Majumdar B, Sarode SC, Sarode GS, Patil S. Etiologic Association between Epstein–Barr Virus and Oral Squamous Cell Carcinoma: A Brief Evidence-based Discussion. J Contemp Dent Pract 2017;18(4):261-264.

This study aims to assess the effect of ozone gas on dentin exposed to Streptococcus mutans biofilm by evaluation of mineral content [log calcium-to-phosphorus (Ca/P)] using energy-dispersive X-ray (EDX) spectroscopy.

Five human third molars were sectioned into four slices of dentin and distributed in four groups: I – control (no treatment); II – ozone therapy; III – biofilm development; IV – ozone therapy followed by biofilm development. Mineral content (log Ca/P) was evaluated by EDX. Data were analyzed by analysis of variance and Tukey's test (p < 0.05).

Results showed that the mineral content of control group (I) was similar to ozone group (II), and was statistically higher than biofilm (III) and ozone + biofilm (IV). The lowest log Ca/P was determined in biofilm group (III).

It can be concluded that ozone gas did not grant preventive effects of demineralization by S. mutans biofilm on dentin surface.

Ozone gas therapy may be an alternative noninvasive treatment aiming to reduce the levels of caries-associated microorganisms. This therapy may, thereby, be an alternative and/or complementary treatment strategy in preventive dentistry.

Chaves RM, Estrela C, Cardoso PC, de JE Barata T, de Souza JB, de Torres EM, Estrela CRA, Magalhães APR, Lopes LG. Ozone Gas Effect on Mineral Content of Dentin exposed to Streptococcus mutans Biofilm: An Energy-dispersive X-ray Evaluation. J Contemp Dent Pract 2017;18(4):265-269.

To determine the presence of metallic microfragments and their elemental composition in the dentinal walls of root canals following preparation using different endodontic instruments and to assess the active cutting edges of instruments with regard to structural defects.

A total of 108 molar teeth were selected and prepared using different endodontic instruments. Teeth were randomly divided into nine groups of 12 teeth each, according to the instruments employed: Manual systems – K-FlexoFile, K-File, and Hedstroem; rotary systems – ProTaper Next, Mtwo, BioRaCe; and reciprocating systems – Reciproc, Unicone, and WaveOne. Both root canals and instruments were assessed using scanning electron microscopy, and the elemental composition of metallic microfragments was determined using energy-dispersive X-ray spectroscopy.

Metallic microfragments were found in the groups prepared with both manual and reciprocating instruments, with no statistically significant differences between groups, thirds, or presence of metallic microfragments (p ≥ 0.05). Moreover, all groups presented structural defects in both new and used instruments; however, rotary instruments (ProTaper Next, Mtwo 702, BioRaCe) were the ones with the lowest number of defects, at statistically significant differences in comparison with other instruments (p < 0.05).

The presence of metallic microfragments on dentinal walls following root canal preparation was associated with manual and reciprocating instrumentation. Furthermore, rotary instruments were the ones with the lowest number of defects. Considering the outcomes measured in this study, rotary instruments performed better than the other two groups, as they were associated with the lowest number of metallic microfragments and structural defects.

During root canal preparation, operative procedures may induce changes to the root canal shape, as well as the release of metallic fragments resulting from the action of instruments on dentinal walls. Therefore, it is important to determine, among the different techniques used for this purpose, which ones are least susceptible to this occurrence.

Solda C, Langaro MC, Machado AN, Vanni JR, de A Decurcio D, Silva JA, Estrela C, Barletta FB. Presence of Metallic Microfragments on Dentinal Walls and Instrument Defects following Root Canal Preparation. J Contemp Dent Pract 2017;18(4):270-276.

To analyze and report the type of relation present between dental caries and body mass index (BMI)-for-age among schoolchildren in Jazan region of Kingdom of Saudi Arabia.

A cross-sectional study with multistaged random sampling technique was designed to recruit the sample of schoolchildren. Caries was examined using the World Health Organization recommended “decayed and filled teeth”/“decayed missing and filled teeth (dft/DMFT)” method. The BMI-for-age was calculated using the value obtained from body weight and height (kg/m²) of each child. The obtained results were plotted on age- and gender-specific percentile curves by the Centers for Disease Control and Prevention and categorized accordingly. Chi-squared test was conducted to analyze the relation between BMI-for-age and dental caries. Logistic regression was performed to judge the predictor variables. The p-value < 0.05 was considered as significant.

A total of 360 children were part of this study with equal recruitment from both genders. The mean dft/DMFT value for girls (2.52) was more than that for boys (1.88); and the (p = 0.00) calculated value was statistically significant. Most of the children had normal BMI-for-age (60.6%) and very few were obese (4.7%). Dental caries, fast food, and snacks between meals were significant independent predictor variables for BMI (p < 0.05). Dental caries was a strong predictor, and the analysis showed that children with untreated caries had 81% (odds ratio = 0.19; confidence interval = 0.65, 0.58) higher chance of suffering from low BMI.

To conclude, this is the first study attempted to see the relationship between BMI-for-age and dental caries among schoolchildren in Jazan city of Kingdom of Saudi Arabia. Negative relation between dental caries and BMI should warrant health promoters about dental caries as a reason for low BMI in a subset of children.

High and alarming percentage of untreated dental caries demonstrates the oral health needs among the schoolgoing children in Jazan region. Public health dentists should develop and implement prevention programs so that the oral health issues among schoolchildren are addressed.

Quadri MFA, Hakami BM, Hezam AAA, Hakami RY, Saadi FA, Ageeli LM, Alsagoor WH, Faqeeh MA, Dhae MA. Relation between Dental Caries and Body Mass Index-for-age among Schoolchildren of Jazan City, Kingdom of Saudi Arabia. J Contemp Dent Pract 2017;18(4):277-282.

The aim of this study was to investigate the association of different degradations on the roughness, gloss, and color changes of microhybrid composites.

Ten specimens were prepared for Charisma, Amelogen Plus, Point 4, and Opallis resins. Surfaces were polished and baseline measurements of roughness, gloss, and color were recorded. Specimens were then submitted to chemical and mechanical challenges, and the specimens were reevaluated. Roughness and gloss were analyzed by Kruskal – Wallis and Dunn's test (p < 0.05). Color change (ΔE) was analyzed by one-way analysis of variance and Tukey's tests (p < 0.05). The initial and final data were compared using the Wilcoxon test (p < 0.05). Spearman test checked the correlation between the roughness and gloss (p < 0.05).

Regarding surface roughness and gloss, there was no difference between composites before challenges. However, all composites showed a significant increase of roughness after challenges, with highest values for Charisma. The gloss was influenced by challenges, evidencing the best gloss for Point 4. Charisma showed the highest value of color change. There was no correlation between surface roughness and gloss for the initial analysis, and after the challenges.

Composites were influenced by association of challenges, and Charisma showed the highest changes for roughness, gloss, and color.

The type of composite resin influenced the properties of materials, which are surface roughness, gloss, and color change. The dentist should be aware of the performance of different brands, to choose the correct required composite resin for each type of patient or region to be restored.

Lemos CAA, Mauro SJ, dos Santos PH, Briso ALF, Fagundes TC. Influence of Mechanical and Chemical Degradation in the Surface Roughness, Gloss, and Color of Microhybrid Composites. J Contemp Dent Pract 2017;18(4):283-288.

This study aimed to evaluate the push-out bond strength of NeoMTA Plus (NMTA), EndoSequence root repair material fast set putty (ERRMF), biodentine (BD), and ProRoot white mineral trioxide aggregate (PMTA) when used as perforation repair materials after exposure to 2.5% sodium hypochlorite (NaOCl) during the early setting phase.

Horizontal midroot sections were prepared from single-rooted human teeth. Sections (n = 144) were randomly divided into four groups: PMTA, BD, NMTA, and ERRMF. Materials were condensed and allowed to set for 10 minutes. The groups were further divided into two subgroups. The NaOCl group included specimens that were immersed in 2.5% NaOCl for 30 minutes, and the control group included specimens on which a wet cotton pellet was placed over the test material. After 48 hours, the highest force applied to the materials at the time of dislodgement was recorded. Slices were then examined under a digital microscope to evaluate the nature of the bond failure. The surfaces of two specimens from each subgroup were observed by scanning electron microscopy. Data were statistically analyzed with two-way and one-way analysis of variances, independent t-tests, and chi-square tests. The statistical significance was set at 0.05.

In NaOCl-treated groups, PMTA showed a significantly higher push-out bond strength than the other three materials (p = 0.00). In the control groups, the bond strength of BD was significantly higher than that of PMTA, ERRMF, and NMTA (p < 0.05). Compared with the control group, NaOCl treatment significantly increased the push-out bond strength of PMTA (p = 0.00) and ERRMF (p = 0.00) and significantly reduced the bond strength of BD (p = 0.00) and NMTA (p = 0.03). None of the specimens showed an adhesive type of failure. The majority of the samples exhibited a cohesive failure type. Morphological observations revealed that the surfaces exhibited cubic crystals. In ERRMF, the crystals were few in number. Sodium hypochlorite enhanced the crystallization of NMTA.

The push-out bond strengths of PMTA and ERRMF were significantly increased after exposure to 2.5% NaOCl in the early setting phase, and those of BD and NMTA were significantly decreased.

The results of the present study suggest that early exposure of NaOCl increase the push-out bond strength of PMTA and ERRMF. PMTA had the highest push-out values. Therefore, it would be a potentially useful perforation repair material for single visit endodontic treatment.

Alsubait SA. Effect of Sodium Hypochlorite on Push-out Bond Strength of Four Calcium Silicate-based Endodontic Materials when used for repairing Perforations on Human Dentin: An in vitro Evaluation. J Contemp Dent Pract 2017;18(4):289-294.

To evaluate the difference in surface roughness of stainless steel archwires of different commercial brands used in lingual orthodontics.

Precontoured arches measuring 0.016″ × 0.022″ were selected of the following brands: Tecnident, Adenta, G&H, Highland Metals Inc., Ormco, Incognito, and Ebraces. Quantitative evaluation of the surface roughness of archwires was performed by means of an atomic force microscope in contact mode. Three surface readouts were taken of each sample, analyzing areas of 20 × 20 μm. Each scan of the samples produced a readout of 512 lines, generating threedimensional images of the wires. The analysis of variance statistical test was applied to prove significant variables (p > 0.05), with H₀ being rejected and H₁ accepted.

The Incognito brand showed the lowest surface roughness. The archwires of brands Adenta, Tecnident, Highland, and Ormco showed similar values among them, and all close to these obtained by the Incognito brand. The archwires of the Ebraces brand showed the highest surface roughness, with values being close to those of the G&H Brand.

There was a statistical difference in surface roughness of orthodontic archwires among the brands studied.

Companies should pay attention to the quality control of their materials, as these may directly affect the quality of orthodontic treatment.

Facchini FMM, Filho MV, Vedovello SAS, Cotrim FA, Cotrim-Ferreira A, Tubel CAM. Wire Roughness Assessment of 0.016″ × 0.022″ the Technique Lingual Orthodontics. J Contemp Dent Pract 2017;18(4):295-299.

Dental caries and periodontal diseases are all induced by oral biofilm (dental plaque). This study was conducted to evaluate if fluoride-impregnated miswak is as effective in plaque removal and fluoride release as toothbrushing with fluoride toothpaste.

This single-blind, randomized, crossover study was conducted at the Department of Cariology, University of Gothenburg, Gothenburg, Sweden, from February 2010 to January 2011. Fifteen healthy subjects participated in this study. The participants were instructed to use the following: (1) 0.5% NaF-impregnated miswak, (2) nonfluoridated miswak, (3) toothbrush with nonfluoride toothpaste, and (4) toothbrush with 1450 ppm fluoride toothpaste. Each method was used twice a day for 1 week after which plaque amount and fluoride concentration in resting saliva were measured. There was a 1-week washout period between each method.

No significant difference between miswak and toothbrushing was found regarding plaque removal on buccal and lingual surfaces. A somewhat higher fluoride concentration in resting saliva was found after using impregnated miswak when compared with toothbrushing with fluoride toothpaste (p < 0.05).

Miswak and toothbrushing showed the same plaque removing effect on buccal and lingual surfaces. Miswak impregnated with 0.5% NaF resulted in a higher concentration of fluoride in saliva than brushing with 1450 ppm fluoride toothpaste.

Miswak impregnated with 0.5% NaF and toothbrushing results in comparable plaque removal and about the same fluoride concentration in saliva even it was somewhat higher for impregnated miswak.

Baeshen H, Salahuddin S, Dam R, Zawawi KH, Birkhed D. Comparison of Fluoridated Miswak and Toothbrushing with Fluoridated Toothpaste on Plaque Removal and Fluoride Release. J Contemp Dent Pract 2017;18(4):300-306.

The aim of this study was to assess the cariogenic potential of the commonly prescribed pediatric liquid medicaments (PLMs) for dental disease in Jazan region, Kingdom of Saudi Arabia.

Seven most commonly prescribed PLMs were selected by prior questioning the pediatric dentists as well as general dentists in Jazan region. The endogenous pH and sucrose concentrations of the liquid medicaments were assessed. The endogenous pH was assessed by Hanna pH meter instrument. The sucrose concentration was assessed by anthrone reagent method.

All the PLM were acidic. The pH of the PLM ranged from 4.22 to 6.10. All the PLM contained sucrose and its concentration ranged from 5.38 to 11.41 gm% in the samples.

In this study, all the PLM were acidic and contained sucrose. Hence, they have cariogenic potential.

Parents and dentists are unaware of the hidden sugars and cariogenicity of these medications. Strict oral hygiene instructions are mandatory for the children taking these medications. The use of PLM should also be minimized and parents should seek early dental treatment to restore child's oral health.

Gupta M, Panda S. Cariogenic Potential of the commonly Prescribed Pediatric Liquid Medicaments in Kingdom of Saudi Arabia: An in vitro Study. J Contemp Dent Pract 2017;18(4):307-311.

The main goal of endodontics is the prevention of apical periodontitis. This is due to the presence of persistent pathogenic microorganisms, such as Enterococcus faecalis, and its ability to directly cause acute and chronic inflammation in the periapical tissues. Lactobacillus has been shown to promote health in the intestines as well as to inhibit the growth of certain problematic oral bacteria. This study explores shifting the established paradigm of endodontic treatment, which has focused on eliminating all bacteria from the canal system and on elimination of the problematic bacteria through introducing probiotics. A preliminary work was performed to evaluate the possible effectiveness of probiotics in preventing the growth of E. faecalis.

Two probiotic cultures Lactobacillus plantarum ATCC 8041 and Lactobacillus rhamnosus ATCC 7408 were selected to check their antimicrobial activity against E. faecalis ATCC 29212 by two methods: agar cup/well diffusion method and deferred antagonism test.

A total of 0.5 mL of requisite test pathogen culture was inoculated into 20 mL of molten sterile Mueller and Hinton agar and cooled to 45 ± 2°C. Circular wells of diameter 10 mm were punched in each of the poured plates. Appropriately diluted test samples were added to the above-punched wells. The plates were incubated upright position at 37°C for 24 hours in aerobic conditions. Postincubation, zone of inhibition was measured. The cell-free supernatant of Lactobacillus species was also evaluated for antimicrobial activity.

The test probiotic strain was standardized to 0.1 optical density (OD) at 600 nm and inoculated in a 1 cm wide diametric streak across the surface of trypticase soy agar + yeast extract + calcium carbonate (TSYCa) agar using a sterile cotton swab. Then, the plate agar containing the test strain was incubated at 37°C for 24 hours under aerophilic condition and then standardized to 0.1 OD at 600 nm for overnight (18 hours, 37°C). A purified culture of indicator strain (pathogen) was streaked at right angles to the line of original producer growth. Postincubation plates were observed for the inhibition zone width of the indicator strain.

Under the conditions of this study, Lactobacilli had an inhibitory effect on the growth of E. faecalis by agar cup method but not by deferred antagonism test.

This pilot study demonstrated that probiotics show a potential in root canal therapy.

If probioitcs are effective against endodontic pathogens, they can be potentially used as intracanal medicaments. This will be a novel concept of introducing bacteriotherapy in endodontics and replacing pathogenic bacteria by healthy bacteria, normal flora.

Bohora AA, Kokate SR. Good Bugs vs Bad Bugs: Evaluation of Inhibitory Effect of Selected Probiotics against Enterococcus faecalis. J Contemp Dent Pract 2017;18(4):312-316.

The aim of the study is to evaluate the reliability of soft tissue landmark identification between manual and digital plottings in both X and Y axes.

A total of 50 pretreatment lateral cephalograms were selected from patients who reported for orthodontic treatment. The digital images of each cephalogram were imported directly into Dolphin software for onscreen digitalization, while for manual tracing, images were printed using a compatible X-ray printer. After the images were standardized, and 10 commonly used soft tissue landmarks were plotted on each cephalogram by six different professional observers, the values obtained were plotted in X and Y axes. Intraclass correlation coefficient was used to determine the intrarater reliability for repeated landmark plotting obtained by both the methods.

The evaluation for reliability of soft tissue landmark plottings in both manual and digital methods after subjecting it to interclass correlation showed a good reliability, which was nearing complete homogeneity in both X and Y axes, except for Y axis of throat point in manual plotting, which showed moderate reliability as a cephalometric variable. Intraclass correlation of soft tissue nasion had a moderate reliability along X axis. Soft tissue pogonion shows moderate reliability in Y axis. Throat point exhibited moderate reliability in X axis.

The interclass correlation in X and Y axes shows high reliability in both hard tissue and soft tissue except for throat point in Y axis, when plotted manually.

The intraclass correlation is more consistent and highly reliable for soft tissue landmarks and the hard tissue landmark identification is also consistent.

The results obtained for manual and digital methods were almost similar, but the digital landmark plotting has an added advantage in archiving, retrieval, transmission, and can be enhanced during plotting of lateral cephalograms. Hence, the digital method of landmark plotting could be preferred for both daily use and research because of the advantages.

Kasinathan G, Kommi PB, Kumar SM, Yashwant A, Arani N, Sabapathy S. Evaluation of Soft Tissue Landmark Reliability between Manual and Computerized Plotting Methods. J Contemp Dent Pract 2017;18(4):317-321.

Malocclusion plays an important role in the development of periodontitis. Thus, by treating malocclusion, a good gingival health can be achieved. This study was conducted to establish the correlation between orthodontic tooth movement and periodontitis.

This is a retrospective study conducted on 220 patients who underwent orthodontic treatment for malocclusion. They were divided into two groups: Group I patients were treated with fixed orthodontics, while group II patients received myofunctional appliances.

The value for plaque, gingival recession, and tooth mobility significantly increased in group I patients. However, the difference was statistically nonsignificant in group II patients.

The authors concluded that there is correlation between malocclusion and periodontitis. Malocclusion leads to periodontitis.

Malocclusion is the main reason for the development of poor periodontal health. Combined effort has to be played by both periodontist and orthodontist for the treatment of various orthodontic-periodontal problems.

Sharma K, Mangat S, Kichorchandra MS, Handa A, Bindhumadhav S, Meena M. Correlation of Orthodontic Treatment by Fixed or Myofunctional Appliances and Periodontitis: A Retrospective Study. J Contemp Dent Pract 2017;18(4):322-325.

The apical portion of the root canal is very complex and challenging during endodontic treatment. Root canal preparation and obturation to the apical constriction may provide the best prognosis. Incomplete debridement, foramen transportation, and inadequate seal in the apical portion are considered to be responsible for treatment failure. The technique “apical patency” is considered as a way for maintaining the apical part the free of the debris by recapitulation, using a small K-file through the area of the apical foramen. This term was firstly proposed by Buchanan. In this technique, the smallest diameter file is set 1 mm longer than working length and recapitulated after each instrument to prevent packing of debris in the apical part. Apical patency has been found to be effective in achieving an apical seal with gutta-percha. Teeth prepared with a step back method and with maintained apical patency may show less leakage when obturated with cold lateral condensation technique. Data regarding the effect of apical patency on the healing of periapical tissue are very scarce, and it has been shown that the patency file has detrimental effect on the healing of periapical tissues in animal studies. However, using patency file in endodontic treatment is controversial and further studies are needed. The purpose of this article is to review the effect of using a patency file on the extrusion of root canal contents, the apical seal, postoperative pain, and healing of periapical tissues. Furthermore, the effect of establishing patency on reaching irrigation solutions to the apical portion of the canal and prognosis of root canal treatment are discussed.

Mohammadi Z, Jafarzadeh H, Shalavi S, Kinoshita J-I. Establishing Apical Patency: To be or not to be? J Contemp Dent Pract 2017;18(4):326-329.

Endodontic therapy is a specialized procedure more demanded by patients within public oral health care in the country. Then, single-visit endodontic therapy may offer advantages to the health care services, to the professionals, and to the patients by reducing access barriers.

A meta-analysis was done and the variables evaluated were periapical repair, microbiological control, and postobturation pain in randomized clinical trials (RCTs) involving endodontic treatment of nonvital teeth at single- or multiple visits.

About 17 RCTs were included. There were no differences found in periapical repair or microbiological control in single- and multiple-visit therapy. Single-visit endodontic therapy resulted in 21% less postobturation pain (relative risks = 0.79; 95%, confidence interval: 0.66-0.94).

There was less postobturation pain in the single-visit endodontic therapy group. In the public dental care, this analysis favors the adoption of this one therapy because it will be possible to increase the patient access and the supply of this therapy.

It is possible to get a better cost-effectiveness for the patients and the health care service. This is very important because the reduction of the cost to the patient allows it to become a complete treatment. The health service, in turn, is able to be better used, with a greater supply of this service.

Almeida DO, Chaves SCL, Souza RA, Soares FF. Outcome of Single- vs Multiple-visit Endodontic Therapy of Nonvital Teeth: A Meta-analysis. J Contemp Dent Pract 2017;18(4):330-336.

To report a case of association between the surgical treatment of temporomandibular dysfunction and rehabilitation with denture total prosthesis (TP) using nonanatomic teeth (cusp 0°) in patients with anterior recurrent dislocation of the temporomandibular joint (TMJ) and persistent uncontrolled mandibular movement, showing a technical adaptation and conduct.

There are several treatment approaches available for dislocation of the TMJ. The use of condylar mini-anchors for recurrent TMJ dislocation is a valid option and should be considered since it does not alter the joint anatomy. In edentulous patients undergoing TMJ surgical procedures, prosthetic rehabilitation can be seen as a means of treatment preservation.

A 73-year-old female patient attended the oral and maxillofacial surgery clinic presenting with joint instability, ligament laxity, and chronic recurrent TMJ dislocations. She had already been through three previous unsuccessful surgical procedures. A treatment plan was done based on the installation of a mini-anchor in the patient's TMJ through the preauricular surgical access. Dislocations were then resolved, but the lack of mandibular control even to a lesser extent after surgery precluded the use of prosthetics even at rest. Thus, it was planned to manufacture two conventional TPs with 0° cusp angle teeth, a clinical protocol shortened to three sessions in an attempt to improve the stability of the prosthesis.

The use of an individual mini-anchor is simple and effective, and the use of artificial teeth is well suited to the case.

A multidisciplinary intervention (surgery/ prosthesis) is of utmost importance for the resolution and preservation of the treatment of these complex cases.

de S Leão R, da S Júnior EZ, de Alencar MGM, Catunda RQ, de Moraes SLD, do E Vasconcelos BC. Use of Mini-anchors and Rehabilitation with 0° Cusp Angle Teeth Complete Denture in Recurrent Condylar Dislocation: Technical Adequacy and Procedure. J Contemp Dent Pract 2017;18(4):337-341.

Al-Iryani GM, Ali FM. Twelve Impacted Supernumerary Teeth in a Nonsyndromic Patient: A Rare Case Report. J Contemp Dent Pract 2017;18(4):342-344.

Sarode GS, Sarode SC, Patil S. Emperipolesis: An Unreported Novel Phenomenon in Oral Squamous Cell Carcinoma. J Contemp Dent Pract 2017;18(4):345-347.