid showed the highest bond strength, closely followed by Single Etch (Adper Prompt) and NRC, then by EDTA.

CONCLUSIONS

About 24% EDTA can be another comparable replacement for phosphoric acid if used with a Single Etch Primer, like Prime and Bond NT on primary teeth. 34% phosphoric acid has the highest bond strength values with composite resin. Single etch followed by NRC has the second and third highest bond strength values, which are comparable to phosphoric acid.

Tobacco abuse amongst the school going students of 15 to 18 years of Almora district, Uttarakhand: a cross sectional study

PURPOSE

The present study was done to assess the prevalence of tobacco abuse among school going students of the age group 15 to 18 year old in the rural areas of Almora district, Uttrakhand state, India.

MATERIALS AND METHODS

Schools were grouped into 4 zones north, south and east, west based on their location in district, respectively. Second stage one private and one government school was randomly selected from each zone of rural Almora. All students belonging to age 15 to 18 year were selected from the selected schools. Data was collected by a pretested, closed ended questionnaire.

RESULTS

Overall, the prevalence of tobacco consumption among the adolescents was 45.42%. 63% male and 47.1% female adolescents were habituated to it. All female and majority of the male adolescents predominantly consumed a smokeless form of tobacco.

CONCLUSION

The prevalence of tobacco consumption indicates a downward shift in the age for the uptake of tobacco habit by adolescents and a rising prevalence among girls. Our findings suggest that tobacco use prevention and control measures are warranted and should be started very early preferably at primary education level.

Genotoxicity evaluation of hospital wastewaters

In hospitals a large variety of substances are in use for medical purposes such as diagnostics and research. After application, diagnostic agents, disinfectants and excreted non-metabolized pharmaceuticals by patients reach the wastewater. Indeed, some of the substances found in wastewaters are genotoxic and are suspected to be a possible cause of the cancers observed in the last decades. Genotoxicity tests are an excellent means to study the toxicity and the risk associated with these releases. This paper points out the areas of concern for hospital wastewater disposal and reports the findings of genotoxicity tests for hospital effluents from 3 major hospitals in Delhi, namely All India Institute of Medical Sciences, Apollo and Escorts. Mutagenicity of hospital wastewaters from effluent treatment plants (before and after treatment) was studied. The results of this study show that the genotoxicity of hospital wastewaters is highly reduced after the treatment process. This study calls for establishment of advanced and effective effluent treatment plants in the hospitals, which are merely dumping the wastewaters in the municipal sewerage system. The results of this study call for further detailed study in this area.