International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 10 Issue 15, August, 2018

Pages: 01-05

Date of Publication: 16-Aug-2018


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Platelet Rich Fibrin & Guided Tissue Regeneration Aided Coverage of a Mucosal Fenestration \? An Interdisciplinary Approach

Author: Divya S., Deepika P. C., Ambikathanaya

Category: Healthcare

Abstract:Aim: Mucosal fenestrations affecting permanent teeth are clinically challenging because they require a more complex approach. The objective of this case report was to describe a treatment modality used to manage an apical fenestration placed on the left mandibular central incisor root. Case Report: The case report describes the management of a patient with mucosal fenestration of root apex. Mucosal fenestration of root apex was treated by a combination of root canal treatment and surgery. Root-end resection was performed to bring the root apex within the alveolus before root-end filling and packing of the bony defects with platelet rich fibrin. The dehiscence of the buccal labial plate was managed by placement of a barrier membrane. The edges of the soft tissue defect was then deepithelialized, approximated and sutured. Discussion: Various treatment modalities advocated in the literature for the management of mucosal fenestration include- root canal treatment and root-end resection, blind root surface instrumentation and mouth rinsing with chlorhexidine, full thickness mucogingival flap with primary or secondary healing, pedicle flap operations, epithelialized and non-epithelialized grafting procedures for root coverage and full thickness mucogingival flaps with guided tissue regeneration and bone grafting. Conclusion: The endodontic and periodontal surgical techniques used in the management of alveolar or mucosal fenestrations alone are unremarkable but combining them can give optimum outcome.

Keywords: Platelet rich fibrin, Mucosal fenestration, GT

Full Text:

INTRODUCTION:

The relationship between the alveolar bone and the teeth have been dated back to 1963, when O’Connor studied the relationship of teeth with the tooth anatomy, inter-proximal bone, bony wedges and the presence of fenestrations.1 Fenestrations and dehiscences, are being more considered normal variations with regard to presence of the teeth, than pathologic conditions. The criteria for their identification as put forth by Davies RM et al 2. as dehiscence is a lack of cortical bone at the level of the root of the tooth, at least 4 mm apical to the margin of the inter-proximal bone; whereas fenestration is a contained defect of the alveolar bone that exposes the apical or the middle third of the root surface, without involving the marginal bone.

A precise and seldom encountered spectacle is a combination of apical fenestration along with a mucosal fenestration. Mucosal or apical fenestration is termed as a pathologic condition which is characterized by the perforation of the cortical plate and the overlying mucosa by the prominent roots of teeth. It was first described in literature as ‘‘bone fenestration by roots of deciduous teeth’’ by Mene´ndezin 19673. Mucosal fenestration may be attributed to decreased thickness of the alveolar housing, labioversion of the tooth in the dental arch, contour of the root apex, occlusal factors, orthodontic tooth movement, periodontal and endodontic pathology and aberrant frenal attachment.4,5,6

Mucosal fenestration is most frequently found in the mandibular or maxillary anterior teeth region, particularly on the labial aspect because of tooth angulation that places the root apices in alabial version. Mucosal fenestrations have been reported in literature but are far less prevalent as compared to normal fenestration perhaps due to symptom free nature.7Even though they are usually symptom-free, they might act as plaque-retaining areas, resulting in irritation and inflammation of the surrounding mucosa.8

Mucosal fenestrations affecting permanent teeth are clinically challenging because they require a more complex approach. The aim of this case report was to represent a treatment modality used to manage an apical fenestration occured on root surface of the left mandibular central incisor.

CASE REPORT:

A 26 year old male patient reported to the OPD of JSS Dental College and Hospital, Mysore with discoloured lower front tooth. Patient gave a history of trauma 1 year back, following which there was a progressive discoloration of the tooth with intermittent pus discharge. Patient was in good health. No pathologic signs were evident through facial inspection. Oral examination revealed the apical third of the root of 31 that perforated the buccal cortical plate and adjacent alveolar mucosa, being therefore exposed to the oral environment and the discoloured crown of the same tooth. [Fig:1]

There was presence of plaque, calculus and soft debris on the exposed root tip and the margins of the surrounding mucosa were inflammed and tender. The tooth was grade 1 mobile. Pretreatment radiograph revealed discontinuity in the lamina dura around the apex of the 31 with periapical radioluscency [Fig:2]. Also, the tooth was nonvital. The probing depth measured 2mm buccally and 1.5 mm lingually hence, diagnosis of asymptomatic chronic apical periodontitis with mucosal fenenstration on tooth 31 was made.

TREATMENT:

After phase 1 therapy consisting of scaling and root planing, multivisit endodontic treatment was performed. Following working length determination, biomechanical preparation was done using K-file and recapitulation with 5.25% sodium hypochlorite.calcim hydroxide paste was used as intracanal medicament for 10 days. Next appointment, calcium hydroxide paste was removed and root canal was obturated with cold lateral condensation of gutta percha with zinc oxide ugenol as sealant. Surgery was undertaken 2 weeks after endodontic treatment. Fibre reinforced composite splinting was done in relation to 41,31 and 32.  Region 31,32,41,42 was anaesthetized with 2% lignocaine. Crevicular and vertical releasing incisions were made, and full-thickness flap was raised, revealing dehiscence of the buccal cortical bone along the root surface of 31 [Fig:3]

Granulation tissue was immediately apparent surrounding the root apex. Curettage of this tissue revealed the extent of bone loss. The prominent portion of the affected root apex was resected.

The resection was carried up to the level of remaining sound alveolar bone, so that the root margins were flush with the surrounding bone to reposition the affected root in the alveolar housing [Fig. 4a,b].

Any remaining granulation tissue was removed. The root planning was done and then glass ionomer cement(GC Fuji II; GC America, Alsip, IL)was placed over the prepared root end.[Fig: 6]

Autologous graft (platelet rich fibrin) was obtained from the patient and placed in the defect at the periapical region of 31. The root was then covered with GTR membrane (Healiguide).[Fig:6,7]

The edge of the mucosal defect was de-epithelialized, approximated and sutured with resorbable sutures to ensure closure [Fig:8]. The wound was covered with periodontal dressing (coe-pak)

Post-operative instructions were given and antibiotics and analgesics were prescribed.

Patient was recalled after 1 week for removal of the pack. Patient was without any local complications and free of symptoms.  The 2 and 5 months recall showed excellent soft tissue healing [Fig:9a ,b]

Periapical radiograph revealed well performed endodontic treatment, healing and remodelling of the apical area at 6 months recall [Fig:10]. A two year follow-up period with every 6 months radiographic evaluation was recommended.

DISCUSSION:

Mucosal fenestration is a relatively uncommon complication of pulpo-peri radicular disease.9,10,11 The exact aetiology is unknown but review of literature suggests that abnormally labioversed root tips, very thin labial plates and the presence of chronic periapical inflammation may be the probable cause. The first step toward management of mucosal fenestrations is identifying the precipitating cause of its occurrence. In this case, trauma could be the primary etiologic factor, along with prominent root positions and chronic periapical inflammation that might have destroyed the overlying thin facial cortex and mucosa. Mucosal breakdown and exposure of the root tip to the oral cavity leaves the root-tip vulnerable to plaque accumulation and calculus formation which prevents the reformation of mucosal covering.

Various treatment modalities advocated in the literature for the management of mucosal fenestration include- root canal treatment and root-end resection,8,9 blind root surface instrumentation and mouth rinsing with chlorhexidine10, full thickness mucogingival flap with primary11 or secondary healing12, pedicle flap operations4, epithelialized and non-epithelialized grafting procedures for root coverage and full thickness mucogingival flaps with guided tissue regeneration and bone grafting13.

In this case, since the tooth was non vital, it was first treated by root canal therapy to eliminate the focus of infection. Healing of the mucosa was then aided by removal of the granulation tissue, root end resection, and removal of adjacent infected cementum by root planning. The main objective of resection of the abnormally prominent root apices about the level of remaining sound alveolar bone is to return the root within the bony limit of the cortex. This affords a favourable anatomic configuration and eliminates future risk of irritation. Glass ionomer cement was used to achieve a good apical seal after proper isolation. Jhaveri et al14 have reported light cure GIC to be a successful root end filling material.

In the present case, after flap elevation dehiscence of the labial cortical plate was seen. Hence an attempt to regenerate the periodontal supporting tissues was made utilizing the principles of guided tissue regeneration. GTR was used in our case not only as a root coverage procedure, but also as a strategy of endodontic surgery where the ultimate goal was to regenerate the attachment apparatus.

Scientific evidence indicates that principles of GTR can be successfully applied in endodontic surgery to correct alveolar bone defects confined to periapical region. Animal histological studies showed that complete bone filling of periapical bone cavities occurred after endodontic surgery only when a barrier for guided tissue regeneration was used, whereas extensive connective tissue filling of the defects was found after conventional endodontic surgery.

The present case is unique in that it is the first case to utilize platelet rich fibrin (PRF) as a grafting material. The three crucial factors for healing and soft tissue maturation are angiogenesis, growth factors and mesenchymal stem cell activity. PRF consists of a fibrin 3D mesh polymerized in a specific structure, incorporating platelets, leucocytes, growth factors and circulating stem cells.17 The concentrations of growth factors within the platelet concentrate up regulate cellular activity and subsequently promote periodontal regeneration in vivo. Fibrin, fibronectin, platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β)  in PRF aid in angiogenesis, tissue repair and regeneration.18 Hence owing to these advantages PRF was used as an effective biomaterial as projected in this case.

CONCLUSION:

The endodontic and periodontal surgical techniques used in the management of alveolar or mucosal fenestrations alone are unremarkable but combining them can give optimum outcome. Guided tissue regeneration in combination with platelet rich fibrin can successfully be used to treat fenestrated root apices.

Abbreviations:

GTR: guided tissue regeneration

GIC: glass ionomer cement

PRF: platelet rich fibrin

PDGF: platelet derived growth factor

VEGF: vascular endothelial growth factor

TGF-β: transforming growth factor beta

Acknowledgement :

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Conflict of interest: Nil

References:

  1. O’Connor TW, Alveolar bony contours, A thesis submitted to the Faculty of Baylor University Dallas, Texas, 1963.

  2. Davies RM, Downer MC, Hull PS, Lennon MA, Alveolar defects in human skulls, J Clin Periodontol, 1974, 1(2):107–111.

  3. Mene´ndez OR. Bone fenestration by roots of deciduous teeth. Oral Surg Oral Med Oral Pathol 1967;24:654–8.

  4. Ju YR, Tsai HY, Wu YJ. Surgical intervention of mucosal fenestration in a maxillary premolar: a case report. Quintessence Int. 2004;35:125e128.

  5. Abdelmalek RG, Bissada NF. Incidence and prevalence of alveolar bone dehiscence and fenestration in dry human Egyptian jaws. J Periodontol 1973;44:586–8.

  6. Edel A. Alveolar bone fenestrations and dehiscences in dry Bedouin jaws. J Clin Periodontol 1981;8:491–9.

  7. Ling LJ. The treatment of fenestrated root: case reports. J Dent Sci. 1989;9:137e140

  8. Dawes WL, Barnes IE. The surgical treatment of fenestrated buccal roots of an upper molar: a case report. Int Endod J 1983;16:82–6.

  9. Lehman J III, Meister F Jr, Gerstein H. Use of a pedicle flap to correct an endodontic problem: a case report. Journal of Endodontics 1979;5, 317–20.

  10. Lin LJ. The treatment of fenestrated root: case reports. Journal Dental Science1989; 9, 137–40.

  11. Tseng C-C, Chen Y-HM, Huang C-C, Bowers GM Correction of a large periradicular lesion and mucosal defect using combined endodontic and periodontal therapy: a case report. International Journal of Periodontics and Restorative Dentistry 1995;15, 377–83.

  12. Rawlinson A. Treatment of a labial fenestration of a lower incisor tooth apex. British Dental Journal1984; 156, 448–9.

  13. Chen G, Fang CT, Tong C. The management of mucosal fenestration: a report of two cases. Int Endod J. 2009;42(2):156e164.

  14. Jhaveri HM, Amberkar S, Galav L, Deshmukh VL, Aggarwal S, Management of mucosal fenestrations by interdisciplinary approach: a report of three cases, J Endod, 2010, 36(1):164–168.

  15. Von Arx T, Cochran DL, Rationale for the application of the GTR principle using a barrier membrane in endodontic surgery: a proposal of classification and literature review, Int J Periodontics Restorative Dent, 2001, 21(2):127–139.

  16. Pecora G, De Leonardis D, Ibrahim N, Bovi M, Cornelini R, The use of calcium sulphate in the surgical treatment of a ‘through and through’ peri radicular lesion, Int Endod J, 2001,34(3):189–197.

  17. Choukron J, Diss A, Simonpieri A et al. Platelet rich fibrin. A second generation platelet concentrate. Part IV. Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Rad Endod 2006; 101: e 56-e60.

  18. Dvorak HF, Harvey VS, Estrella P, Brown LF, McDenagh J, Dvorak AF. Fibrin containing gels induce angiogenesis. Implications for tumor stroma generation and wound healing. Lab Invest 1987;  57: 673-86.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

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Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


Best Article Award

A Study by Amr Y. Zakaria et al. entitled "Single Nucleotide Polymorphisms of ATP-Binding Cassette Gene(ABCC3 rs4793665) affect High Dose Methotrexate-Induced Nephrotoxicity in Children with Osteosarcoma" is awarded Best Article for Vol 13 issue 19
A Study by Kholis Ernawati et al. entitled "The Utilization of Mobile-Based Information Technology in the Management of Dengue Fever in the Community Year 2019-2020: Systematic Review" is awarded Best Article for Vol 13 issue 18
A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
A Study by Chandran Anand et al. entitled "A Prospective Study on Assessment of Quality of Life of Patients Receiving Sorafenib for Hepatocellular Carcinoma" is awarded Best article for Vol 13 issue 15
A Study by Rosa PS et al. entitled "Emotional State Due to the Covid – 19 Pandemic in People Residing in a Vulnerable Area in North Lima" is awarded Best Article for Vol 13 issue 14
A Study by Suvarna Sunder J et al. entitled "Endodontic Revascularization of Necrotic Permanent Anterior Tooth with Platelet Rich Fibrin, Platelet Rich Plasma, and Blood Clot - A Comparative Study" is awarded Best Article for Vol 13 issue 13
A Study by Mona Isam Eldin Osman et al. entitled "Psychological Impact and Risk Factors of Sexual Abuse on Sudanese Children in Khartoum State" is awarded Best Article for Vol 13 issue 12
A Study by Khaw Ming Sheng & Sathiapriya Ramiah entitled "Web Based Suicide Prevention Application for Patients Suffering from Depression" is awarded Best Article for Vol 13 issue 11
A Study by Purushottam S. G. et al. entitled "Development of Fenofibrate Solid Dispersions for the Plausible Aqueous Solubility Augmentation of this BCS Class-II Drug" is awarded Best article for Vol 13 issue 10
A Study by Kumar S. et al. entitled "A Study on Clinical Spectrum, Laboratory Profile, Complications and Outcome of Pediatric Scrub Typhus Patients Admitted to an Intensive Care Unit from a Tertiary Care Hospital from Eastern India" is awarded Best Article for Vol 13 issue 09
A Study by Mardhiah Kamaruddin et al. entitled "The Pattern of Creatinine Clearance in Gestational and Chronic Hypertension Women from the Third Trimester to 12 Weeks Postpartum" is awarded Best Article for Vol 13 issue 08
A Study by Sarmila G. B. et al. entitled "Study to Compare the Efficacy of Orally Administered Melatonin and Clonidine for Attenuation of Hemodynamic Response During Laryngoscopy and Endotracheal Intubation in Gastrointestinal Surgeries" is awarded Best Article for Vol 13 issue 07
A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by situs slot and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. situs slot "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma situs slot entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by situs slot et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
Late to bed everyday? You may die early, get depression situs slot
Egg a day tied to lower risk of heart disease situs slot
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List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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