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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 31 | Issue 4
Page Nos. 285-400

Online since Tuesday, March 3, 2020

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EDITORIAL  

Artificial intelligence in oral medicine and radiology Highly accessed article p. 285
Ajay Pratap Singh Parihar
DOI:10.4103/jiaomr.jiaomr_7_20  
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ORIGINAL ARTICLES Top

A novel mixture of curcumin paste and prednisolone for treating oral lichen planus: A case controlled comparative study Highly accessed article p. 286
Shantala R Naik, Prashant Gupta, L Ashok, Tanya Khaitan, Anjani K Shukla
DOI:10.4103/jiaomr.jiaomr_171_19  
Background and Aims: This study was done to evaluate the clinical efficacy as a topical drug of a novel mixture of prednisolone and curcumin in oral lichen planus. Methods: Our study included 60 cases of symptomatic oral lichen planus. Patients were divided into two groups of 30 each. Group 1 received first mode of therapy of topical curenext gel. Group 2 received second mode of therapy of novel mixture of curenext gel and prednisolone. They were reviewed after 10 days and 20 days. Findings: Novel mixture effectively reduced the reticulation, erosion and pain and these differences were significant when compared with first mode of therapy. Conclusion: We would recommend the use of novel mixture for treatment of any case of symptomatic oral lichen planus than using curenext alone. Practical Implications: Topical curcumin alone is not effective against oral lichen planus. If this is mixed with a steroid, the mixture could give the benefits of steroid and curcumin together and hence appear to be more effective.
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Evaluation of the salivary zinc assay as a potential diagnostic tool in potential malignant and malignant lesions of the oral cavity Highly accessed article p. 293
Marwa Mohmmad Khalil, Samira Zraiki, Muhammed Imad Khayat
DOI:10.4103/jiaomr.jiaomr_180_19  
Introduction: Recently, trace elements are receiving much attention in the detection of oral cancer and potentially malignant disorders, as they are found to be significantly altered in the head and neck, lung, and breast carcinomas. Undoubtedly, by early diagnosis of potentially malignant lesions based on the values of micronutrients, the occurrence of cancers may be decreased. Aims and Objectives: The aim of the study was to evaluate the salivary levels of zinc (Zn) in patients with oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL). Materials and Methods: The study subjects included histopathologically confirmed cases of OL and OSCC with age and sex-matched healthy controls, reporting to the Department of Oral Medicine, Faculty of Dentistry, Tishreen University from January 2017 to July 2019. The subjects were asked to spit in a graduated container every 1 min till 5 mL of saliva was obtained. Levels of Zn were estimated by standard spectrophotometric methods in accordance with the underlying validated principles using the kits from Medichem, Germany. Settings and Design: This study is a randomized clinical trial. Statistical Analysis Used: ANOVA and Chi-square'' test. Results: There was a highly significant decrease in the level of salivary Zn in patients with OSCC when compared to OL patients and controls (P < 0.05). Salivary Zn levels were decreased in OL patients when compared to controls. However, the difference was not statistically significant. Conclusion: Salivary Zn could be used as a biomarker for OSCC and OL.
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Efficacy of alum in recurrent aphthous stomatitis Highly accessed article p. 298
Vasundhara Bandagi, Sanjeev Onkar, Rajendra Birangane, Abhay Kulkarni, Rohan Chaudhari, Pratik Parkarwar
DOI:10.4103/jiaomr.jiaomr_123_19  
Aphthous ulcers are the most common lesions encountered in the oral cavity. The mild recurrent apthous stomatitis (RAS), is an extremely painful condition. Various treatment modalities are tried for RAS. Alum is also tried and found to be successful. Alum is used in traditional medicine for the treatment of oral ulcers without significant side effect. Aim: To assess the efficacy of alum for the treatment of recurrent aphthous stomatitis. Settings and Design: Longitudinal study was carried out in the Department of Oral Medicine and Radiology under institution setting. Methods and Materials: This study was conducted on 50 patients with RAS, aged between 15 and 40 years. The diagnosis of RAS was made based on its clinical appearance and the history provided by the patient. Application of alum on aphthous ulcers was done. Statistical Analysis Used: The data obtained was tabulated and subjected to statistical analysis. Results: In 50 patients reporting to the Department of Oral Medicine with RAS, 70% were female and 30% were male. Majority of cases found in the range of 21–30 years. The majority of patients gave VAS 0 on the second day of application. The rest of the patients gave a VAS 0 on the third day of application. Complete healing of the ulcer was seen in 85% of the patients on third day and the rest of the patients showed healing on fourth day. Conclusions: The results showed that alum significantly reduces the severity of pain and duration of healing without any side effects.
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Prevalence of post traumatic trigeminal neuralgia (PTTN): Observational study at dental college, Kanpur p. 303
Kriti Garg, Rohan Sachdev, Vishal Mehrota, Garima Singh, Sekhar Mukherjee, Saman Ishrat
DOI:10.4103/jiaomr.jiaomr_146_19  
Context: The trigeminal nerve is a mixed nerve performing both sensory and motor functions and supplies the orbit, the maxilla and the mandible, any trauma whether accidental or iatrogenic are the common cause of trigeminal neuropathy. Most cases of posttraumatic trigeminal neuralgia (PTTN) occur due to extraction of tooth, root canal treatment, and any kind of jaw fracture affecting the crown -root of a tooth. Aims: The aims of this study are to know the prevalence of PTTN in dental outpatient department (OPD) and to know the relation between traumatic dental extraction of teeth and occurrence of PTTN. Settings and Design: An institutional observational study. Methods and Material: The study was conducted during November 2018 to May 2019 and patients from dental OPD were selected based on the criteria of inclusion and exclusion factors. Statistical Analysis Used: Data collected were analyzed using the Statistical Package for Social Sciences (SPSS) software version 17 using descriptive frequency method. Results are represented as frequency and percentages. Results: The total new cases reported to the dental OPD were 8280 patients, out of those 129 patients of PTTN were recorded. In this study, the prevalence of PTTN patients was 1.55% and the males were more affected than female. Conclusions: PTTN is most often secondary to iatrogenic trauma during dental extractions and other orodental surgical procedures performed in oral cavity with localized sensory defects to inferior alveolar nerve, lingual nerve, and branches of maxillary nerves.
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Oral lesions associated with Dengue fever p. 307
Jayaprasad Anekar, Jayalakshmi Baipadavu, Raj A Chirakara, Deepika Nappalli, Krishna S Kumar, Ivin E John
DOI:10.4103/jiaomr.jiaomr_141_19  
Aims: Dengue is one of the most common arthropod-borne infection, which is of great public health importance. Literature presenting the specific and nonspecific general symptoms of dengue is available. However, descriptions of oral manifestations of dengue are not easily available. The aim of this study is to describe the uncommonly presented manifestations with importance to oral presentation. Methods and Materials: After obtaining institutional ethical clearance, 200 dengue cases were subjected to clinical and laboratory examinations. Dengue fever (DF) was diagnosed based on the World Health Organization (WHO) clinical criteria and serology. Informed consent was obtained from every patient. Results: The most common oral manifestations were lip crust and tongue coating. The occurrence of petechiae, erythema, gingival bleeding, and hemorrhagic plaque was associated with prolonged bleeding time, and it was a statistically significant association. There was also a statistically significant association between thrombocytopenia and tongue coating. Conclusions: Oral manifestations are an important finding in dengue patients. The timely identification of these symptoms can aid in the diagnosis and help the effective management of the disease.
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A Study to Evaluate the Efficacy of Platelet Rich Fibrin with Nanocrystalline Beta-Tricalcium Phosphate in the Treatment of Periodontal Intrabony Defects p. 311
Nimmi Singh, Sneha Mayuri, Anindita Banerjee, Nitubroto Biswas, Prabhat Kumar Singh, Rajat Sehgal
DOI:10.4103/jiaomr.jiaomr_202_19  
Background: Presently, there is no gold-standard regenerative material for the treatment of periodontal intrabony defects. The use of bone grafts in combination with guided tissue regeneration membrane is a predictable treatment option but is expensive. Platelet concentrates are increasingly being used due to their ease of use and cost-effectiveness. Aims: The objective of the present study is to compare clinically and also by Cone Beam Computed Tomography (CBCT), the effect of platelet-rich fibrin combined with synthetic beta-tricalcium phosphate to synthetic beta-tricalcium phosphate alone in the treatment of periodontal intrabony defects. Materials and Methods: 10 patients possessing 2 almost identical interproximal intrabony defects in either side of mandible were selected and the defects were further divided into 2 groups randomly: Control Group A (Beta-tricalcium phosphate placed) and Test Group B (Beta-tricalcium phosphate with platelet-rich fibrin placed). Regeneration of soft tissue and hard tissue (using CBCT) were evaluated after 6 months from baseline in both groups. Statistical Analysis Used: The intragroup and intergroup comparisons were done using Paired and student t-test. Results: Intragroup showed significant improvement in both soft tissue and hard tissue parameters. Mean of all parameters was better in the test group; however, the intergroup difference was not statistically significant. Conclusions: Within the limitations of the present study, the use of beta-tricalcium phosphate bone graft combined with platelet-rich fibrin and beta-tricalcium phosphate bone graft alone are both equally effective for the treatment of periodontal intrabony defects.
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Knowledge, attitude and practice towards areca nut use among medical student of Nagpur city p. 318
Apeksha S Dhole, Shreya Chandrashekhar Kohale, Mukta Motwani, Adeeba Siddique
DOI:10.4103/jiaomr.jiaomr_176_19  
Background: Areca nut is consumed by approximately 600 million people worldwide and is the fourth most common psychoactive substance used globally and also gaining popularity among younger populations. There is substantial evidence that areca nut is the sole factor for the causation of premalignant condition like oral submucous fibrosis, aggravating asthma, liver fibrosis, hypertension, etc., and has its deleterious effects on other system of the body as well. As the MBBS curriculum does not include the awareness regarding the detrimental effects of areca nut use, it becomes mandatory for people from health science fraternity including medical students to have knowledge and awareness regarding such harmful agents. Therefore, the study is planned to assess the knowledge, attitude and practice toward areca nut consumption among medical students. Aim: To assess the knowledge, attitude, and practice toward areca nut consumption among medical students of Nagpur city. Methodology: After getting approval from the Institutional Ethics Committee dated 22nd July2019, this cross-sectional study was carried out at VSPM DC and RC in collaboration with NKP SIMS Nagpur. The validated questionnaire was designed which comprised of 23 close-ended questions to asses about knowledge, attitude, and practice toward consumption of areca nut. The questionnaire was prepared on Google form which was then sent via e-mail among 200 medical students including interns and post-graduates willing to participate in the study and their responses were obtained by five-point Likert scale that ranges from strongly agree to strongly disagree. Results: There was a high percentage of unawareness regarding knowledge and attitude parameters and lack of practice of areca nut among medical students. Conclusion: There is need “to update” the knowledge and awareness among medical students regarding hazards of the areca nut use by conducting CME programs in order to provide better life quality to the patients.
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Serum lipid profile in patients with oral potentially malignant disorders p. 323
P Ramaswamy, Ch Sai Kiran, B Mrudula Raju, M Swathi, A Anusha, Goteti Elizabeth Sharanya
DOI:10.4103/jiaomr.jiaomr_167_19  
Aim: To estimate serum lipid profile in patients with oral potentially malignant disorders. Materials and Methods: Around 100 patients with oral potentially malignant disorders and 20 patients as controls were subjected to serum lipid profile after obtaining institutional ethical clearance. Estimation of lipid profile value was done for total serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and triglycerides (TG) using Endpoint method. Results: HDL levels were significantly lower in females with oral potentially malignant disorders (P = 0.047). The mean value of total cholesterol, HDL, VLDL, and TG was lower in leukoplakia compared to lichen planus, smoker's palate, combined leukoplakia, and smoker's palate lesion and oral submucous fibrosis, i.e. 140.78, 32.444, 28.444, 141.33, respectively. The mean value of LDL was low in lichen planus compared to other groups, i.e. 73.167. Conclusion: This study concluded that the lower serum lipid levels might serve as a diagnostic indicator or marker in the early diagnosis of oral potentially malignant disorders in females.
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Comparative efficacy of intralesional placental extract and intralesional triamcinolone acetonide in the management of OSMF p. 328
Christopher V Shinde, Nisheeth Saawarn, Sahil Kohli, Pooja Khare, Ajita Singh, Krishna M Sagar
DOI:10.4103/jiaomr.jiaomr_155_19  
Context: Oral submucous fibrosis (OSMF) is characterized by excessive collagen production in the submucosa leading to progressive fibrosis of the oral mucosa and atrophic changes of the epithelium. Aim: To clinically evaluate the efficacy of intralesional injections of placental extract (2ml) in comparison to intralesional injections of triamcinolone acetonide (40mg/ml; 1ml) in the management of OSMF patients. Methodology: This randomized, parallel-group, single-blinded outcome-based study, consisted of 40 diagnosed cases of OSMF. The patients were divided into two groups of 20 each in placental extract group and triamcinolone acetonide group. Patients were administered test medications weekly in respective groups by intralesional mode for a period of 10 weeks. Parameters taken into consideration and compared weekly were burning sensation, pain, mouth opening, tongue protrusion, and cheek flexibility. Result: The data so obtained was tabulated and subjected to statistical analysis using Chi-square test, Mann–Whitney test, Wilcoxon ranked test, and t-test by means of SPSS version 20 software to reach conclusive results. There was significant improvement in burning sensation, pain, mouth opening, tongue protrusion, and cheek flexibility in both groups. Better and faster improvement in tongue protrusion and cheek flexibility was achieved in triamcinolone group as against placental extract group. Conclusion: The intralesional triamcinolone acetonide was found to be a superior intralesional drug in comparison to placental extract.
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Estimation of salivary copper, zinc, iron and copper to zinc ratio in oral submucous fibrosis patients and its comparison with healthy individuals p. 333
Gitanjali Khulbe, Praveena Tantradi, Renuka Ammanagi, Sujata Byahatti
DOI:10.4103/jiaomr.jiaomr_81_19  
Background: Trace elements have been found to be altered in oral submucous fibrosis (OSMF), an oral potentially malignant disorder which occurs as a result of a derangement in collagen metabolism. The literature on variation observed in the parameters of trace elements, in the saliva of OSMF patients and its correlation with the staging of OSMF, is limited. Hence, a case-control study was carried out to estimate the salivary concentrations of copper, zinc, and iron in OSMF patients. Materials and Methods: Out of the 120 patients enrolled, 60 OSMF cases and 60 healthy individuals were studied. Unstimulated whole saliva from each subject was centrifuged and the supernatant stored at -80°C. Laboratory analysis was done to estimate copper, zinc, and iron and the values were statistically analyzed. Results: The mean values of salivary copper, zinc, and iron were lower in OSMF cases than the controls and the mean copper to zinc ratio was higher in the cases, the differences being statistically insignificant. Conclusion: The chance differences that occurred in our study might have been due to lifestyle variations among the different subjects. Saliva may or may not be a representative of the changes seen in the trace element levels of OSMF patients.
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Assessment of linear measurements with intra oral grid on intra oral periapical image – A comparison of digital and conventional film images using bisecting angle and paralleling techniques p. 339
K Roja Reddy, Ramesh Tatapudi, R Sudhakara Reddy, C Naresh Kumar, T Navya Teja, G Swathi
DOI:10.4103/jiaomr.jiaomr_201_19  
Background: The success of various treatments protocols depends on pre-operative diagnostic aids such as radiographic assessment with linear measurements, in such scenario radiographic grid with its unique design aids like a scale for image analysis on intraoral periapical radiograph. Hence, the intra oral grid is a simple and accurate way of measuring objects, and another advantage is to overcome various magnification errors associated with measurements. So, the present study was designed to know its accuracy in assessing the linear measurements. Materials and Method: The study sample comprised a total of 40 subjects, which were categorized into four groups. A total of 240 exposures were taken, where each patient was subjected to six radiographs, of which two are conventional intraoral periapical radiographs without grid, and two are conventional intraoral periapical radiographs with grid by bisecting and paralleling technique and another two radiographs are taken by digital CMOS sensor with intraoral periapical grid in all four groups. The measurements were performed on the radiographs using scale and divider and in case of radiograph with the grid by counting the grid lines from specific points. Results: The results of the study revealed on comparison of conventional and digital radiographs with and without a grid in both bisecting and paralleling technique in all the four groups, there was a statistically significant difference noticed with digital radiography compared to the conventional method in assessing the measurements with the grid with P value <0.005. Similarly, paralleling technique showed a significant difference in its mean measurement values in all the four groups compared to bisecting angle technique in both conventional and digital methods in case of usage of grid. Conclusion: Intraoral grid was used as a scale in the instances where the exact size of various anatomical structures and pathologies cannot be determined visually in radiograph and even in cases of distortion; this can be used for standardization.
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Cone beam computed tomography – the importance of z-axis p. 346
Anusuya G Savalagi, Roshan A Chandwani, Sagar A Khairnar
DOI:10.4103/jiaomr.jiaomr_152_19  
Background: Conventional imaging is the backbone of dentistry. Intraoral and extraoral radiographs are commonly used for diagnosis and clinical management for multiple maxillofacial pathologies. However, they are of a two-dimensional nature and have numerous limitations and disadvantages. Cone beam computed tomography (CBCT) adds a third dimension to the two-dimensional image. The multiple pathological conditions that remain undetected in two-dimensional imaging can be easily diagnosed with CBCT and, to a large extent, help with treatment planning and prognosis. Aim: To compare intraoral and extraoral two-dimensional imaging to CBCT to prove the importance of CBCT in diagnosis and treatment planning. Setting and Design: Different cases in which patients underwent two-dimensional intraoral / extraoral imaging and CBCT were reported and variations in radiographic diagnosis were compared. Conclusion: CBCT is a boon to dentistry. The third dimension adds invaluable information that modifies the diagnosis and treatment plan and hence helps improve the prognosis.
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FORENSIC ODONTOLOGY: ORIGINAL ARTICLES Top

Tooth coronal index (TCI), antegonial angle, and antegonial depth measurement for age estimation using digital panoramic radiograph p. 353
Priyanka Tidke, Sunita Kulkarni, Vaishali Agrawal, Ullas Saxena, Rucha Pandharipande
DOI:10.4103/jiaomr.jiaomr_111_19  
Introduction and Aim: Age estimation in living individuals is a relatively recent area of applied research within the forensic sciences. Tooth coronal index (TCI) method of age estimation is based on the relationship of age and size of pulp on dental radiographs. This study was an attempt to device simple, cost-effective method to perform morphometric analysis of dental pulp for age estimation. Materials and Methods: In all, 200 subjects were studied for this study. They were classified into four groups (21–30, 31–40, 41–50, and 51–60 years). Subjects then had undergone digital radiographic procedure [radiovisiography (RVG) and orthopantomogram (OPG)], and morphometric analysis (TCI, antegonial angle, and depth) was done. Results: On analysis of complete models with TCI, antegonial angle, and depth, there were 21 (42%) cases with predicted age within ± 5 years in the test data set. In the complete data set (n = 200), 78 (39%) cases were predicted with age within ± 5 years. The models derived for the second premolar and with TCI, antegonial angle, and antegonial depth were better predictor of age when compared with model with only single parameter. On predictions based only on TCI, both the OPG and RVG methods were at par with regard to the overall prediction. Conclusion: There are no significant differences in correlation of age with TCI using OPG and RVG. Correlation of age when three parameters (TCI, antegonial angle, and antegonial depth) are combined is more significant when compared with TCI alone.
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Age estimation using pulp tooth area ratio in North Indian population p. 359
Munish Kumar, Sweta Choudhary
DOI:10.4103/jiaomr.jiaomr_148_19  
Introduction: One of the most common dental expert advice asked by the law enforcing agencies is to provide identity and age of the accused or person involved. Age determination is done for various causes including that of dead bodies for reasons as unlawful cases and also in badly disfigured bodies in disasters, such as natural calamities or manmade like fires, accidents, etc., In living individual, the age estimation is done to crosscheck whether an individual has attained the age for lawful liability when records are not available or suspected. Materials and Methods: Study was done on 300 individuals (150 males-females each) using RVG of Right maxillary canine and data is processed by AutoCAD 2006. Results: Intraclass correlation coefficients (r) for reliability of predicted age calculated have significant P value (<0.05). Discussion: The purpose of this study was to validate the Modified Cameriere's method of age estimation using pulp tooth area ratio given by Jeevan et al. on North Indian population. Conclusion: We can conclude from this study that AutoCAD is definitely a tool for measurements of pulp/tooth area ratio which can further be used for age estimation in forensic odontology; Gender has no significant influence on age estimation..
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REVIEW ARTICLES Top

Why CBCT is imperative for implant placement p. 363
Aveek Mukherji, Mohit Pal Singh, Prashant Nahar, Saurabh Goel, Hemant Mathur, Zibran Khan
DOI:10.4103/jiaomr.jiaomr_174_19  
Dental implants are widely used for the rehabilitation of edentulous spaces. Diagnostic images of the surgical site is essential for preoperative planning, intra-operative assessment, and postoperative evaluation. At present, Cone-Beam Computed Tomography(CBCT) is the best imaging modality for qualitative and quantitative analysis of the surgical site for implant placement. It allows pragmatic planning and subsequent post operative evaluation with submillimetric accuracy. CBCT software enables simulation of implant placement to choose the ideal dimension, position and orientation. This article briefly describes why CBCT is crucial for dental implants and explains how to utilise its advantages. Radiological pictures of a few cases have been discussed to highlight the merits and demerits of this imaging modality for pre-surgical and post surgical evaluation of implant placement.
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Ameloblastomatous calcifying cystic odontogenic tumor: A review of a rare lesion p. 370
Aastha Manchanda, Seema Patil
DOI:10.4103/jiaomr.jiaomr_181_19  
Calcifying cystic odontogenic tumor (CCOT) is an uncommon developmental lesion accounting for less than 2% of odontogenic tumors. Because of its diverse histopathology, there has always been confusion about its nature as a cyst or a neoplasm, although it is well known that this lesion often occurs in association with other odontogenic tumors such as complex odontoma and ameloblastoma. It is noted that if CCOT is associated with an ameloblastoma, its behavior and prognosis will be that of an ameloblastoma, not of a CCOT. This article presents a review of all reported cases of ameloblastomatous CCOT in the last 15 years in journals indexed with PubMed.
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CASE REPORTS Top

Adenomatoid odontogenic tumor – A diagnostic imaging using cone bean computed tomography p. 374
Jaishri Pagare, Satyapal Johaley, Jyoti Bhavthankar, Mandakini Mandale
DOI:10.4103/jiaomr.jiaomr_136_19  
Adenomatoid odontogenic tumor (AOT) is a rare noninvasive benign tumor of the jaw that originates in the second decade of the life from the odontogenic epithelium without mesenchyme. Radiological examination is an essential component for the diagnosis of benign tumors, the radiographic modality used to acquire the image was speculated to have an effect on the perception of radiopacities, particularly for the cases with minimal intralesional calcifications. Therefore, the capability of radiographic modality in detecting the intralesional calcification was critical for diagnosis of AOT. Cone beam computed tomography (CBCT) provides precise imaging of bony structures with minimal calcification without superimposition and distortion. In this case report, we are reporting a case of AOT of maxilla with characteristic CBCT appearance of AOT of maxilla.
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Gemination mandibular third molar – A rare case with use of CBCT in diagnosis and treatment planning p. 377
Pooja Bhatt, Himanshu Gupta, Hemant Mathur, Anand Porwal
DOI:10.4103/jiaomr.jiaomr_156_19  
It is not uncommon to find dental anomalies in routine practice. Developmental dental anomalies may be seen in tooth number, size, shape, and structure. Gemination and fusion are anomalies of shape with close similarity but with different etiology. Differential diagnosis is difficult and so the term “double teeth” is often used. The incidence of double teeth is less than 1% and even more so in permanent dentition. Here, we present a unique case of gemination in mandibular third molar diagnosed effectively with the help of three-dimensional imaging and managed with the surgical technique.
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Nasopharyngeal carcinoma presenting as muscular atrophy – A rare case report and role of oral physician p. 382
Ravinder Singh, Amit Aggarwal, Deepak Gupta, Samita Singal
DOI:10.4103/jiaomr.jiaomr_58_19  
The presenting features of nasopharyngeal carcinoma (NPC) are varied and very few cases present with symptoms unless advanced stages of NPC are present. The disease is one of the most baffling, difficult to diagnose, and abjectly understood entities because of the location of the involved area. The role of oral physician is difficult to specify in this disease except that sometimes patients report to them for facial symptoms. We are presenting a rare case in which the facial muscles were atrophied on one side with mild facial pain which on advanced radiological imaging and histopathology turned out to be nasopharyngeal carcinoma. The role of oral physician becomes critical in diagnosing cases of nasopharyngeal carcinoma which present with no symptoms or few symptoms related to the disease.
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Management of pemphigus vulgaris with rituximab: A case report and brief review on emerging treatment options p. 386
Massillamani Francis, Naga Leela Guntuku, Dhandu Leena, R Geetha
DOI:10.4103/jiaomr.jiaomr_132_19  
Pemphigus vulgaris is the most common autoimmune vesiculobullous disorders. It presents with flaccid bullae on the skin and erosions on the mucosa. Severe cases can be life-threatening and hence prompt treatment can prevent untoward consequences. Earlier, steroids were the mainstay of treatment but it causes further medical problems. Nevertheless, new studies have emerged about the pathogenesis of the diseases and treatment protocols have been updated with newer drugs that had comparatively less adverse effects. We report a case of pemphigus vulgaris with extensive involvement of skin and oral mucosa treated with rituximab and adjuvant immunosuppressants and a brief update on various treatment protocols.
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Treatment evaluation of odontogenic keratocyst by using CBCT and fractal dimension analysis on panoramic radiograph p. 391
Eha Renwi Astuti, Ni Putu Mira Sumarta, Ramadhan Hardani Putra, Berty Pramatika
DOI:10.4103/jiaomr.jiaomr_138_19  
The odontogenic keratocyst (OKC) is a benign intraosseous lesion that derives from remnants of the dental lamina. General practitioners usually use panoramic radiograph and cone-beam computed tomography (CBCT) as radiography examination of a suspected OKC lesion in the mandible or maxilla. Evaluation of post marsupialization could be assessed by using fractal dimension (FD) analysis of trabecular bone in panoramic radiograph and CBCT. In the present case, we use panoramic radiograph and CBCT for the treatment evaluation of OKC. The aim of this case report is to describe a case of OKC and evaluation of treatment progress by using FD analysis on panoramic radiograph and CBCT. A 40-year-old female patient came with a complaint of slowly enlarged swelling on the left mandible for 10 years. Low-grade pain occasionally happened to that women. Panoramic radiographs revealed multi-locular radiolucency extending from anterior of the mandible body to ascending ramus. Coronoid and condyloid process, and inferior border of the mandible were intact. OKC was confirmed based on biopsy of the lesion from extraction site of left lower third molar tooth. We did marsupialization from tooth extraction socket and let it open as a window to apply obturator. The researchers did a serial panoramic radiograph to evaluate treatment, showing reduction of radiolucency size and increasing of FD in lesion peripheral, it means that there was an osseous healing process. One year after marsupialization, the researchers did CBCT examination to evaluate bone regeneration and density. The result of CBCT showed the size reduction of the lesion in sagittal, coronal, and axial planes. CBCT also revealed bone formation from the periphery of the lesion. CBCT assessment and FD analysis of trabecular bone on panoramic radiograph is a reliable imaging method for the treatment evaluation of OKC and determination of ossification as well.
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Diagnosis lies in the eyes of beholder: Linear gingival erythema in a non-HIV pediatric patient p. 397
Khushboo Gupta, Saurabh Singh, Sathya Kannan
DOI:10.4103/jiaomr.jiaomr_125_19  
Linear gingival erythema (LGE), formally referred to as HIV gingivitis, is the most common form of HIV associated periodontal disease in the HIV infected population. There is now evidence that this disease also occurs in HIV negative immunocompromised individuals and is not specific to HIV infection. A 13 years old boy presented with gingival inflammation in upper and lower anterior teeth mimicking LGE, but blood investigations showed HIV negative status. The microbial sample from the affected area confirmed candida infection and antifungal therapy with scaling helped to resolve the lesion. This case report emphasis that the clinician should obtain an in depth medical history to investigate such a condition. If there are signs and symptoms suggesting a systemic disease such as HIV, appropriate diagnostic testing such as blood testing or cytology must be considered. Patients with LGE should undergo laboratory testing to ensure that any underlying disorder is diagnosed and treated at the earliest possible time.
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