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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 31 | Issue 2
Page Nos. 93-192

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EDITORIAL  

Taking cone beam computed tomography to the next level p. 93
Ajay Pratap Singh Parihar
DOI:10.4103/jiaomr.jiaomr_88_19  
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ORIGINAL ARTICLES Top

A comparative evaluation of diode laser ablation versus scalpel excision for management of oral leukoplakia p. 94
Syed A Yasmeen, BH Satheesha Reddy, MV Ramesh, Smita Shrishail Birajdar, Anusha Yarram, Nerella Narendra Kumar
DOI:10.4103/jiaomr.jiaomr_4_19  
Background and Aim: Oral leukoplakia, a potentially malignant disorder with malignant transformation rate ranging from 0.6% to 20%, requires immediate attention. Therefore, for moderate to severe dysplasia, complete surgical removal is the treatment modality. This study aimed to evaluate two treatment modalities of oral leukoplakia using diode laser and scalpel surgery and to compare the outcome of both interventions regarding postoperative pain and functional disturbances. Materials and Methods: A total of 30 patients with oral leukoplakia were recruited and block randomization was done splitting into diode and scalpel groups. Patients were evaluated for pain and functional disturbances postoperatively using visual analog score (VAS) and Gorsky criteria, respectively, in the first 3 days and 1st, 2nd, and 4th weeks and periodically followed up for 4 years for recurrences. Results: The mean age was 38 years. The results showed a significant difference in diode group compared with scalpel group for postoperative pain assessed in VAS scale using paired “t-test” and functional disturbance using Chi-square test. None showed recurrence in the subsequent 4 years of follow-up among diode, whereas scalpel group showed recurrence in two patients. Conclusion: Complete resolution of the lesion with minimum patient discomfort was observed in patients treated with diode compared with scalpel, suggesting diode laser is an effective method over the conventional method.
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Assessing the dimensions of mandibular incisive canal and its relationship to adjacent anatomical landmarks using cone beam computed tomography in Indian sub-population – A retrospective study p. 100
Pratik Chandrakant Malusare, Amita Navalkar, Deepa Das, Bhakti Patil
DOI:10.4103/jiaomr.jiaomr_56_19  
Objective: The purpose of the study is to explore the capability of the CBCT to provide information concerning the position and dimensions of the mandibular incisive canal in relation to adjacent anatomical landmarks. Methodology: CBCT scans of 150 subjects were retrospectively studied to analyze the dimensions of the mandibular incisive canal and to assess the relationship of the mandibular incisive canal to the adjacent anatomical structures of the mandible. Results: 150 CBCT scans were evaluated for the position and dimensions of mandibular incisive canal to adjacent structures. In 87% of cases, the MIC was identified and had a mean length of 13.4mm (range, 5.6 to 24.7 mm) on the right side and 12.4 mm (range, 4 to 22.5 mm) on the left side. From the mental foramen, the incisive canal runs forward toward the incisors, in a slight downward direction, with its diameter decreasing as it progresses towards the midline. Discussion: The data from this study indicates surgical anatomic relationships should be considered in pre-surgical planning to avoid neurosensory disturbances and other potential complications. With the increased interest in performing a thorough pre-surgical examination in the inter-foraminal region, crosssectional images should be utilized to obtain information on the appearance, location, and course of the foramina and canals and their relation to other anatomical structures of the jaw.
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Competence of handling medical emergencies among dental graduates and post-graduate students – A cross-sectional questionnaire study p. 107
Aveek Mukherji, Mohit Pal Singh, Prashant Nahar, S Bhuvaneshwari, Saurabh Goel, Hemant Mathur
DOI:10.4103/jiaomr.jiaomr_24_19  
Introduction: Dentists are encountering a growing number of geriatric and medically compromised patients and at the same time are performing more invasive and possibly painful dental treatments. Medical emergencies are 5.8 times more likely to occur in dental offices than in medical offices. So, it is essential for the dentists to be adequately prepared and equipped to manage the common medical emergencies that may occur during their work. Aims and Objectives: To observe the knowledge, experience, and perceptions of the interns and post-graduate students regarding emergency medical care and its practical application. Materials and Method: A cross-sectional study was carried out among post-graduate students and interns (with or without medical emergency training) of a dental college and hospital through a self-administered structured closed-ended questionnaire. Results: The participants lacked the knowledge to handle medical emergencies and were unconfident to face them. Conclusion: Undergraduate health courses should develop strategies to teach appropriate management of life-threatening emergencies in dental clinics to ensure safer dental healthcare services for the population. The available medical emergency training is alarmingly inadequate.
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Assessment of disc position in clinically diagnosed patients of internal derangement of the temporomandibular joint through MRI p. 117
Haider Iqbal, Abhishek Sinha, Nitin Agarwal, Sunita Srivastava, Debanti Giri, Ankit Saha
DOI:10.4103/jiaomr.jiaomr_13_19  
Aims and Objectives: To study the efficacy of MRI in assessing the disk position in clinically diagnosed patients of TMJ, Disk Displacement with Reduction and Disk Displacement without Reduction, and also compare the MRI findings between a control group and patients with Disk Displacement. Materials and Methods: Magnetic Resonance Imaging (MRI) was performed on a total of 16 clinically diagnosed patients of Internal Derangement of the TMJ, 13 of whom were diagnosed with Disk Displacement with Reduction, and the remaining 3 were diagnosed with Disk Displacement without Reduction. 6 asymptomatic volunteers formed the Control Group. The selected patients were then made to undergo an MRI Scan of the TMJ using a 1.5 Tesla MRI Scanner. The MRI scans were evaluated by a radiologist who was unaware of the clinical findings of the patients who were being included in the study. Statistical Analysis Used: Chi square test. Result: Of the total of 3 diagnosed patients of ADDWOR, MRI detected it in 2 cases and thus detection of MRI being 66.7%. Similarly, of the total 13 patients diagnosed with ADDWR, MRI detected it in 10 and thus detection of MRI being 71.4%. Comparing the frequency of detection between the two procedures, χ2 test revealed similar detection between the two procedures (χ2 = 0.03, P =0.870). To test the reliability (reproducibility) of MRI findings, the findings were also performed on 6 controls. Comparing the frequency of MRI findings between the two groups, χ2 test revealed similar visualization in both groups {83.3% (in Control) vs. 70.6% (in patients), χ2 = 0.37, P = 0.541}. Conclusion: There is a high similarity between the Clinical and the Radiological Diagnosis by using MRI as the investigative modality, and thus MRI is considered one of the most efficient modality for assessing the articular disk in Temporomandibular Joints.
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An anatomic and radiographic study of medial sigmoid depression in human mandible p. 123
Md Asdullah, Anshul Aggarwal, Kauser J Khawja, Masood H Khan, Juhi Gupta, K Ratnakar
DOI:10.4103/jiaomr.jiaomr_218_18  
Introduction: Medialsigmoid depression (MSD) is well-defined radiolucency in the inferior aspect of sigmoid notch seen on the few panoramic radiographs. Anatomically, MSD corresponds to a depression on medial side of upper ramus just below the sigmoid notch. The significance of this normal anatomical landmark lies in its propensity to be misinterpreted on the panoramic radiograph as a defect or a pathological entity especially a cyst. Aim and Objective: To study the prevalence of the medial sigmoid depression of mandibular ramus in dry humanmandible anatomically and radio- graphically and on panoramic radiograph of patients. Materials and Methods: The study consisted of Panoramic radiographs of the50 dry human mandibles and 50 Panoramic radiographs of adult out-patient (selected randomly) visiting the Department of Oral Medicine and Radiology was taken. The entire selected mandibles included in the study were evaluated for the medial sigmoid depression. Panoramic radiographs of the selected mandibles were made using X-Mind Pano Ceph 1800 VA (SATELEC) panoramic machine and were interpreted for the various parameterspertaining to medial sigmoid depression. Results: The medial sigmoid depression (MSD) was present among 70% of the patients and in 82% of mandibles. The findings ofMSD was similar by anatomically and radio logically among the mandibles. The presence of MSD was 27% insignificantly (P > 0.05) lower in patients compared with mandibles (RR = 0.73, 95%CI = 0.49-1.09, P = 0.16). The presence of MSD was higher among the male patients (76%) rather than in females (64%). Conclusion: The recognition of MSD was quite competent in anatomic specimen, panoramic radiograph of the specimen and patients. Its appearance may be considered as a normalvariants on the panoramic radiographs.
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Estimation of the level of salivary proinflammatory cytokine in oral lichen planus – A case–control study in cuddalore-based population p. 128
J Nandhini, S Ramasamy, Ronak Nazir Kaul, S Sakthivel, M A. I Munshi, Shilpa Sunil
DOI:10.4103/jiaomr.jiaomr_43_19  
Aim: To estimate and compare the proinflammatory cytokine [tumor necrosis factor (TNF)-α] level in the saliva of oral lichen planus (OLP) and controls. Materials and Methods: A total of 22 OLP cases who were clinically and histopathologically proven (12 male and 10 female patients, with a mean age of 42 years) and 22 controls matched for age, sex, and socioeconomic status were enrolled in the study. Salivary TNF-α level was analyzed by immunoassay kits. Statistical Package for Social Science version 21.0 software was used for data analysis. Results: The salivary TNF-α level was significantly higher (P < 0.001) in patients than in controls. Conclusion: The results suggest that TNF-α may be a good diagnostic biomarker for this potentially malignant disorder.
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Evaluation of morphometric variations in mental foramen and prevalence of anterior loop in South Indian population – A CBCT study p. 134
Vani Chappidi, LA Swapna, Voulligonda Dheeraj, GR Nikitha, Madhuri Kanakagiri
DOI:10.4103/jiaomr.jiaomr_219_18  
Introduction: The mental foramen (MF) opens on the lateral aspect of the mandible near premolar region on both sides of the mandible. The portion of inferior alveolar nerve present anterior to the MF, prior to exiting the canal, is referred to as the anterior loop (AL) of the inferior alveolar nerve. These anatomical variations cannot be evaluated by conventional imaging techniques. Cone beam computed tomography (CBCT) provides three-dimensional reliable images of maxilla–mandibular region. Hence, it plays an important role to detect and evaluate these anatomical variations and to prevent intra- and postoperative complications. Materials and Methods: This retrospective observational study includes 500 CBCT images of the mandible. The average size, location, shape of MF, and presence of AL were assessed in sagittal, tangential, and axial sections. Results: Out of 250 CBCT scans analyzed, 132 scans (52.8%) were of males and 118 scans (47.2%) belonged to females. The mean size of MF as measured in the sagittal sections was found to be 3.36 mm in height and 2.54 mm in length. The most common position for the MF related to the mandibular teeth in this study was between first and second premolars in 310 CBCT images (62%). A majority of the MF were oval in shape (n = 346, 69.2%) followed by round shape (n = 154, 30.8%). The presence of AL of inferior alveolar nerve was found in only 20% (n = 100) of cases in this study. Conclusion: Considering these variations in MF and AL, the use of CBCT seems necessary for better evaluation and treatment planning.
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Role of digital volumetric tomography in assessing morphological variations in condyle and temporal components of patients with asymptomatic temporomandibular joint p. 140
Shruthi S Hegde, Gayathri S Rao, Atul P Sattur, Kirty R Nandimath, Rajeeth S Shetty, Medhini Madi
DOI:10.4103/jiaomr.jiaomr_52_19  
Background: Radiographic features of remodeling are difficult to analyze. This has led to the popularity of using digital volumetric tomography (DVT) for temporomandibular joint (TMJ) imaging. To understand variations in normal anatomy and morphology of the condyle and temporal components of the TMJ, it is necessary to differentiate normal variant from pathology. Methods: A total of 160 condyle and temporal components of TMJ in patients with asymptomatic TMJ were assessed by two observers using orthopantomograph (OPG) and compared with DVT using axial, coronal, and sagittal sections for the different condylar and temporal changes separately. Different relationship between variables were evaluated and statistically analyzed. Results: The assessment made by two observers showed agreement between two observers for OPG and DVT (P < 0.05). A significant increase in occurrence of remodeling changes was observed with increase in age in both condyle and temporal components. A significant difference was observed between male and female in condylar and temporal changes also among the right and left sides. Remodeling changes were detected more accurately in DVT compared with OPG. The common bony changes seen were flattening followed by concavity and osteophytes. There is a significant difference in detecting these changes. Conclusion: Knowledge of morphologic variability in the TMJ is of utmost important to differentiate normal variant from pathology which would help in arriving at proper diagnosis. A more accurate and authentic information on condylar and temporal bony changes were obtained by DVT.
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Audiovisual modeling: An efficient, time-saving, radiation-specified method of reducing dental anxiety in children undergoing panoramic radiographic imaging and IOPA radiographic imaging p. 147
Rupali V Mhaske, Lata M Kale, Vishwas D Kadam, Aishwarya M Kale, Vijaya M Ingle, Snehal S Vispute
DOI:10.4103/jiaomr.jiaomr_5_19  
Background: Children undergoing panoramic radiographic imaging (PRI) and intraoral periapical (IOPA) radiographic imaging show anxiety due to the presence of a revolving PRI machine and IOPA X-ray unit and a different environment which can pose behavioral concerns. Staying still for 15–20 s is not possible for young children. This could lead to distortions and require repetitions, leading to more radiation exposure. Aim: The aim of the study was to reduce the dental anxiety and reduce the increased radiation exposure and saving time in PRI and IOPA radiographic imaging by audiovisual modeling. Methodology: Forty children age 2–12 years indicated for PRI and IOPA radiographic imaging were subjected and observed before and after audiovisual modeling. The patients were modeled by audiovisual modeling before imaging in the oral radiology department. The anxious and disruptive behavior was assessed using the anxious and disruptive behavior code by a single blinded observer. Statistical Analysis Used: Statistical Software SPSS 13.0. Results: There was significant difference in the occurrence of body movement and complaining and restraint before and after audiovisual modeling in the same patients. There were statistically significant differences in the overall events before and after audiovisual modeling. Conclusion: The basic behavior management technique and use of audiovisual modeling can reduce the anxiety and disruptive behavior in children undergoing PRI and IOPA radiographic imaging and also reduces increased radiation exposure, saving time for the process thus reducing the cost of repeated imaging.
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FORENSIC ODONTOLOGY: ORIGINAL ARTICLES Top

Determination of gender by using mandibular flexure – A radiographic study p. 152
Leena James, Tejavathi Nagaraj, Sita Gogula, CK Sumana, Haritma Nigam, Swati Saxena
DOI:10.4103/jiaomr.jiaomr_65_19  
Introduction: In forensic medicine identification of age, gender is an initial step in determining one's identity. After the pelvis, mandible plays an important role in determining gender when the whole body is not present. Forensic dentists require knowledge encompassing a number of disciplines since the dental records obtained can identify an individual or afford the information needed by the authorities to establish neglect, fraud, or abuse. Aim: Determination of gender by using mandibular ramus flexure. Materials and Methods: The study was conducted on 50 male and 50 female orthopantomographs taken in the Department of Oral Medicine and Radiology. Each image was examined for the presence of flexure on the posterior margin of the ramus at the occlusal plane. The posterior margin of the ramus was carefully traced graphically and the occlusal plane level was delineated as guided by the height of cusp tips at the occlusal surfaces of the mandibular molars. Results: In the present study, it was proved 64% accuracy in determination of gender with P value of 0.005. Conclusion: By using ramus flexure, sex can be determined moderately and can be used as a supplementary in determining the sex.
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Occlusal radiograph a hidden tool for sex determination: A radiographic study p. 155
Kotya Naik Maloth, Kundoor Vinay Kumar Reddy, Nayanala Venkata Anusha, Kesidi Sunitha, Chakilam Saraswathi, Ramya Charitha Iraganaboina
DOI:10.4103/jiaomr.jiaomr_44_19  
Aim: To evaluate the reliability of dental arch linear and angular measurements on occlusal radiographs and to assess the usefulness of occlusal radiographs in sex determination. Materials and Methods: A prospective study was conducted on 50 patients (25 males and 25 females) using occlusal radiographs with age ranging from 20 to 25 years. Standard occlusal radiographs were taken without any errors by intraoral dental X-ray machine with required ideal exposure parameters after taking due radiation protection and safety measures. The radiographs were carefully processed and the images obtained were traced for angular and linear measurements, attributing capital letters to the maxillary arch and small letters to the mandibular arch. The obtained data were analyzed by ANOVA using SPSS Software Version 22.0 for statistical analysis using discriminate methods. Results: In the present study, all the linear measurements of occlusal radiographs showed a statistically significant differentiation and angular measurements namely “CIA” L, “MIC” L, “CIA” R, and “MIC” rare found highly significant in the differentiation of sex. Conclusion: We conclude that the occlusal radiographic measurements (odontometry) can be used for sex determination and is recommended as an aid for sex determination in forensic science.
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REVIEW ARTICLES Top

Glittering potentially malignant shell: Arecanut p. 159
Siddharth Kumar Singh, Shareya Faizi, Sunira Chandra, Shruti Sinha
DOI:10.4103/jiaomr.jiaomr_35_19  
Areca nut is consumed extensively throughout the world with significant public health and oral implications. This habit is more prevalent amid communities belonging to India and the South-East Asia region (SEAR). In the past few decades, surveys have reported that consuming areca nut has increased among population and a high proportion of school children use areca-nut daily in some form. Low cost, easy availability, advertising, role modeling, social acceptance and perception of areca nut as harmless is what contributes to its use. Areca nut users are at high risk of oral submucous fibrosis, a debilitating and potentially malignant condition and also suffer adverse health outcomes. Though industrially made areca nut products have been banned in all states and union territories of India, but it is still widely available. WHO Framework Convention on Tobacco Control provides evidence-based policies for reducing tobacco use, but no global policy exists for the control of areca nut use. Associative research is needed to sermon this nugatory global public health emergency and to mobilize efforts to control areca nut use. In addition, possible prevention and cessation programs for areca nut users, effective actions to increase awareness regarding health risks among general public and to minimize its use both at personal and government levels should be undertaken.
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Growth factors in the treatment of oral mucositis in patients receiving treatment for head and neck cancers - A review p. 162
Pratima Soni, Komali Garlapati, Anuja Kammari, Harika Guduru
DOI:10.4103/jiaomr.jiaomr_176_18  
Many cancer patients undergoing systemic chemotherapy or radiotherapy or a combination of both, especially in head and neck region, are inherently prone to develop a frequent complication i.e. oral mucositis. This acute and distressing sequel of cancer therapy drastically impairs routine activities such as mastication, deglutition, and speech thereby affecting the overall quality of life of these patients. Because of the complex nature of oral mucositis, its management becomes challenging. An in-depth understanding of the etiopathogenesis of oral mucositis has provided numerous treatment options, but none with a proper guideline. Recent years have also seen a considerable emphasis on growth factors, which has led to the recognition that they might have potential in the therapeutic management of these complications, either by regeneration through biomimetic or mimicking the processes that occur during embryonic and post-natal development. As the understanding of the biological and physiological role of growth factors increases, it is certain that they will play an increasingly important role in clinical insights. This review attempts to highlight the role of growth factors in the management of oral mucositis.
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Integral elements of a research protocol p. 167
Prashanthi Reddy, Upendra Singh Bhadauria
DOI:10.4103/jiaomr.jiaomr_220_18  
The research is conducted in accordance to a protocol that illustrates each essential part and the manner in which it is carried out. The research proposal outlines the key aim and provides numerous benefits to the researcher. There are numerous integral elements of a research protocol which ensure that the protocol is accurate, concise and provides adequate information about the study, ensures it is ethically sound, illustrates the need and the hypothesis of the study. The methodology explains the study design, procedures, and techniques used to achieve the proposed objectives. It defines the variables and demonstrates in detail how the variables will be measured, whereas the analysis plan and the statistical tests to determine the significance helps in rejecting or accepting the null hypothesis. Referencing is an extremely important aspect of the research protocol. A protocol with appropriate hypothesis, clear methodology, no typographical error, and easy readability is bound to create an impact on the existing and future literature.
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CASE REPORTS Top

Aggressive central giant cell granuloma – A case series with literature review p. 171
Manjula Hebbale, Versha Rani Giroh, Amit Mhapuskar, Darshan Hiremutt
DOI:10.4103/jiaomr.jiaomr_45_19  
Central giant cell granuloma (CGCG) of the maxillofacial region is generally present as an asymptomatic slowly growing localised disease to aggressive neoplasm-like rapid expansive progression typically present with localised disease. It is an uncommon benign lesion with a low incidence that occurs in the craniofacial region especially in jaw bones. It is a localised osteolytic lesion with varied biologic behavior of aggression which affects the jaw bones. There is much controversy regarding it arising as a result of trauma and its connection with the giant cell lesion seen in the long bones. As it is uncommon, it does not possess any characteristic clinical or radiologic features and resembles neoplasms; the diagnosis is initially some odontogenic or non-odontogenic neoplasm till a definitive histologic diagnosis of CGCG is made. We report five cases of an aggressive form of CGCG at different sites of involvement in the jaw bones.
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A commonly missed diagnosis: Poncet's disease p. 176
Vishal Mehrotra, Kriti Garg, Parvathi Devi, Shiv Chauhan
DOI:10.4103/jiaomr.jiaomr_14_19  
Tuberculosis (TB) is on the rise particularly in developing countries like India. The lung happens to be the most common site for the occurrence of the same, but extra pulmonary manifestation is not that uncommon. Joint involvement in TB is usually monoarticular, rarely may present as polyarthritis. Reactive arthritis in TB is known as Poncet's disease, a rare aseptic form of arthritis characterized by polyarticular impairment observed in patients with active TB, with no evidence of direct bacillary invasion of the joints. The condition is different from tuberculous arthritis which is usually monoarticular and is caused by direct tubercular involvement of the joint. A 40 year female patient reported with gradually enlarging swelling of left preauricular region and painful joints based on clinical history and investigations she was diagnosed with Poncet's disease.
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Calcifying cystic odontogenic tumor of anterior mandible - A case report with series of follow up radiographs p. 181
Hima John, S Padmashree, PS Shilpa, Sayyad Z Innus
DOI:10.4103/jiaomr.jiaomr_25_19  
The calcifying odontogenic cyst was first described by Gorlin et al. who were impressed by the presence of numerous ghost cells. Currently, this particular entity is known as calcifying cystic odontogenic tumor (CCOT). Since its recognition, the lesion is seen occurring both peripherally and centrally in the jaws. Its origin, pathogenesis, and histopathological variations have evoked considerable discussions in the past which has resulted in formulation of various classifications. This paper highlights a case of CCOT in the anterior mandible, the characteristic features, treatment and follow-up are discussed, emphasizing on the series of follow-up radiographs.
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Pachyonychia congenita: A case report p. 184
Silpa Ramachandran, Suman Jhansi Lakshmi, Elangovan Somasundaram, Senthil Kumar Balasubramanian
DOI:10.4103/jiaomr.jiaomr_23_19  
Pachyonychia congenita (PC) is a rare autosomal dominant disorder of keratinization. It is usually present at birth or develops within 1 year of birth. It is classified into four types, but type-1 (Jadassohn–Lewandowsky type) and type-2 (Jackson–Lawler type) are the most common. PC is characterized by dystrophic, thickened nails, and painful palmo–plantar keratoderma. The nails are dramatically affected in most patients, but oral lesions are seen in patients affected by the Jadassohn–Lewandowsky type. In literature, fewer than 500 cases have been reported about PC. We report a case of PC in an 18-year-old male patient who presented with subungual hyperkeratosis, palmar-plantar keratosis, and leukokeratosis.
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Plexiform ameloblastoma arising from the dentigerous cyst – A rare case report p. 188
Durga Okade, Tejavathi Nagaraj, IP Mahalakshmi, Swati Saxena
DOI:10.4103/jiaomr.jiaomr_60_19  
Ameloblastoma, a benign epithelial odontogenic tumor, is locally aggressive. This tumor comprises about 1% of tumors and cysts arising in the jaws. It appears most commonly in the third to fifth decades and with equal frequency between sexes. They are usually benign in growth pattern but frequently invade locally and occasionally metastasize. Ameloblastoma prevalently occurs in the mandibular molar and the ramus areas. Recurrence frequently appears after inadequate treatment. Therefore, an appropriate diagnosis and treatment planning should be done to prevent the complications and for better prognosis. In this study, a case of plexiform ameloblastoma was presented with its clinical, radiological, histological features, and treatment modalities.
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