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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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   Table of Contents - Current issue
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July-September 2019
Volume 37 | Issue 3
Page Nos. 223-313

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EDITORIAL  

It's time for creative solutions: Collaborations p. 223
Sudhindra M. Baliga
DOI:10.4103/JISPPD.JISPPD_284_19  PMID:31584019
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ORIGINAL ARTICLES-OBSERVATIONAL STUDIES Top

Are dental caries and overweight/obesity interrelated? A cross-sectional study in rural and urban preschool children Highly accessed article p. 224
Bhavika Sharma, KR Indushekar, Bhavna Gupta Saraf, Divesh Sardana, Neha Sheoran, Sunny Mavi
DOI:10.4103/JISPPD.JISPPD_140_18  PMID:31584020
Background: Obesity and dental caries are two distinct diseases which are somewhat preventable through a common risk factor approach, as they have common underlying etiological factor, i.e., high sugar intake. Aim: The aim of the study is to examine the correlation between dental caries and body mass index (BMI) in rural and urban areas of Hisar (Haryana, India) and intercompare their correlations. Settings and Design: This was a cross-sectional study in rural and urban preschool children of Hisar, Haryana. Methods: A total of 500 urban and 500 rural children (age group 3–6 years) were selected from schools of Hisar and the values of their mean BMI and mean decayed, missing, and filled teeth (dmft) (using the World Health Organization criteria, 2005) were compared using independent sample t-test among different groups and subgroups. Pearson correlation coefficients between dmft and BMI were calculated for groups and subgroups and intercompared. Results: Males had significantly higher BMI than females (P < 0.05) and urban preschool children had significantly higher BMI than rural preschool children (P < 0.05). Mean deft was statistically non-significant across the genders and both geographical areas. Non-significant negative correlation was observed between dmft and BMI across different areas and genders. The overall prevalence of obesity/overweight was 20.2% (25.6% urban preschool children; 14.8% rural preschool children). More rural preschool children were underweight (23.8%) than urban preschool children (14.4%) with the overall prevalence of underweight being 19.1%. Conclusions: There was no significant correlation between dental caries and BMI in preschool children of rural and urban areas. Obesity/overweight was more prevalent in urban preschool children, whereas rural preschool children predominantly were underweight.
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Influence of gratification behavior on early childhood caries and body mass index in preschool children p. 232
Battula Purnima, KS Uloopi, C Vinay, Rayala Chandrasekhar, Kakarla Sri RojaRamya
DOI:10.4103/JISPPD.JISPPD_68_19  PMID:31584021
Background: Early childhood caries (ECC) and obesity are becoming major public health problems in children. Apart from biological and social risk factors, gratification response, a psychological behavior, may also have a large influence on body mass index (BMI) and occurrence of ECC in preschool children. Aim: The study aimed to ascertain the impact of delayed gratification as a behavioral risk factor for the occurrence of ECC and obesity in preschool children of age 5–6 years. Settings and Design: Comparative cross-sectional study. Materials and Methods: Fifty children with ECC (Group I) and 50 caries-free children (Group II) were included to participate in a task similar to the famous Stanford marshmallow experiment to assess their ability to delay gratification. BMI was calculated by obtaining the biometric measures of height and weight. Body weight status was determined using BMI for age percentile growth charts revised by the Indian Academy of Pediatrics, 2015. Children's caries experience and BMI status were associated with their gratification response. Statistical Analysis: Statistical analysis was performed using Fisher's exact test and Chi-square test. Results: Higher percentage of children with ECC delayed their gratification (54%) than caries free (40%). Children who exhibited instant gratification (37%) had a higher BMI when compared to those who delayed their gratification (25%). Conclusion: Children with ECC were more self-controlled, and children with high BMI were more impulsive. Hence, delayed gratification for cariogenic reward is a behavioral risk factor for ECC, whereas instant gratification is an alarming risk factor for higher BMI in preschool children.
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Stress-mediated quality of life outcomes in parents of disabled children: A case–control study p. 237
Bhaswati Chakraborty, Arathi Rao, Ramya Shenoy, Latha Davda, BS Suprabha
DOI:10.4103/JISPPD.JISPPD_266_18  PMID:31584022
Background: The purpose of the present study was to resolve whether caregiving for a child with disability influences the physical and mental health of the caregivers and whether stress is related to the quality of life of the caregivers. Methods: The Parental Stress Scale questionnaire for the assessment of parental stress and the Short Form-12 version 2 questionnaire for the assessment of physical and mental health quality of life were distributed among 69 parents of developmentally disabled children and 137 parents of healthy children (control group). Various sociodemographic factors were also included. Results: A significant difference was seen between the two groups in terms of employment, presence of disabled sibling, smoking, and physical activity. Parents of developmentally disabled children had significantly higher stress levels and worse mental health-related quality of life. Overall physical health quality of life was similar between cases and controls. Stress had a negative correlation with both mental and physical health quality of life of the parents. Conclusion: Stress related to raising a child with disability negatively influences the parental quality of life. Stress management aiming at its prevention and reduction might be significant aspects of intervention for the improvement of the quality of life of the caregivers.
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Presence of oral habits and their association with the trait of anxiety in pediatric patients with possible sleep bruxism p. 245
Larissa Soares-Silva, ClŠudia Tavares-Silva, Andrea Fonseca-Gonçalves, Lucianne Cople Maia
DOI:10.4103/JISPPD.JISPPD_272_18  PMID:31584023
Background: Bruxism is a repetitive masticatory muscle activity with a multifactorial etiology , that can be associated to emotional factors. Aim: The aim of the study is to identify the presence of oral habits (OHs) and their association with the trait of anxiety (State-Trait Anxiety Inventory for Children [STAI-C]) in pediatric patients with possible sleep bruxism (PSB). Methods: Children between 3 and 12 years of age with PSB reported by their parents with complete deciduous or mixed dentition were included in the present study. Sociodemographic data (SD) as well as those on OHs such as only natural (ON), artificial breastfeeding (OA) or both (NA), finger sucking (FS), pacifier use (PC), and biting nails (BN) or objects (OB) were obtained through an interview with the parents/guardians answered the Brazilian version of the STAI-C questionnaire. Statistical Analysis Used: SD and OH as well as STAI-C findings were descriptively evaluated, while the associations between OH and STAI-C with PSB were evaluated using the Chi-square test (P < 0.05). Results: The final sample was 52 children (6.62 ± 1.8 years). Of these, 51.9% were males, 82.7% reported not living in social risk areas, and 21.2% were only children. Considering the OH, patients participated in ON (26.9%), OA (9.6%), and both (63.5%); 13.5% had an FS habit and 46.2% had related PC use; and 80.8% were reported to have OB biting behaviors, while 53.8% participated in BN. The STAI-C was present in 25 (48.1%) patients with PSB and was not associated with the presence of OH. Conclusion: There is no association between STAI-C and OH in pediatric patients with PSB.
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ORIGINAL ARTICLES - LABORATORY RESEARCH Top

In vitro evaluation of cytotoxicity of Emblica officinalis (amla) on cultured human primary dental pulp fibroblasts p. 251
Aditi Madhukar Bulbule, Praveenkumar S Mandroli, Kishore G Bhat, Chetna M Bogar
DOI:10.4103/JISPPD.JISPPD_85_18  PMID:31584024
Context: The dental pulp tissue is capable of healing after surgical amputation of infected/inflamed tissue during vital pulp therapy, when in contact with a suitable medicament. Emblica officinalis (amla), a traditional medicine, is one such medicament which has never been evaluated for its healing potential in pulp therapy. Aims: The aim of the study was to evaluate the cytotoxicity of E. officinalis (amla) against human primary dental pulp fibroblasts. Settings and Design: This was in vitro study. Subjects and Methods: Human dental pulp fibroblasts were obtained from dental pulp tissue of extracted over-retained primary incisors. The primary cells were cultured using the Dulbecco's Modified Eagle's Medium and used for the study after the fourth passage. The test medicament was E. officinalis with mineral trioxide aggregate (MTA) (100%) and untreated cells as positive and negative controls, respectively. Methyl-thiazol-diphenyl-tetrazolium (MTT) cytotoxicity assay was performed, and the cell survival was observed and analyzed at intervals of 24, 48, and 72 h. Statistical Analysis Used: Cell survival within groups was compared with Wilcoxon matched-paired t-test and in between groups at each point interval was analyzed with the Kruskal–Wallis ANOVA test. The level of significance was set at 0.05. Results: Within the groups, across the time periods of evaluation, there was a decline in cell survival in both the groups but was statistically significant in the MTA group. On interval-wise comparison, the decline in cell survival was statistically significant between the three groups at 72 h (P = 0.001). Conclusions: E. officinalis preserved the vitality of the human primary dental pulp fibroblasts and has the potential to be developed into vital pulp therapy medicament.
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Antimicrobial efficacy of medium chain fatty acids as root canal irrigants: An in vitro study p. 258
Krishnapriya Devan, Faizal C Peedikayil, TP Chandru, Soni Kottayi, N Dhanesh, K Rahul Suresh
DOI:10.4103/JISPPD.JISPPD_63_19  PMID:31584025
Background: Enterococcus faecalis and Candida albicans are the microbes that are most resistant to elimination by disinfecting agents and are the causative agents for reinfection of the root canal treated teeth. Medium chain fatty acids (MCFAs), which are the main components of coconut oil, are proven antimicrobial agents. Thus, the aim of this study was to evaluate their antimicrobial efficacy against E. faecalis and C. albicans. Methodology: Ninety extracted single-rooted mandibular premolar teeth were decoronated, biomechanically prepared, autoclaved, and divided into three groups (n = 30): Group A (inoculated with E. faecalis), Group B (inoculated with C. albicans), and Group C (control group). Each group was again subdivided into three groups (n = 10) and irrigated with lauric acid (LA), decanoic acid (DA), and octanoic acid, respectively, for 5 min. Paper point samples were taken from canal walls and transferred into Brain Heart Infusion broth and potato dextrose broth and placed in an incubator at 37°C. The appearance of tubidity was checked at 24, 48, 72, and 96 h using direct contact test. The data were then statistically analyzed using the analysis of variance and Tukey honestly significant difference post hoc tests. Results: Among the three MCFAs, LA showed the maximum inhibitory against E. faecalis at 24 h and the inhibitory activity decreased considerably at 48, 72, and 96 h. DA was the most effective against C. albicans with a maximum inhibition at 48 h. DA also showed significant substantivity at 72 and 96 h. Conclusion: Within the limitations of this study, it can be concluded that MCFAs show promising antimicrobial efficacy against E. faecalis and C. albicans.
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Comparative evaluation of compressive strength and surface microhardness of EQUIA Forte, resin-modified glass-ionomer cement with conventional glass-ionomer cement p. 265
P Poornima, Paromita Koley, Mallikarjuna Kenchappa, NB Nagaveni, Kashetty Panchakshari Bharath, Indavara Eregowda Neena
DOI:10.4103/JISPPD.JISPPD_342_18  PMID:31584026
Purpose: The study aimed to evaluate and compare the compressive strength and surface microhardness of EQUIA Forte, light cure, and conventional glass-ionomer cement (GIC). Methodology: Fifty-four pellets of G-Coat (GC) Gold Label 2, GC Gold Label light-cured universal restorative material, and EQUIA Forte GIC were prepared of dimensions (6 × 4) mm and were divided into three groups (18) each and were stored at 37°C for 1 h and then immersed in 20 ml of deionized water, artificial saliva, and lactic acid six each, respectively, over 30 days. Samples were subjected to surface microhardness and compressive strength test on the 1st day, 7th day, and 30th day. Results were subjected to ANOVA and Bonferroni post hoc test. Results: Comparing the compressive strength of EQUIA Forte from day 1 to 30 when placed in artificial saliva, there was a significant increase on day 30 (P = 0.007); compared to other groups. The surface microhardness of EQUIA Forte from day 1 to 30 when placed in artificial saliva nonsignificantly decreased comparing to other groups. Conclusion: Surface microhardness and compressive strength of EQUIA Forte were significantly high in comparison to the other groups.
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Scanning electron microscopic observation of primary tooth dentin following final irrigation with 95% ethanol: An in vitro study p. 271
Anitha Santosh, Adesh Kakade, Sayali Mali, Rutika Lalwani, Sheetal Badnaware, Bhagyashree Deshmukh, Heeresh Shetty
DOI:10.4103/JISPPD.JISPPD_113_19  PMID:31584027
Background: The beneficial effects of irrigants during endodontic treatment are well known; however, it may have some deleterious effects on the internal root canal wall, thereby altering its physical properties. Aim: The purpose of the study was to assess the effect of 95% ethanol on morphological characteristics of primary root dentin. Materials and Methods: Biomechanical preparation was done in twenty extracted single-rooted primary anterior teeth using Rotary ProTaper Universal System. Samples were divided into two groups based on the final irrigation protocol: nonalcohol group (NAG) and alcohol group (AG). 3% sodium hypochlorite and 17% ethylenediaminetetraacetic acid were used for irrigation in both the groups, whereas 95% ethanol was used as a final irrigant in AG. After the treatment, these teeth were longitudinally sectioned and studied under the scanning electron microscope (SEM). Results: SEM observation of NAG showed scattered debris with unaffected morphology of dentinal tubules (DT). In AG, DT showed severe erosion with the loss of peritubular and intertubular dentin. Conclusion: A final rinse with 95% ethanol can change the morphology of the internal root surface and aid in smear layer removal in primary teeth.
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Indigenous irrigants as potent antimicrobials in endodontic treatment: An in vitro study p. 275
Parvathi Satti, Pranitha Kakarla, Sai Sankar Jogendra Avula, Radhika Muppa, Sri Vishnu Kiran Rompicharla, Swati Biswas
DOI:10.4103/JISPPD.JISPPD_112_19  PMID:31584028
Background: The success of an endodontic treatment depends on effective disinfection and complete sealing of root canal. The irrigants that are currently used in the field of endodontics have certain limitations, so the quest for an ideal root canal irrigant continues. Nowadays, the use of herbal extracts such as Triphala and liquorice are used for their potent antimicrobial activity and less side effects. Aim: This study aims (1) to evaluate the antimicrobial efficacy of Triphala and liquorice against Enterococcus faecalis.(2) To determine any cytotoxic effect on isolated human periodontal ligament (PDL) fibroblasts. Materials and Methods: The antimicrobial efficacy of Triphala and liquorice extracts was analyzed at different concentrations (12.5, 25, 50, 75, and 100 mg/ml) using the well-diffusion method. Three percent sodium hypochlorite (NaOCl) and distilled water were taken as positive and negative controls. Minimum inhibitory concentration of the active extract was determined by the broth dilution assay. Human PDL fibroblast tissue culture was used to assess the cytotoxicity of the preparations. The data thus obtained were subjected to statistical analysis. Results: The results showed that the mean antimicrobial efficacy of Triphala and liquorice at 50 mg/ml is 20.33 and 9.33, respectively, which are statistically significant (P < 0.0001) as compared with a concentration 12.5 and 25 mg/ml. 50 mg/ml showed significant results (P < 0.001) on comparing with hypochlorite. Triphala and liquorice showed no cytotoxic effect as compared to NaOCl on human PDL fibroblasts. Conclusion: Among the three tested materials Triphala showed the highest antimicrobial efficacy followed by NaOCl and liquorice.
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ORIGINAL ARTICLES - CLINICAL RESEARCH Top

Analysis of bone mineral density and content in children with molar incisor hypomineralization using dual-energy X-ray absorptiometry scan: A pilot study p. 282
Morankar Rahul, Goyal Ashima, Gauba Krishan, Singla Veenu
DOI:10.4103/JISPPD.JISPPD_321_18  PMID:31584029
Aim: The objective was to evaluate the bone mineral density (BMD) and bone mineral content (BMC) in children affected with molar incisor hypomineralization (MIH) using dual-energy X-ray absorptiometry (DEXA) scan. Materials and Methods: The study comprised a total of 30 children aged 6–10 years. Fifteen children were affected with MIH (moderate and severe variety) diagnosed using the European Academy of Paediatric Dentistry 2003 criteria, and remaining 15 children not affected with MIH serve as a control group. DEXA scan was done in all the selected children under standard conditions. Results: A positive association was seen between childhood illness and MIH. The mean subtotal BMC (grams) in MIH and control group was 633 ± 80.05 and 670.33 ± 166.41, respectively, whereas mean subtotal BMD (g/m2) was 1.00 and 0.87 ± 0.35, respectively, with no statistically significant difference between two groups. BMD and BMC at the lumbar spine and thoracic spine locations were also did not vary significantly between MIH-affected children and controls. Conclusion: Childhood illnesses were more common in MIH-affected children compared to controls. Bone maturation parameters (BMD, BMC) do not differ between MIH affected and control children.
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Effect of three different compositions of topical fluoride varnishes with and without prior oral prophylaxis on Streptococcus mutans count in biofilm samples of children aged 2–8 years: A randomized controlled trial p. 286
Sushma Yadav, Vinod Sachdev, Manvi Malik, Radhika Chopra
DOI:10.4103/JISPPD.JISPPD_62_19  PMID:31584030
Background: Various strategies for controlling caries focus on disrupting the interaction between risk factors. Of these, fluoride varnish has been shown to reduce the colony-forming (CFU) units and water-insoluble extracellular polysaccharide amount. Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) and xylitol-containing fluoride varnishes have recently gained importance as caries-protective fluoride varnishes. Aim: This study aims to assess and compare the reduction in Streptococcus mutans count in biofilm samples after topical application of three different fluoride varnishes and to evaluate the effect of oral prophylaxis prior to fluoride varnish application. Materials and Methods: Sixty healthy children with no active caries, in the age group of 2–8 years, were randomly divided into Group A = fluoride varnish containing CPP–ACP; Group B = fluoride varnish containing xylitol; and Group C = fluoride varnish with 0.9% difluorosilane; further, the groups were divided into two subgroups, namely A1, B1, and C1 with prior oral prophylaxis and A2, B2, and C2 without oral prophylaxis. Plaque samples were collected at baseline, 1st month, and 3rd month; cultured; and incubated, and CFU/ml was calculated. Results: Data were compiled, and CFU/ml was analyzed by independent t-test, paired t-test, and one-way ANOVA. There was no statistical difference between the fluoride groups. Furthermore, no statistically significant difference was seen between the subgroups. Conclusion: Fluoride varnish containing CPP–ACP showed higher reduction in S. mutans count followed by xylitol-containing fluoride varnish and Fluor Protector®. There was no effect of prior oral prophylaxis on the efficacy of fluoride varnish.
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Comparing the effect of dry and wet brushing on dental plaque removal in children p. 292
Ghassem Ansari, Hassan Torabzadeh, Zeynab Sadat Nabavi, Paniz Sheikh Hassani
DOI:10.4103/JISPPD.JISPPD_71_19  PMID:31584031
Aims: This study was aimed to assess the efficacy of wet and dry brushing on cleaning outcome of tooth surfaces. Methods: Forty-three children aged 10–12 years were randomly selected and instructed for this brushing project. Each case served as self-control. Each patient was requested to brush through one of the wet/dry techniques for 1 week and other technique on the 2nd week. Samples had a washout step using pumice prophylaxis prior to each brushing week. Tooth Cleanliness Index was used to measure the plaque removal level. Two uniform Oral-B toothbrushes were used one for each week through the Modified Stillman technique. Mann–Whitney test was employed along with the Wilcoxon signed-rank test to analyze the data. Results: The level of brushing efficacy was slightly higher in males with no statistically significant difference between sexes. Remaining plaque measured was higher in wet group with significant difference (7.3 ± 1.7 for dry brushing and 7.6 ± 2.6 for wet brushing) (P < 0.05). Conclusions: Dry and wet brushing did not show a significant difference in their capacity to remove plaque indicating that dry brushing could be considered as an acceptable brushing technique.
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Comparative evaluation of three obturation systems in primary molars – A randomized clinical trial p. 297
Srinitya Rajasekhar, Sreekanth Kumar Mallineni, Sivakumar Nuvvula
DOI:10.4103/JISPPD.JISPPD_276_18  PMID:31584032
Objectives: The objective of this study is to evaluate and compare the radiographic efficacy of the quality of obturation and to assess the number of voids and the obturation time in primary teeth using Pastinject™, disposable needle, and capillary tips. Materials and Methods: A total of 34 teeth with 103 canals were randomly divided into three groups using chit method, based on used application: Group 1: Pastinject™ (Micro-Mega, Besancon, France); Group 2: Disposable needle (23G short needle BD Discardit™, Becton Dickinson India Pvt. Ltd.), and Group 3: Capillary tips (Meta Biomed© Co. Ltd., China). All the groups were named based on obturation systems used. To compare the quality of obturation, the Chi-square test was used; to assess the number of voids, Kruskal–Wallis ANOVA test was used; and to evaluate the obturation time, post hoc Scheffe one-way ANOVA test was used. All P values having <0.05 were considered as statistical significant (P < 0.05). Kappa statistics were performed to check interexaminer reliability. Descriptive statistics were used for evaluation using SPSS (version. 21). Results: Capillary tips resulted in better optimal filled canals and less obturation time, compared to disposable needle and Pastinject (P < 0.001). There was no significant difference evident among three groups in relation to voids (P = 0.111). Conclusion: Capillary tip technique proved to be the most effective, yielding a higher number of optimally filled canals and minimal voids, combined with easier placement of the material into the canals when compared to Pastinject and disposable needle obturation.
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CASE REPORTS Top

Cu-sil dentures: A novel approach of Papillon–Lefèvre syndrome management p. 303
Shreya Tyagi, Abi M Thomas, Vinod Balla, Ruchika Kundra
DOI:10.4103/JISPPD.JISPPD_256_18  PMID:31584033
Papillon–Lefèvre syndrome (PLS) is a rare genetic disorder characterized by palmoplantar keratosis and premature loss of primary and permanent dentition. Its onset can be as early as 1–4 years of age. The genetic disorder is mutation in the cathepsin C gene. Hereby, we discuss the fabrication of Cu-sil dentures for the prosthetic rehabilitation of a 14-year-old girl with PLS. The case report describes the procedure and associated relevant information regarding the management protocols.
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Congenital insensitivity to pain in a 1-year-old boy p. 308
MK Navya, GV Pramod, GP Sujatha, L Ashok
DOI:10.4103/JISPPD.JISPPD_340_18  PMID:31584034
Congenital insensitivity to pain (CIP) is a rare autosomal recessive genetic condition which causes reduced pain sensation, thermal sensation, and habit of self-mutilation. It is a life-threatening condition where due to reduced pain sensation, patient might not understand the severity of the injury which can eventually lead to death. Such people live a compromised life and can also affect them psychologically. Here, we are reporting a case of an infant with clinical features suggestive of CIP with a mutation in exon 5 of PRDM12 gene. The child has minimal response to pain along with self-mutilation and mental retardation.
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A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child p. 311
Amit Khatri, Namita Kalra, Rishi Tyagi, Gaurav Panwar, Kopal Garg
DOI:10.4103/JISPPD.JISPPD_232_18  PMID:31584035
Infections, trauma, iatrogenic causes, congenital malformations, or complications of systemic diseases can result in perforation of the nasal septum. An intranasal stent is a removable prosthesis that can be inserted into the nasal cavity to support the form of nose. The stenting can be used for recanalization and nasal valve preservation. This case report presents a method for the fabrication of a customized nasal stent in a 14-year-old female patient with posttraumatic unilateral collapsed nasal vestibule.
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