Reliability of Linear and Curvilinear Measurements on Cone-Beam Computed Tomography Images for the Evaluation of Implant Sites and Jaw Pathologies

Objective: To evaluate the intra-examiner and inter-examiner reliability of linear and curvilinear measurements for the complete assessment of implant sites and jaw pathologies using Cone-Beam Computed Tomography (CBCT). Material and Methods: Fifty cone-beam computed tomographic images of patients were retrieved from the archives of Dentomaxillofacial Radiology. CBCT images taken for implant planning and evaluation of intrabony jaw pathologies (benign cyst/tumor) were included. Two expert oral and maxillofacial radiologists analyzed the images independently and made the measurements. The images for implant planning were analyzed for width, the height of the edentulous site, and the qualitative analysis of bone in the region. Jaw pathologies were assessed for linear dimensions and curvilinear measurements. Results: The inter-observer measurement error for implant site analysis ranged from 0.12 to 0.42 mm with almost perfect agreement (ICC: 0.94 to 1). The inter-observer measurement error for jaw pathology was 0.09 to 0.25 mm (ICC: 0.98-1). Curvilinear measurements showed perfect agreement between the observers. The intraobserver reliability for the various parameters used for the assessment of the implant site and jaw pathologies indicated almost perfect agreement. Conclusion: Reliability between the radiologists is high for various measurements on CBCT images taken for implant planning and jaw pathologies

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction – A Split-Mouth Randomized Trial

Objective: To evaluate the feasibility of posterior maxillary teeth extraction buccal infiltration with or without the use of palatal injection. Material and Methods: A total of 70 patients underwent extraction of bilateral maxillary posterior teeth under 2% lignocaine hydrochloride with 1:2,00000 adrenaline infiltration in this single-centric split-mouth randomized trial. The test side was administered with a buccal infiltration of 2 mL of anesthetic alone. An extended waiting period of 10 minutes was given before the commencement of the procedure. A standard protocol was followed for the control side. A single operator performed all extractions. Results: A total of 140 posterior maxillary teeth were extracted. Patients marked pain perception on a visual analogue scale in three different instances. During the administration of injections for the test side, the pain score was less than that of the control side and was statistically significant. The overall pain during the extraction procedure was comparable and statistically insignificant. The overall success of the method was 90%. Conclusion: Extraction of posterior maxillary teeth was feasible with a single buccal infiltration without palatal injection in most cases using an extended waiting period. Dentists can attempt extraction without palatal injections with optimal success. However, the alternate technique could be used when there is a necessity for rescue palatal anesthesia

Comparative Evaluation of Surface Roughness of Resin- Modified Glass Ionomer and Glass Hybrid Restorative Materials Simulated by Tooth Brushing: An in-Vitro Study

Objective: To compare the effect of tooth brushing on surface roughness of Resin-Modified Glass Ionomer Cement (RMGIC; GC Gold label 2LC Light Cured Universal Restorative) and Glass Hybrid (GH; GC EQUIA SYSTEM- EQUIA Forte™ Fil and EQUIA Forte™ Coat) restorative material at 1- and 3-months interval simulated by tooth brushing. Material and Methods: RMGIC and GH material specimens (20 each) were prepared according to manufacturer instructions in 10 mm × 2 mm dimensions using a mylar strip. A specially designed toothbrush simulator was used along with Oral B Pro 2 2000N powered toothbrush and Colgate Total dentifrice (Colgate-Palmolive India limited; Relative dentin abrasivity - RDA: 70 - Low abrasive) to perform brushing strokes. Specimens were subjected to surface roughness analysis before and after simulated tooth brushing at baseline, 1, and 3 months. Results: The intragroup comparison was done using repeated-measures ANOVA. Intergroup comparisons were done using an independent sample t-test and General Linear Model (ANCOVA). Surface roughness increased from baseline through 3 months in both RMGIC and GH groups. The mean surface roughness in RMGIC group was significantly higher than GH group at baseline 1 and 3-months, respectively (p<0.001, <0.001, and <0.001). Interaction between group and baseline surface roughness was not significant (p=0.466).  The estimated marginal means were significantly higher in RMGIC than GH group (p=0.008). Conclusion: The surface roughness of both RMGIC and GH restorative increased from baseline to 1 month and 3 months after the simulated toothbrushing protocol. GH exhibited significantly lower surface roughness than RMGIC at all the tested intervals

Perception of Indian Dental Students to Pursue Higher Education Abroad during COVID-19

Objective: To evaluate Indian dental students’ perception of seeking international dental higher education during COVID-19. Material and Methods: We conducted an online survey among the dental students. A self-administered questionnaire was prepared, which had information on country choice, reasons for the decision to study abroad, measures to be taken by the foreign universities because of COVID-19, the application’s status, current plan, and opinions on exploring other possibilities. Results: Four hundred students constituted the final sample, out of which the majority were females (69.3%). Most of the students were not sure about their status in the application process (63%). The current plan to study abroad remained uncertain for almost half of the students (50.2%). Concerning the status of the application process, a significantly higher number of female students were “not sure” and are still “searching colleges” (p<0.001). Similarly, a higher number of females were “uncertain” or “postponed” or “canceled” when compared to the males concerning the current plan to study abroad (p=0.001). Also, a significantly higher proportion of female students cited the study budget as the main deterrent for pursuing a career abroad and opined that “flexible study options” will help them get admissions post-COVID-19 (p=0.001 and 0.035). Conclusion: A substantial impact was perceived by Indian dental students concerning higher education abroad, more among females

Evaluation of Sugar Content and Erosive Potential of the Commonly Prescribed Liquid Oral Medications

Objective: To assess the total sugar content, endogenous pH, total soluble solids content (TSSC) and titratable acidity of the commonly prescribed long-term and short-term liquid oral medicines (LOM) for children and to compare the erosive potential with the total sugar content and total soluble solids of the LOM. Material and Methods: Twenty-three most commonly prescribed pediatric LOM were evaluated in- vitro for the cariogenic and erosive potential. Manufacturers' information on labels, endogenous pH, titratable acidity, TSSC, and the total sugar content was determined. Descriptive statistics and the Mann- Whitney U test were applied. Results: Overall, 22 LOM contained sugar. Only 3 LOM revealed the sugar content of the formulation but did not disclose the quantity (Cheston, Ventorlin and Eptoin). None of the samples revealed the sugar content as well as endogenous pH in their labels. The overall mean total sugar content was 6.92 ± 3.49 g/100ml, ranging from 3.40 ± 0.00 (corticosteroids) to 9.67 ± 0.61 (antitussive/expectorant). The mean endogenous pH for the total sample of medicines was 5.91 ± 1.51 (range of 3.5 to 10.3). Eptoin (0.013%) presented the lowest titratable acidity and Imol (1.171%) presented the highest titratable acidity with an overall mean of 0.40 ± 0.73. Omnacortil and Epilex presented the highest TSS content (19.3%), and Ventorlin presented the lowest TSS content (18.7%) with an overall mean of 18.97 ± 0.19. Over twelve medicines were identified to have the potential to cause dental erosion. No significant differences were seen in the total sugar content, total soluble solids, titratable acidity, and the endogenous pH between the short-term and long-term LOMs (p=0.145, p=0.263, p=0.067 and p=0.107), respectively. Conclusion: The pediatric LOMs showed the presence of the sugar, low endogenous pH, high titratable acidity and high total soluble solids

Age Estimation by Modified Demirjian’s Method in a Hospital-Based Population: A Radiographic Study

Objective: To test the modified Demirjian's method of dental age estimation on the South Indian population and correlate it with the patient's chronological age. Material and Methods: This retrospective radiographic study was performed on digital panoramic radiographs taken during a one-year duration. Radiographs of patients in the age range from 8 to 18 years were included in the study. The radiographs were examined and according to the stage of the crown and root status of the left side mandibular teeth. The stage of calcification was observed for eight teeth in the mandibular arch and was recorded in a specially designed proforma. Each rated tooth with stage was converted into a score using a conversion table specified for girls and boys. Results: 224 digital panoramic radiographs were retrieved from the radiologic database. Out of total study sample, 49.5% (n=111) were boys and 50.5% (n=113). The mean chronological and estimated dental age using dental maturity scores resulted in an overestimation of 3 years and eight months. Also, it was noted that there was a strong positive association between chronological (real) and dental age. Conclusion: It was observed that there was a strong correlation between chronological and dental age. A new formula for determining the chronological age from the estimated dental age was derived. Further studies on a larger population may prove the reliability of this age estimation method

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G)

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G)

Comparison of Oncostatin M in Patients with Chronic Periodontitis with and without Diabetes

Objective: To compare the Oncostatin M (OSM) concentrations in tissues of patients with chronic periodontitis with and without diabetes. Material and Methods: Sixty-four subjects visiting the dental outpatient department were categorized as “healthy” (Group 1), “periodontitis” (Group 2), and “diabetes with periodontitis” (Group 3) groups. The clinical oral examination included assessment of plaque, gingivitis, probing depth, clinical attachment level. Blood glucose was assessed for group 3 patients. OSM concentration in the tissues was assessed using ELISA in all groups. Results: The mean OSM was 0.02 ± 0.04 pg/mg in the healthy group, 0.12 ± 0.09 pg/mg in the chronic periodontitis group and 0.13 ± 0.10 pg/mg in the diabetes-periodontitis group. A significantly higher mean OSM was seen in Group 2 and Group 3 than Group 1. The amount of OSM positively correlated with probing depth and clinical attachment level. Conclusion: Periodontal disease causes a rise in Oncostatin M, independent of the diabetic status. Expression of OSM in the gingival tissues can serve as an inflammatory marker

Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: \u27findings with minimal impact on denture fabrication\u27 and \u27findings which affect denture fabrication and require further evaluation.\u27 Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication