Association of Residual Ridge Resorption with Age, Gender and Underlying Medical Conditions in Completely Edentulos Patients - A Retrospective Study
Godlin Jeneta J1, Subhashree. R2*, Nivedhitha M.S3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
2 Senior lecturer, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
3 Professor, Dept of Conservative Dentistry & Endodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
*Corresponding Author
Subhashree. R,
Senior lecturer, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, PH Road,
Chennai - 600077, Tamil Nadu, India.
Tel: 9790741570
E-mail: subhashreer.sdc@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 17, 2021
Citation:Godlin Jeneta J, Subhashree. R, Nivedhitha M.S. Association of Residual Ridge Resorption with Age, Gender and Underlying Medical Conditions in Completely Edentulos Patients - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):3849-3855. doi: dx.doi.org/10.19070/2377-8075-21000788
Copyright: Subhashree. R©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Residual ridge resorption is based on multifactorial problem. This study aimed to assess the association between the age, gender, medical complications of the completely edentulism patient with the period of edentulism and the rate of residual ridge resorption. A total of 421 patients with completely edentulism status was selected in this study. The data were extracted from the digital software attending in a private hospital setup. The data extracted were based on the inclusion and exclusion criteria of the study. Most of the study population where male than females. The period of edentulism were between 2-5 years and more than 5 years. The residual ridge resorption was assessed based on the clinical photographs and radiographs. The results of the study revealed that there is a significant association of age, gender, medical complication, period of edentulism and ridge resorption with a p value of < 0.5. The results of the present study revealed that, most of the completely edentulism patient above 60 years had more medical complication, ridge resorption and period of edentulism. Males had more medical complications, ridge resorption than females. Ridge resorption is associated with the underlying medical complications and the period of edentulism. Better understanding of the medical history of the patient can determine the residual ridge resorption pattern.
2.Introduction
3.Conclusion
4.References
Introduction
The bone tends to resorb when the tooth is removed which leads
to residual ridge resorption. The pattern of resorption varies
from maxilla to mandible, the maxillary width reduces whereas
the mandibular width widens [2]. The resorption rate is rapid
during the initial stage after extraction. The rate of resorption
is more in maxilla than in mandible due the quality of the bone
[36]. The resorption of the ridge occurs from the labial cortical
plate to lingual and eventually leads to the knife edged pattern
of the ridge followed by low well rounded [15]. Alveolar ridge
bounds the teeth in all directions and acts as an anchor to the
teeth(tencate). The stages of ridge resorption is characterised by
Atwood as six orders. The initial order if before extraction, order
2 is post extraction, order 3 is high well rounded, order 4 is
knife edged, order 5 is low well rounded and order 6 is depressed.
These sarges of ridge resorption occur at different times after a
tooth is removed [14].
The term for ridge resorption is residual ridge resorption (RRR)
given by Atwood. It is a chronic, progressive and cumulative pattern
of disease of the bone. The amount of RRR varies at different
age groups and has multiple factors[29]. A severe RRR always
leads to improper construction of the complete denture in
completely edentulous patients and the treatment planning will
become quite challenging to the dentist.
There are many factors for RRR and can be divided into two
categories mainly: local factors and systemic factors. The quality,
anatomy, size and shape of the ridge is categorised under localised
factors whereas age, gender, systemic conditions, habits are categorised
under systemic factors [15, 10]. During the menopause the oestrogen deficiency accelerates and leads to generalised mineral
loss to the women. This loss of bone mass leads to RRR. The
mandibular ridge resorption is more common in women than in
men. Likewise, systemic factors also lead to RRR . Patients with
osteoporosis encounter severe RRR with low bone density, thinning
of the cortical plate. Many underlying systemic conditions
like thyroid, hypertension, diabetes are the risk factors for osteoporosis
and may lead to severe RRR. Habits such as alcoholism
leads to deleterious effects on bone structure. Smoking is also a
major risk factor for bone fracture and bone loss. Smoking and
many periodontal diseases have an association and have been
proved by many studies.
RRR may also occur with patients wearing dentures for a long
period of time and patients with long term edentulism. There are
many studies which have measured the RRR with different devices
like cephalometric, OPG, calliper and VAS. Wical and Swoope determined
initially with the help of orthopantomographic (OPG)
[3, 4, 16]. OPG were used to analyze the location of different
anatomical structures especially mental foramen with relation to
the crestal level of the bone by many researchers to study the pattern
of RRR according to different ages of the patients. Knowing
the aetiology, metabolic factor, anatomical factor, systemic factor,
pathogenesis of resorption, and the histological factors are available
in the literature. However, there is a little knowledge in the
association of age, period of edentulous, the systemic condition
in association to the residual ridge resorption in the literature.
Previously our team has a rich experience in working on various
research projects across multiple disciplines [18, 17, 26, 13, 9, 7,
21, 27, 20, 5, 37, 1, 11, 31, 33]. Now the growing trend in this area
motivated us to pursue this project.
This study aims to assess the association between the different
medical conditions, age gender of the completely edentulous patient
and the rate of bone resorption seen clinically which will aid
in proper treatment planning knowing the medical condition of
the patients.
Materials And Methods
A single centre retrospective study was done in an institutional
setting. The ethical approval was received from the institution's
ethical committee. The study involved selected patients data who
were completely edentulous and had undergone complete denture.
The necessary approvals in gaining the datas were obtained
from the institutional ethical committee (SDC/SIHEC/DIASDATA/
0619-0320). The number of people involved in this study
includes 3 i.e guide, reviewer and researcher.
Selection of subjects:
All patients who had undergone in completely edentulous and
had undergone complete denture from the time period of June
2019 to April 2020 were selected for this study. There were three
people involved in this study (guide, reviewer, and researcher).
All available data were taken into consideration and there was no
sorting process.
Data collection:
The patient's details were retrieved from the institution's patient
record management software (Dental Information Archiving
Software). Data regarding patients age, gender, medical condition,
period of edentulism were taken into consideration for this study.
Cross verification of the data was done with the help of photographs
and radiographs. The data was manually verified, tabulated
and sorted.
Inclusion Criteria:
All patients were completely edentulous and had undergone complete
denture. All age groups were taken into account.
Exclusion Criteria:
Patients' records that were incomplete were removed from the
study. Repetitive entries were excluded as well.
Statistical Analysis:
The tabulation of data was analysed using SPSS software. (IBM
SPSS Statistics 26.0) The method of statistical analysis that was
used in this study was Chi Square Test to compare two proportions.
The analysis was done for: age, gender, medical condition,
period of edentulism in this study.
Results & Discussion
The total population of the study was 421.The age distribution of
the present study population is as follows - 11.16% were between
30-50 years of age , 26.60% were between 50-60 years of age
and 62.23% were above 60 years of age (figure 1). In our study,
59.89% were males whereas 40.14% were females (figure 2). The medical complications associated with the edentulous patient in
the present study revealed that 18.53% had hypertension, 26.37%
had diabetes, 4.513% had Asthma, 8.797% had other systemic
conditions, and 41.81% were disease free (figure 3). The edentulism
status of the present study revealed that 24.70% had < than
1 year, 39.67% had 2-5 years, and 35.63% had > 5 years of period
of edentulism (figure 4). The resorption status of the study revealed
that 38% of the population had ridge resorption and 62%
did not have ridge resorption (figure 5).
The association between the age and the medical complications
revealed that 0.95%, 9.89%, 7.60% of hypertension was seen in
the age group of 30-50 years, 50-60 years, above 60 years respectively.
0.41%, 4.04%, 21.62% of diabetes were seen in the age
group of 30-50 years, 50-60 years, above 60 years respectively.
1.43%, 3.09% of Asthma were seen in the age group of 50-60
years, above 60 years respectively. 1.66%, 0.71%, 6.41% of other
complications were seen in the age group of 30-50 years, 50-60
years, above 60 years respectively. 7.84%, 10.45%, 23.52% of no
medical complications were seen in the age group of 30-50 years,
50-60 years, above 60 years respectively. Chi square association
was done and found to be statistically significant. Chi square value:
69.440, df value: 8, p value: 0.03 ( < 0.05) (figure 6).
The association between the age and ridge resorption revealed
that 1.66%, 12.83%, 23.52% of the patient between the age group
of 30-50 years, 50-60 years, above 60 years respectively had residual
ridge resorption whereas 9.50%, 13.78%, 38.72% of the
patient between the age group of 30-50 years, 50-60 years, above
60 years respectively had no residual ridge resorption. Chi square
association was done and found to be statistically significant. Chi
square value: 15.615, df value: 2, p value: 0.000 ( < 0.05) (figure 7).
The association between the age and period of edentulism reveals that 9.26%, 6.65%, 8.79% had less than 1 years of period of
edentulism within the age group of 30-50 years, 50-60 years, and
above 60 years respectively. 1.90%, 18.53%, 19.24% of the completely
edentulous patients had 2- 5 years of period of edentulism
within the age group of 30-50 years, 50-60 years, and above 60
years respectively. 1.43%, 34.20% of the completely edentulous
patients had more than 5myears of period of edentulism within
the age group of 50-60 years, and above 60 years respectively.
Chi square association was done and found to be statistically significant.
Chi square value: 186.032, df value: 4, p value: 0.020 ( <
0.05) (figure 8)
The association between the gender and the medical complications
revealed that 13.05%, 5.46%, of hypertension was seen in
males and females respectively. 15.91%, 10.45% of diabetes were
seen in males and females respectively. 1.19%, 3.33% of Asthma
were seen in males and females respectively. 5.23%, 3.56% of
other complications were seen in males and females respectively.
24.47%, 17.34% of no medical complications were seen in males
and females respectively. Chi square association was done and
found to be statistically significant. Chi square value: 12.726, df
value: 4, p value: 0.013 ( < 0.05) ( figure 9).
The association between the gender and ridge resorption revealed
that 23.75%, 14.25% had ridge resorption between the males and
females respectively. 36.10%, 25.89% had no ridge resorption between
males and females respectively. Chi square association was
done and found to be statistically not significant. Chi square value:
0.750, df value: 1, p value: 0.383 ( > 0.05) (figure 10).
The association between the gender and period of edentulism
reveals that 10.45%, 14.25% of males and females had less than
1 years of period of edentulism respectively.19.71%, 19.95% of
males and females had 2- 5 years of period of edentulism 29.69%,
5.94% of males and females had more than 5 years of period of
edentulism. Chi square association was done and found to be statistically
significant. Chi square value: 54.905, df value: 2, p value:
0.00 ( < 0.05) ( figure 11).
The association between the medical complication and the prevalence
of ridge resorption revealed that 7.36%, 13.30%, 2.61%
10.93% of patients with hypertension, diabetes, asthma, others,
nil respectively had residual ridge resorption whereas 11.16%,
13.06%, 1.90%, 30.88% of patients with hypertension, diabetes,
asthma, others, nil respectively had no residual ridge resorption.
Chi square association was done and found to be statistically significant.
Chi square value: 21.541, df value: 4, p value: 0.034 ( <
0.05) ( figure 12).
The association between period of edentulism of the completely
edentulous patient and the prevalence of ridge resorption revealed
that 5.23%12.59%, 20.19% had ridge resorption with < 1
year, 2-5 years, and > 5 years  of period of edentulism respectively.
19.48%, 27.08%, 15.44% had no ridge resorption with < 1
year, 2-5 years, and > 5 years of period of edentulism respectively.
Chi square association was done and found to be statistically
significant. Chi square value: 37.491, df value: 2, p value: 0.04
( < 0.05) (figure 13).
The study results showed that most of the residual ridge resorption
is based on the underlying medical complications. hypertension,
diabetes and asthma had residual ridge resorption. Similar
study done by Atwood had found significant association between
the medical complication and ridge resorption. In the present study 2.61% had residual ridge resorption, this may be due to the
consumption of the corticosteroids which reduces the quality of
the bone. Many researchers have proved that there is an association
between asthma and bone resorption [35].
In the present study the males had more residual resorption
than females, however it was statistically significant. Females are
subjected to the risk factor of osteoporosis after menopause
stage[34]. Many studies have shown that the oestrogen deficiency
affects the rate of resorption. The period of edentulism also is
associated with residual ridge resorption. In our present study it
is shown that the rate of resorption is predominantly seen in the
patients with more than 5 years of edentulism. One of the studies
done by Lopez proved that if the bone undergoes atrophy over
a period of time due to not being in use, there will not be any
remodelling of bone occuring [30].
Our institution is passionate about high quality evidence based
research and has excelled in various fields [19, 20, 8, 22, 28, 32, 6,
12, 24, 25]. We hope this study adds to this rich legacy.
Figure 1: Shows the age distribution of the completely edentulous patients. X axis represents the age of the completely edentulous patient and Y axis represents the number of patients with complete denture. 11.16% were between 30-50 years of age (red), 26.60% were between 50-60 years of age (green) and 62.23% were above 60 years of age (blue).
Figure 2: Shows the gender distribution of the completely edentulous patients. X axis represents the gender of the completely edentulous patient and Y axis represents the number of patients with complete denture. 59.89% were males (blue) whereas 40.14% were females (red).
Figure 3: Shows the distribution of the medical complications of the completely edentulous patients. X axis represents the medical complications of the completely edentulous patient and Y axis represents the number of patients with complete denture. 18.53% had hypertension (red), 26.37% had diabetes (green), 4.513% had Asthma (blue), 8.797% had other systemic conditions (yellow), and 41.81% were disease free (grey).
Figure 4: Shows the distribution of the period of edentulism of the completely edentulous patients. X axis represents the period of edentulism of the completely edentulous patient and Y axis represents the number of patients with complete denture. 24.70% had < than 1 year (red), 39.67% had 2-5 years (green), and 35.63% had > 5 years of period of edentulism.
Figure 5: Shows the distribution of the presence of ridge resorption of the completely edentulous patients. X axis represents the presence of ridge resorption of the completely edentulous patient and Y axis represents the number of patients with complete denture. 38% of the population had ridge resorption (red) and 62% did not have ridge resorption (blue).
Figure 6: Shows the association between the age of the completely edentulous patient and the medical complications (hypertension, diabetes, asthma, others, nil). X axis represents the age of the patients and Y axis represents the number of patients with complete dentures. Chi square association was done and found to be statistically significant. Chi square value: 69.440, df value: 8, p value: 0.03 ( < 0.05), hence proving that more medical problems are prevalent in the older age group and diabetes is the most common medical condition among denture wearers.
Figure 7. Shows the association between the age of the completely edentulous patient and the prevalence of ridge resorption. X axis represents the age of the patients and Y axis represents the number of patients with complete denture with ridge resorption. Chi square association was done and found to be statistically significant. Chi square value: 15.615, df value: 2, p value: 0.000 ( < 0.05), hence proving denture wearers above 60 years of age reported with less ridge resorption than other age groups.
Figure 8. Shows the association between the age of the completely edentulous patient and the period of edentulism. X axis represents the age of the patients and Y axis represents the number of patients with complete denture with period of edentulism. Chi square association was done and found to be statistically significant. Chi square value: 186.032, df value: 4, p value: 0.020 ( < 0.05), hence proving as the age increases the period of edentulism increases and more than 5 years is seen above 60 years.
Figure 9: Shows the association between the gender of the completely edentulous patient and the medical complications (hypertension, diabetes, asthma, others, nil). X axis represents the gender of the patients and Y axis represents the number of patients with complete denture. Chi square association was done and found to be statistically significant. Chi square value: 12.726, df value: 4, p value: 0.013 ( < 0.05), hence proving that more number of male denture wearers had medical conditions (diabetes, hypertension) than females.
Figure 10: Shows the association between the gender of the completely edentulous patient and the prevalence of ridge resorption. X axis represents the gender of the patients and Y axis represents the number of patients with complete denture with ridge resorption. Chi square association was done and found to be statistically not significant. Chi square value: 0.750, df value: 1, p value: 0.383 ( > 0.05), however more number of males had alveolar ridge resorption than females.
Figure 11: Shows the association between the gender of the completely edentulous patient and the period of edentulism. X axis represents the gender of the patients and Y axis represents the number of patients with complete denture with period of edentulism. Chi square association was done and found to be statistically significant. Chi square value: 54.905, df value: 2, p value: 0.00 ( < 0.05), hence proving that more number of males were edentulous for a longer period of time (>5yrs) than females.
Figure 12: Shows the association between the medical complications of the completely edentulous patient and the prevalence of ridge resorption. X axis represents the medical complications of the patients and Y axis represents the number of patients with complete denture with ridge resorption. Chi square association was done and found to be statistically significant. Chi square value: 21.541, df value: 4, p value: 0.034 (< 0.05), proving that more ridge resorption occurs with underlying medical complications ( hypertension, diabetes, asthma).
Figure 13: Shows the association between the period of edentulism of the completely edentulous patient and the prevalence of ridge resorption. X axis represents the period of edentulism of the patients and Y axis represents the number of patients with complete denture with ridge resorption. Chi square association was done and found to be statistically significant. Chi square value: 37.491, df value: 2, p value: 0.04 ( < 0.05), proving that ridge resorption was more common among the patients with longer duration of edentulism.
Conclusion
The results of the present study revealed that, most of the completely
edentulous patients above 60 years had more medical conditions
and were edentulous for a longer period of time without
opting for dentures. More number of males were edentulous for
a longer duration,had medical conditions and ridge resorption than females. Ridge resorption was associated with the underlying
medical conditions and the duration of edentulism.
References
-
[1]. Manohar T, Santhanam A. Correlation between bizygomatic and maxillary
central incisor width for gender identification. Brazilian Dent Sci. 2019 Oct
31;22(4):458-66.
[2]. Atwood DA. Some clinical factors related to rate of resorption of residual ridges. 1962. J Prosthet Dent. 2001 Aug;86(2):119-25. PMID: 11514795. [3]. Atwood DA. Reduction of residual ridges: a major oral disease entity. J Prosthet Dent. 1971 Sep;26(3):266-79. PMID: 4934947.
[4]. Atwood DA, Coy WA. Clinical, cephalometric, and densitometric study of reduction of residual ridges. J Prosthet Dent. 1971 Sep;26(3):280-95. doi: 10.1016/0022-3913(71)90070-9. PMID: 5284182.
[5]. Azeem RA, Sureshbabu NM. Clinical performance of direct versus indirect composite restorations in posterior teeth: A systematic review. J Conserv Dent. 2018 Jan-Feb;21(1):2-9. Pubmed PMID: 29628639.
[6]. Chandrasekar R, Chandrasekhar S, Sundari KKS, Ravi P. Development and validation of a formula for objective assessment of cervical vertebral bone age. Prog Orthod. 2020 Oct 12;21(1):38. Pubmed PMID: 33043408.
[7]. Chen F, Tang Y, Sun Y, Veeraraghavan VP, Mohan SK, Cui C. 6-shogaol, a active constiuents of ginger prevents UVB radiation mediated inflammation and oxidative stress through modulating NrF2 signaling in human epidermal keratinocytes (HaCaT cells). J Photochem Photobiol B. 2019 Aug;197:111518. Pubmed PMID: 31202076.
[8]. Ezhilarasan D, Apoorva VS, Ashok Vardhan N. Syzygium cumini extract induced reactive oxygen species-mediated apoptosis in human oral squamous carcinoma cells. J Oral Pathol Med. 2019 Feb;48(2):115-121 Pubmed PMID: 30451321.
[9]. Govindaraju L, Neelakantan P, Gutmann JL. Effect of root canal irrigating solutions on the compressive strength of tricalcium silicate cements. Clin Oral Investig. 2017 Mar;21(2):567-571. Pubmed PMID: 27469101.
[10]. Jeffcoat MK, Chesnut CH 3rd. Systemic osteoporosis and oral bone loss: evidence shows increased risk factors. J Am Dent Assoc. 1993 Nov;124(11):49- 56. Pubmed PMID: 8227773.
[11]. Manohar J. A Study on the Knowledge of Causes and Prevalance of Pigmentation of Gingiva among Dental Students. Indian Journal of Public Health Research & Development. 2019 Aug 1;10(8).
[12]. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):3275-3280. Pubmed PMID: 31955271.
[13]. Muthukrishnan A, Warnakulasuriya S. Oral health consequences of smokeless tobacco use. Indian J Med Res. 2018 Jul;148(1):35-40. Pubmed PMID: 30264752.
[14]. Nishimura I, Damiani PJ, Atwood DA. The reduction of residual ridges (RRR) measured longitudinally in rats. J Prost Dent. 1986 Jan 1;55(1):133.
[15]. Nishimura I, Hosokawa R, Atwood DA. The knife-edge tendency in mandibular residual ridges in women. J Prosthet Dent. 1992 Jun;67(6):820-6. Pubmed PMID: 1403869.
[16]. Oikarinen K, Raustia AM, Hartikainen M. General and local contraindications for endosseal implants--an epidemiological panoramic radiograph study in 65-year-old subjects. Community Dent Oral Epidemiol. 1995 Apr;23(2):114-8. Pubmed PMID: 7781299.
[17]. Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don KR, Jayaraj G, Santhanam A. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res. 2020 Jan-Feb;31(1):22-25. Pubmed PMID: 32246676.
[18]. Paramasivam A, Vijayashree Priyadharsini J, Raghunandhakumar S. N6- adenosine methylation (m6A): a promising new molecular target in hypertension and cardiovascular diseases. Hypertens Res. 2020 Feb;43(2):153- 154. Pubmed PMID: 31578458.
[19]. J PC, Marimuthu T, C K, Devadoss P, Kumar SM. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018 Aug;20(4):531-534. Pubmed PMID: 29624863.
[20]. Vijayashree Priyadharsini J, Smiline Girija AS, Paramasivam A. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol. 2018 Oct;94:93-98. Pubmed PMID: 30015217.
[21]. Priyanka S, Kaarthikeyan G, Nadathur JD, Mohanraj A, Kavarthapu A. Detection of cytomegalovirus, Epstein-Barr virus, and Torque Teno virus in subgingival and atheromatous plaques of cardiac patients with chronic periodontitis. J Indian Soc Periodontol. 2017 Nov-Dec;21(6):456-460. Pubmed PMID: 29551863.
[22]. Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJL. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig. 2019 Sep;23(9):3543-3550. Pubmed PMID: 30552590.
[23]. Ramesh A, Varghese S, Jayakumar ND, Malaiappan S. Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients - A case-control study. J Periodontol. 2018 Oct;89(10):1241-1248. Pubmed PMID: 30044495.
[24]. R H, Ramani P, Ramanathan A, R JM, S G, Ramasubramanian A, K M. CYP2 C9 polymorphism among patients with oral squamous cell carcinoma and its role in altering the metabolism of benzo[a]pyrene. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Sep;130(3):306-312. Pubmed PMID: 32773350.
[25]. Samuel SR. Can 5-year-olds sensibly self-report the impact of developmental enamel defects on their quality of life? Int J Paediatr Dent. 2021 Mar;31(2):285-286. Pubmed PMID: 32416620.
[26]. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51-60. Pubmed PMID: 31710096.
[27]. Sitharthan R, Sundarabalan CK, Devabalaji KR, Yuvaraj T, Mohamed Imran A. Automated power management strategy for wind power generation system using pitch angle controller. Measurement and Control. 2019 Mar;52(3-4):169-82.
[28]. Sridharan G, Ramani P, Patankar S, Vijayaraghavan R. Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med. 2019 Apr;48(4):299-306. Pubmed PMID: 30714209.
[29]. Steidler NE, Cook RM, Reade PC. Residual complications in patients with major middle third facial fractures. Int J Oral Surg. 1980 Aug;9(4):259-66. Pubmed PMID: 6780474.
[30]. Swoope CC. Complete denture prosthodontics--1998. J Prosthet Dent. 1974 Oct;32(4):383-90. Pubmed PMID: 4528483. [31]. Venu H, Raju VD, Subramani L. Combined effect of influence of nano additives, combustion chamber geometry and injection timing in a DI diesel engine fuelled with ternary (diesel-biodiesel-ethanol) blends. Energy. 2019 May 1;174:386-406.
[32]. Vijayashree Priyadharsini J. In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens. J Periodontol. 2019 Dec;90(12):1441-1448. Pubmed PMID: 31257588.
[33]. Wang Y, Zhang Y, Guo Y, Lu J, Veeraraghavan VP, Mohan SK, Wang C, Yu X. Synthesis of Zinc oxide nanoparticles from Marsdenia tenacissima inhibits the cell proliferation and induces apoptosis in laryngeal cancer cells (Hep-2). J Photochem Photobiol B. 2019 Dec;201:111624. Pubmed PMID: 31722283.
[34]. Watson EL, Katz RV, Adelezzi R, Gift HC, Dunn SM. The measurement of mandibular cortical bone height in osteoporotic vs. non-osteoporotic postmenopausal women. Spec Care Dentist. 1995 May-Jun;15(3):124-8. Pubmed PMID: 8619174.
[35]. Wical KE, Swoope CC. Studies of residual ridge resorption. II. The relationship of dietary calcium and phosphorus to residual ridge resorption. J Prosthet Dent. 1974 Jul;32(1):13-22. Pubmed PMID: 4525508.
[36]. Wittkampf AR. Augmentation of the maxillary alveolar ridge with hydroxylapatite and fibrin glue. J Oral Maxillofac Surg. 1988 Nov;46(11):1019-21. Pubmed PMID: 3183802.
[37]. Wu F, Zhu J, Li G, Wang J, Veeraraghavan VP, Krishna Mohan S, Zhang Q. Biologically synthesized green gold nanoparticles from Siberian ginseng induce growth-inhibitory effect on melanoma cells (B16). Artif Cells Nanomed Biotechnol. 2019 Dec;47(1):3297-3305. Pubmed PMID: 31379212.
