The Journal of Contemporary Dental Practice

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2018 | November | Volume 19 | Issue 11

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Barnali Majumdar

‘Third Space’ Perspective on Redefining Oral Pathology: Hypothetical Considerations

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:2] [Pages No:1293 - 1294]

Keywords: Interstitium, Oral cancer, Oral pathology

   DOI: 10.5005/jp-journals-10024-2420  |  Open Access |  How to cite  | 


Recent molecular analysis has shown the evidences which claims human interstitum as a new organ in the body. However, in routine hematoxylin and eosin stained sections these spaces are not evident and thus probably has not received much attention. The implications of this discovery in oral pathology, especially cancer metastasis are immense. Although the structure and components of oral mucosa differ from that of skin and gastrointestinal tract (GIT) in various aspects, if the above findings are established in the oral submucosa, various oral diseases related to fluid and fluid dynamics may perhaps be reviewed. In this editorial, we have made attempt to hypothetically consider the various possible implications of ‘third space’ in the field of dentistry.



Vanessa R Magaz, Bárbara F Llovera, Miriam Martí, Aurora Garre

Clinical Impact and Cosmetic Acceptability of Chlorhexidineenriched Toothpaste and Mouthwash Application on Periodontal Disease: A Randomized Clinical Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1295 - 1300]

Keywords: Allantoin, Chlorhexidine, Dexpanthenol, Mouthwash, Periodontal-disease-index, Toothpaste

   DOI: 10.5005/jp-journals-10024-2421  |  Open Access |  How to cite  | 


Aims: Oral hygiene is key to prevent periodontal disease (PD). The efficacy of chlorhexidine-containing products has been largely proven, often being tooth discoloration an unwanted associated side-effect. Importantly, some differences related to the pharmaceutical presentation of these products have also been reported. This study aimed to evaluate the efficacy of two different pharmaceutical forms [toothpaste (TP) and mouthwash (MW)] of a new product containing chlorhexidine, dexpanthenol, allantoin and bioadhesive excipient (CDAB) (Bexident® Gums Coadjuvant Treatment) on volunteers with PD. Their preferences, acceptability and cosmetic properties, as well as tooth discoloration, were also assessed. Materials and methods: Total 60 subjects showing mildmoderate symptoms of gingivitis were randomly assigned to two different groups: one receiving TP (n = 30) and the other one receiving MW (n = 30). Periodontal disease index (PDI) was used to evaluate clinical signs at baseline (T0) and after 21 days (T21) of daily use of the products. Satisfaction was assessed through the affirmative/negative answers obtained with the visual analog scale (VAS). Results: All participants completed the study. A significant improvement of PDI score after treatment was reported in both groups (T21/T0) (p < 0.001). Thus, gingivitis improved from moderate to negative [increase = 20.0% (TP)/36.7% (MW)] and from mild to negative [increase = 56.7% (TP)/50.0% (MW)]. After treatment, all subjects reported to have healthier and/or less bleeding teeth (TP 9.0/9.4; MW 8.0/8.2) and would recommend the product (TP:100%/MW:96.6%) with no specific preference regarding its presentation. No change of teeth color was observed. Conclusion: Subjects with PD who received oral care with a new formulation of either chlorhexidine-containing TP or MW for 21 days, reported a significant improvement of their symptoms and resolution of the gingivitis with no associated tooth discoloration. Patients did not show a specific preference for any of the pharmaceutical presentations. Clinical significance: This new formulation of a chlorhexidinecontaining product in both TP and MW forms resulted effective for PD treatment and well accepted by the patients.



Narendra Kumar, Pallavi Sirana, Anshu Malhotra, Nandini Singhal, Nisha Chaudhary

Comparative Analysis of Sagittal Condylar Guidance Recorded by Intraoral Gothic Arch Tracing and Panoramic Radiograph in Completely Edentulous Patients

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1301 - 1305]

Keywords: Intraoral gothic arch, Panoramic radiographs, Sagittal condylar guidance

   DOI: 10.5005/jp-journals-10024-2422  |  Open Access |  How to cite  | 


Aim: To compare the intraoral gothic tracing method with panoramic radiographs in patients requiring complete dentures. Materials and methods: The present study was conducted on 20 edentulous subjects of both genders. Hanau Wide. Vue semi.adjustable articulator was used to record sagittal condylar guidance in all patients. Panoramic radiographs were taken in all patients and Frankfurt horizontal plane was traced on both sides of orthopantomogram (OPG) and second plane was marked by joining the most superior and most inferior point on the glenoid fossa curvature. Frankfort's horizontal plane was crossed with this line to record radiographic condylar guidance angle. NNT software was used to record the condylar guidance angle. Results: Mean ± standard deviation (SD) clinical SCG (25.15 ± 3.24) and radiographic seismocardiography (SCG) (27.54± 5.01) was non significant (p > 0.05) on left side. Mean ± standard deviation (SD) clinical SCG (26.84 ± 3.69) and radiographic SCG (29.3 5 ± 4.58) was significant (p < 0.05) on right side. The SCG did not show difference in values recorded by both methods on both sides. The difference in values in both sides by clinical method and radiographic method was non-significant (p > 0.05). Conclusion: There was correlation between sagittal condylar guidance obtained by both intraoral gothic arch method as well as radiographic method done on digital panoramic radiographs. Clinical significance: Correct centric jaw relation determines the success of the complete denture. Radiographic and clinical methods provide sufficient minute details necessary for the betterment of management.



Luiz R Paranhos, Eduardo dos S Rodrigues, Paula Benetti, Pâmela L Santos

A Comparison of Torque Stress on Abutment Screw of External Hexagon and Morse Taper Implant

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1306 - 1311]

Keywords: Abutment, Dental implant, Dental prosthesis, Rehabilitation oral

   DOI: 10.5005/jp-journals-10024-2423  |  Open Access |  How to cite  | 


Aim: This three-dimensional (3D) finite element analysis observed the stress distribution on the prosthetic screws on external hexagon implant and morse taper implant with different tightening loads. Materials and methods: For this, two different 3D models assembly were obtained from the manufacturer and transferred to finite element analysis software: External hex implant model (EHM), and Morse taper implant model (MTM), both compounds by 3.75 x 7 mm implant, abutment and abutment screw. Bolt pretension force was applied on the shaft next to the threads of the prosthetic abutment. Preload was calculated using the torque on the prosthetic screw as recommended by the manufacturer (EHM30 and MTM20) and 10 Ncm torque above the manufacturer recommendations (EHM40 and MTM30). Maximum von mises equivalent stresses were obtained on the screws. Results: Preload values results were 243.18N (EHM30), 229.71N (MTM20), 324.24N (EHM40) and 344.57N (MTM30). In EHM30, EHM40 and MTM20 models the maximum stresses were below the yield strength of the abutment screw material. However, the maximum stress in MTM30 model was higher than the reference value. Conclusion: The torque loads above the manufacturer recommendations can cause plastic deformation in the MT abutment screw threads. The screws of morse taper implant can be more sensitive to higher loads than external hexagon implant. Clinical significance: The adequate torque can result in screw loosening, while fracture may occur if torque is excessive. Abutment screw suffers many screwing cycles in its lifetime in a way that some tightening forces are above manufacturer recommendations.



Najat M Farsi, Eman A El Ashiry

Prevalence of Extra Root Canal Orifices of Maxillary First Permanent Molars in a Saudi Subpopulation Utilizing Microcomputed Tomography

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1312 - 1316]

Keywords: In vitro study, Maxillary first molars, Microcomputed tomography (micro-CT), Root canal orifices

   DOI: 10.5005/jp-journals-10024-2424  |  Open Access |  How to cite  | 


Aim: To study the prevalence of additional root canal orifices of upper first permanent molars in Saudi subpopulation in Jeddah, Kingdom of Saudi Arabia, utilizing micro-computed tomography X-ray (micro-CT). Materials and methods: One hundred extracted upper first permanent molars of Saudi patients were included in the study. Micro-CT was used to detect the prevalence of extra root canal orifices of the permanent upper first molars. Results: The evaluation of three-dimensional (3D) images of this study showed that of 100 upper permanent first molars scanned and analyzed, 10.53% had 6 pulp canal orifices, 35.09% had 5 pulp canal orifices, 47.37% had 4 pulp canal orifices and 7.01% had 3 pulp canal orifices. Conclusion: The current data showed the highest prevalence of 4 and 5 root canal orifices compared to 3 and 6 root canal orifices. Clinical significance: The knowledge of anatomic variations of teeth before starting root canal treatment can help dentists to detect and manage all root canals successfully.



Roshan Uthappa, Civy V Pulayath, Siraj P Ismail, Shabna Moyin, Sameer Punathil, Shashit S Bavabeedu

Assessment of Enamel Surface Microhardness with different Fluoride Varnishes–An In Vitro Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1317 - 1321]

Keywords: Demineralization, Fluoride varnish, Remineralization, Surface microhardness

   DOI: 10.5005/jp-journals-10024-2425  |  Open Access |  How to cite  | 


Aim: This study aimed to assess the microhardness of the enamel surface after fluoride varnish application. Materials and methods: Thymol of 0.1% in distilled water was used to store the collected healthy sixty teeth. The samples were divided into three groups randomly as per the different application of fluoride varnish. Group A: Fluor protector varnish (FIV) application, group B: Duraphat varnish application and group C: Bifluorid 10 varnish application. The present study followed the pH cycling protocol. Microhardness tester was used to test the microhardness of enamel surface and was expressed as microhardness measurements of Vickers hardness number (VHN) which was performed at baseline, on the 3rd day andon 7th day. Results: At baseline, group A samples mean SMH value was 230.64 ± 12.32 which was slightly more than group B with 229.45 ± 10.22 and group C with 230.10 ± 11.45. There was no significant difference showed with the analysis of variance between the groups. On the 3rd day, there was a slight increase in the mean SMH in group A with 235.39 ± 6.44 and no significant difference between the groups was seen statistically. On the 7th day, the group A showed high SMH value of 262.20 ± 4.89 compared to other groups which didn't show a significantly high statistical difference. Conclusion: On conclusion, post-application of fluorprotector varnish showed higher enamel surface microhardness compared to Duraphat and Bifluorid 10 varnishes. Clinical significance: In young children, fluoride varnishes are effectively used as a noninvasive, anti-caries agent in the treatment of initial caries. Therefore, in routine dental practice, the knowledge about different fluoride varnishes is of importance.



Rudys Rodolfo de Jesus Tavarez, Adriana S Malheiros, Matheus C Bandeca, Alvaro H Borges, Anna C Brito, Júlio de A Gurgel, Twigg MD Hayashida, Etevaldo MM Filho

Dentogingival Alterations and Their InƒPuence on Facial and Smile Attractiveness

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1322 - 1328]

Keywords: Attractiveness, Dental aesthetics, Dentogingilval alterations, Diastema, Smile

   DOI: 10.5005/jp-journals-10024-2426  |  Open Access |  How to cite  | 


Aim: This study aimed to evaluate the influence of labial and dentogingival characteristics on facial and smile attractiveness. Materials and methods: Four different close-up photographs each of six women models with different labial and dentogingival characteristics were obtained. One of the models was considered standard. Photographs were arranged in an album were evaluated by 100 laypersons, and 30 dentists who ranked each close-up of the models from according to the degree of attractiveness from first to sixth place, with first being the model considered most attractive and justified the reasons for choosing. Results: The standard model received the best scores for both lips (7.75) and face (5.18). Medium-sized lips were preferred (p < 0.05), and the smile positively or negatively interfered with aesthetic perception depending on the dentogingival alteration present. Diastema was the alteration that had the greatest negative influence. Conclusion: Not all Dentogingival alterations interfere with aesthetic evaluation. The lips are not decisive in facial attractiveness. Attraction is assessed significantly differently by laypeople than by dentists. The smile directly influences the analysis of facial beauty. Clinical significance: Dentogingival alterations may be imperceptible, especially when evaluating the facial joint, so its correction will not always be necessary.



Sandeep Mehta, Anuj S Parihar, Tarun Vyas, Shivakshi Chansoria, Bhoopendera S Rajput

Assessment of Lingual Concavities in Submandibular Fossa Region in Patients requiring Dental Implants– A Cone Beam Computed Tomography Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1329 - 1333]

Keywords: Cone beam computed tomography (CBCT), Implant, Submandibular fossa

   DOI: 10.5005/jp-journals-10024-2427  |  Open Access |  How to cite  | 


Aim: The present study was aimed at assessing the lingual concavities in the submandibular fossa region in patients requiring dental implants with the help of cone beam computed tomography (CBCT). Materials and methods: The present study included 140 patients who visited the department with the missing mandibular posterior teeth. CBCT images were obtained using planmeca machine. Cross sections of 1 mm of submandibular fossa in the region of 1st and 2nd molar were studied and Type I to III lingual concavities were analyzed by a radiologist. Results: Type I lingual concavity (< 2 mm) was seen in 23%, type II (2–3 mm) in 62% and Type III (> 3 mm) in 15% of patients. The difference was significant (p < 0.05). Males had slightly higher mean ± S.D value at 1st molar (2.6 mm ± 0.94) and 2nd molar (2.8 mm ± 0.90) on the left side and (2.7 mm ± 0.92) at 1st molar and (2.9 mm ± 0.93) at 2nd molar on the right side. The difference was nonsignificant (p > 0.05). Females had mean ± S.D value at 1st molar (2.3 mm ± 0.90) and (2.5 mm ± 0.92) at 2nd molar on the left side and (2.4 mm ± 0.91) at 1st molar and (2.8 mm ± 0.93) at 2nd molar. The difference was nonsignificant (p > 0.05. The difference between both genders was statistically nonsignificant (p > 0.05). Conclusion: Type I bone is the best for placing an implant. The chances of complications are more in type II and III bone. CBCT provides necessary information before planning implant in the edentulous area. Clinical significance: Cone beam computed tomography (CBCT) is the best radiographic aid which is effective in delineating different types of bone in the mandibular posterior region.



Akinwale O Akinbade, Kizito C Ndukwe, Foluso J Owotade

Comparative Analgesic Effects of Ibuprofen, Celecoxib and Tramadol after third Molar Surgery: A Randomized Double Blind Controlled Trial

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1334 - 1340]

Keywords: Celecoxib, Ibuprofen, Postoperative pain, Third molar surgery, Tramadol

   DOI: 10.5005/jp-journals-10024-2428  |  Open Access |  How to cite  | 


Background: This study compared the effects of ibuprofen, celecoxib and tramadol on pain after surgical extraction of impacted mandibular third molars. Patients and methods: This double blind randomized controlled trial recruited 135 healthy subjects who required surgical extraction of impacted mandibular third molars, with a mean age of 26.51 ± SD 6.29 years. The subjects were randomized into three equal groups and given appropriate doses of each drug immediately after extraction. They continued the drugs up to 48 hours after extraction. Postoperative pain intensity was self-recorded by subjects at 4, 8, 16, 24 and 48 hours after extraction, using visual analogue scale (VAS). Data analysis involved descriptive statistics, 2-sample Wilcoxon Mann–Whitney U test and Kruskal Wallis rank test. Statistical analysis was done using intention-to-treat analysis. The mean VAS at each point of postoperative pain assessment was compared using one way analysis of variance (ANOVA) among the three groups. Statistical significance was inferred at p < 0.05. Results: The mean VAS score of the celecoxib group (32.35± SD 23.96) at 4 hours was the lowest among the three groups. This was followed by the ibuprofen group with mean VAS score of 38.96 ± SD 22.30. Whereas, the subjects in tramadol group experienced the highest VAS score (53.31 ± SD 23.30) at 4 hours. There was statistically significant difference in the mean VAS scores at 4 hours after extraction when the three groups were compared (p = 0.0039). Celecoxib group also had the lowest mean VAS scores at 8 hours, 24 hours and 48 hours after the extraction. None of the subjects in the ibuprofen and celecoxib groups reported any adverse effect of the analgesics, whereas 47.61% of the tramadol group did. Conclusion: Celecoxib was the most effective analgesic of the three studied drugs in controlling postoperative pain after mandibular third molar extraction in our subjects. It was closely followed by ibuprofen while tramadol was found to be the least effective. Clinical significance: The outcomes of this study suggest that celecoxib can be prescribed for effective control of postoperative pain after third molar surgery especially in patients with peptic ulcer disease who will not tolerate the adverse effect of traditional nonsteroidal anti-inflammatory drugs. It also shows that ibuprofen can be an analgesic of choice for patients who are not at risk of gastrointestinal complications of nonsteroidal anti-inflammatory drugs (NSAIDs). Tramadol could be considered for patients with milder postoperative pain after third molar surgery.



Md Imran Ul Haque, Puneet Sharma, Aditya Tiwari, Sambit Subhas, Manu Rana

Comparative Evaluation of Different Bone Markers in Peri-implant Crevicular Fluid of Immediate Loaded and Nonloaded Dental Implants

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1341 - 1345]

Keywords: Bone markers, Crevicular fluid, Immediate loaded dental implants

   DOI: 10.5005/jp-journals-10024-2429  |  Open Access |  How to cite  | 


Aim: The present study was conducted to determine different bone markers in immediate loaded and nonloaded dental implants. Materials and methods: It comprised of 60 patients (males–30, females–30) which were divided into two groups of 30 each. Group, I received immediate loaded dental implants, and group II received non-loaded dental implants. Modified bleeding on probing index, peri-implant sulcus depth was assessed in both groups at 1 month, 2 months, 3 months and 4 months. The crevicular fluid was obtained to determine bone markers levels such as transforming growth factor-alpha (TGF-á), osteocalcin (OCN), osteopontin (OPN), parathyroid hormone (PTH) and osteoprotegerin (OPG). Results: Both groups revealed non- significant difference in modified bleeding on probing index and peri-implant sulcus depth (p > 0.05). Bone markers found to be elevated more in group I as compared to group II. However, the difference was non- significant (p > 0.05). Conclusion: Transforming growth factor alpha (TGF-á), OCN, OPN, OPG and PTH and parathyroid hormone (PTH)levels were higher in immediate loaded dental implants as compared to nonloaded dental implants. Clinical significance: Immediate loaded dental implants showed an increase in expression of bone markers such as TNF-á, OCN, OPN, PTH and OPG which may be useful in deciding future of immediate loaded dental implants



Mustafa M Al-Khatieeb, Reem A Rafeeq, Alan I Saleem

The Relationship Between Orthodontic Force Applied by Monoblock and Salivary Levels of Alkaline Phosphatase and Lactate Dehydrogenase Enzymes

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1346 - 1351]

Keywords: Alkaline phosphatase (ALP), Lactate dehydrogenase (LDH), Monoblock, Orthodontic force, Salivary levels

   DOI: 10.5005/jp-journals-10024-2430  |  Open Access |  How to cite  | 


Aim: The current study was aimed to determine the relationship between the orthodontic force applied by monobloc and the salivary level of alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) enzymes, considering the time factor after insertion of the appliance and whether there is a correlation between these enzymes. Materials and methods: A sample of 28 growing patients requiring orthodontic treatment with myofunctional appliance (Monoblock) was taken for the current study with an age range 9 to 12 years, all patients had Angle's class II division 1 malocclusion with no or mild crowding, the sample was selected using simple random sampling. Only 16 subjects (10 males and 6 females) were included who follow certain inclusion criteria. Unstimulated saliva was collected from the patients before monoblock insertion, then 1 hour after insertion, followed by 14 days and 28 days. Salivary levels of ALP and LDH were measured using a spectrophotometer and compared with the base line. Results: The results revealed that ALP and LDH levels increased with increasing time after monoblock insertion, and there was the statistically insignificant difference after 1-hour post-insertion for ALP enzyme level, but highly significant after 14 and 28 days. While for LDH level, there was the statistically significant difference after 1-hour post-insertion, but highly significant difference after 14 and 28 days post-insertion. In this regard to the relation between salivary ALP and LDH enzymes levels at different time intervals, showed that there were no significant correlations between the enzymes using Pearson's correlation test. Conclusion: The ALP and LDH salivary enzymes activity is affected by mechanical forces generated by monoblocactivator and these enzymes activities can also be increased during the rapid growth phase of childhood such as late infancy and early puberty where the age of subjects was selected in the current study. Clinical significance: The determination of ALP and LDH salivary enzymes activities during the skeletal maturity is crucial for the success of myofunctional monobloc treatment; therefore, saliva can be used as a noninvasive diagnostic tool for determination of chemical biomarkers for detection of bone remodeling process during myofunctional monoblock treatment



Yousef Jahandideh, Anahita A Moghaddam, Hossein Pourkhalili

Accuracy of Implant Abutment Level Impression with and without Impression Coping

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1352 - 1357]

Keywords: Dental abutments, Dental implants, Dental impression techniques, Prosthodontics

   DOI: 10.5005/jp-journals-10024-2431  |  Open Access |  How to cite  | 


Aim: Transferring an accurate copy of the patient's soft and hard tissue to the dental laboratory is of essential importance. Various methods of implant impression have different outcomes on dimensions of final cast. This study aimed to compare two methods of implant impression on abutment level with and without impression coping on two parallel implants. Materials and methods: In this experimental study, a resin model with two holes for fixing the implant was made. The first and second implants had a 4 and 11 mm distance to canine respectively. In this study two methods were used for impression: first was direct (without impression coping) and second was indirect (with the impression coping). Ten impressions were prepared for a total of 10 stone casts. For analyzing the abutment analogs positions, each cast was analyzed using a cruicial malformation and malarticulatoin (CMM) in three dimensions (X, Y, and Z). The difference in dimensions of final casts and laboratory models were analyzed using Independent t-test. Results: The results did not show a significant difference between direct and indirect methods in Z and Y axis in absolute transmission (Är). The dimensional changes in the X-axis in the direct method was 0.647 ± 0.155 which is 0.067 ± 0.146 more than the indirect method. A significant difference (p = 0.044) was observed between the two methods in X-axis. Conclusion: Based on the results, this research found the indirect impression on abutment surface to be more accurate than the direct one. In general, two methods were not significantly different, and dentists can use the simple method of the direct impression for making implant prosthetics. Clinical significance: Reconstruction of implant's accurate position in the process of impression, along with a tension-free insertion, is the first step in having an accurate prosthesis. Abutment level impression with the impression coping is slightly more accurate than the one without impression coping.



Junaid MH Kapadia, Anshu R Agarwal, Samvit Mishra, Purva Joneja, Asad S Yusuf, Deepak S Choudhary

Cytotoxic and Genotoxic effect on the Buccal Mucosa Cells of Patients Undergoing Fixed Orthodontic Treatment

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1358 - 1362]

Keywords: Chromium, Deoxyribonucleic acid (DNA) damage, Nickel, Orthodontic, Zinc

   DOI: 10.5005/jp-journals-10024-2432  |  Open Access |  How to cite  | 


Aim: To evaluate the presence of metal ions and deoxyribonucleic acid damage on the cells of buccal mucosa in subjects scheduled to undergo fixed orthodontic treatment. Materials and methods: Eighty patients scheduled to undergo orthodontic treatment were included in the present study. Samples were collected from buccal mucosa of the subjects at five different intervals: before the starting of the fixed appliance therapy, 5 months after the insertion of the appliance, 10 months after insertion of the appliance, 15 months after insertion of the appliance and 20 months after insertion of the appliance. Flow cytometry was further used for assessment of apoptosis. Comet assay was used for evaluating the metal ions associated deoxyribonucleic acid ((DNA) damage of buccal epithelial cells. Atomic absorption spectrometry was used for measuring the nickel (Ni), chromium (Cr) and zinc (Zn) levels in the cells of the buccal mucosa. Analysis of data was done by SPSS software version 16.0. Results: A significant increase in the Ni, Cr and Zn concentration during orthodontic treatment was observed. A progressive non-significant decrease in the percentage of viable cells from a baseline value to the end of the treatment was observed. A significant increase in the head diameter, DNA in tail and tail length, starting from the pretreatment value to the end of orthodontic treatment, was also observed. Conclusion: Timely checking of deoxyribonucleic acid (DNA) damage and nuclear changes should be done for detecting earlier adverse changes. Clinical significance: In patients wearing orthodontic appliances, no clinical impact occurs by wearing fixed appliances.



Fabio A Pereira, Iranilda A de Mendonça, Renata I Werneck, Simone T Moysés, Samuel J Moysés

Human Development Index, Ratio of Dentists and Inhabitants, and the Decayed, Missing or Filled Teeth Index in Large Cities

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1363 - 1369]

Keywords: Dental caries, Epidemiology, Human development, Social determinants

   DOI: 10.5005/jp-journals-10024-2433  |  Open Access |  How to cite  | 


Aim: This study aimed to investigate the associations between human development and the demographic ratio of dentists with the prevalence of dental caries at 12 years of age in large Brazilian cities. Materials and methods: Data were collected from 27 state capitals, Secondary databases were used: the municipal human development index (MDHI); the ratio of dentists qualified to exercise their profession according to the number of inhabitants; and the decayed, missing or filled teeth index (DMFT). Pearson correlation coefficient analysis and multiple logarithmic regression analysis were performed. Results: The MDHI showed a strong correlation with DMFT and explained 48.1% of the variation in the cities. The ratio of dentists to the number of inhabitants displayed an insignificant, weak correlation with the variations in the DMFT. Conclusion: Social factors strongly influence the oral health/ disease process in Brazilian capitals, thus actions are needed for the promotion of health at more distal, or structural levels that modify the environment, thus enabling healthier choices for individuals. These results challenge traditional beliefs that only the ratio of professional dentists to inhabitants and the provision of dental services have beneficial effects on the prevention and control of oral health problems. Clinical significance: The prevalence of dental caries is strongly correlated with social factors, as the MDHI.



Nibha K Singh, Suma B Chalapathy, Roger P Thota, Kiran Chakravarthula, Ramesh Tirnati, Kartheek Yenugupalli

Evaluation of Stress Distribution Among Two Different Preangled Abutments of Implants in Two Different Densities of Bone at Different Levels Along the Implant–In Vitro Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1370 - 1375]

Keywords: Bone density, Finite element analysis, Finite element models, Implant, Pre-angled abutments

   DOI: 10.5005/jp-journals-10024-2434  |  Open Access |  How to cite  | 


Aim: The present study evaluated the stress distribution among two different pre-angled abutments of implants in two different densities of bone at different levels along the implant. Materials and methods: The stress allocation was assessed and compared between the control group, i.e., 0° and two different pre-angled abutments, i.e., 10° and 20° in two different bone densities as D2 and D3, using the finite element analysis. The geometric configuration of the mandible was generated using Ansys version 14.5graphic pre-processing software. Young's modulus (E) of elasticity and Poisson's ratio (ì) of the material were integrated into the representation. Average vertical load of 150 N was applied on the central fossa and buccal cusp of the mandibular first molar. Highest values of von Mises stresses were observed in different bone densities and angulated abutments at different levels. Results: With increase in the abutment angulation between D2 and D3 densities along implant abutment junction the percentage of stress concentration was maximum with the values being 0.05 %, 108.67% and 128% in 0°,10°, and 20° angulations respectively, whereas, along the implant, the percentage of stress was increased with 0.6 %, 98.55% and 115.6% in 0°,10°, and 20° angulation. Conclusion: Stress concentration was observed maximum at the implant abutment junction irrespective of the angulations and the densities used and the value of stress concentration accumulated within the cortical bone increases with increase in bone density and angulation of the implant. Clinical significance: These finding would aid in recognizing the importance of quality of cortical bone which and helps in avoiding the overloading of the implant abutment interface for the long-term prognosis of the implant.



Kaprice Chemin, Márcia Rezende, Fábio M Milan, Thereza B Dantas, Kátia do N Gomes, Stella Kossatz

Clinical Evaluation of 10% Hydrogen Peroxide on Tooth Sensitivity and Effectiveness in at Home Dental Bleaching

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1376 - 1380]

Keywords: Dental bleaching, Dentin sensitivity, Hydrogen peroxide

   DOI: 10.5005/jp-journals-10024-2435  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to evaluate the dental effect and sensitivity of at-home dental bleaching with 10% hydrogen peroxide (H2O2). Materials and methods: Twenty volunteers with A2 or darker central incisors were selected for this study. Was used 10% H2O2 for thirty minutes twice a day, for two weeks. Shade evaluation was assessed visually by the value-oriented shade guide Vita Classical shade guide, Vita Bleachedguide 3D-MASTER and by the Easyshade spectrophotometer at baseline, during bleaching (first and second weeks), and post-bleaching (one month). The perceptions of sensitivity were recorded by the patients through the numerical rating scale (0 to 4) and 0 to 10 visual analog scales daily. Data from the shade guide units was subjected to a one way repeated measures (RM) analysis of variance (ANOVA) test (á = 5%). The overall ÄE, absolute risk and intensity of tooth sensitivity were calculated as well as the 95% confidence interval. Results: The absolute risk of tooth sensitivity was 65% and the intensity was mild. Data from ÄSGU and ÄE after 1 month of bleaching for H2O2 10% showed significant whitening, 4 units for Vita Classical, 5 units for Vita Bleachedguide and 9.7 units for spectrophotometer. Conclusion: At-home bleaching using 10% hydrogen peroxide is effective in 14 days of bleaching. The most common adverse events were mild tooth sensitivity, and no subjects discontinued use early because of a treatment-related adverse event. Clinical significance: At-home dental bleaching with 10% hydrogen peroxide gel reduces the time of use of the tray, maintaining the effectiveness with low intensity of dental sensitivity. Brazilian clinical trials registry (REBEC) RBR-45xmzj.



Narendra Kumar, Kirti Dahiya, Rohan Sikka, Pallavi Sirana, Vikram Kapoor

To Assess and Evaluate the Variation of Mandibular Anatomy Using Cone Beam Computed Tomography Before Planning an Implant Surgery: A Population-based Retrospective Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:6] [Pages No:1381 - 1386]

Keywords: Angulation, Axial height, Cone beam computed tomography (CBCT), Mandible, Population

   DOI: 10.5005/jp-journals-10024-2436  |  Open Access |  How to cite  | 


Aim: The accurate placement of implants in mandible requires consideration for angulations of the bone along with the vertical dimensions. The aim of this present study was to assess the variation of mandibular anatomy using computed tomography (CT) radiography and to evaluate the effect of presence and absence of teeth on the mandibular anatomy before planning an implant surgery. Material and methods: The present population-based retrospective study was conducted using 167 digital CT scan images those selected from departmental archives. The samples were sub-divided two groups: group 1included digital CT of edentulous mandible while group 2 included digital CT of edentulous mandible. The axial height, vertical height, and angulations were recorded separately for each group. Results: The results of the present study showed a gradual increase in mandibular angle in both the groups with a statistically significant difference only in the canine-premolar area. The axial height showed a significant difference at canine and first premolar area and a second premolar and the first molar area. However, available height showed a significant difference in canine and first premolar area and distal to the second molar area. When both the sides were compared, no statistically significant difference was observed between right and left sides. Conclusion: It was concluded that due to the variability of the mandibular anatomy and because of the effects of various imperative factors, 3D imaging like CT scans should be recommended for safer and secure presurgical planning. Clinical significance: In surgical osteotomies and implant placement especially in post-extraction sockets, two-dimensional (2D) image of panoramic radiographs should not be considered that reliable as these three-dimensional (3D) imaging radiographs. Therefore CT scans of various angulations and sections must be considered by the clinicians to rationally study the mandibular anatomy and their risk associated areas.



Hani Tohme, Joseph Makzoume, Jihad Fakhoury, Carole Yared

Effect of Cyclic Dislodging on the Retention of Two Attachment Systems for Implant-supported Overdentures: An In Vitro Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1387 - 1393]

Keywords: Attachments, Dental implants, Edentulous patient, Overdentures, Retentive force

   DOI: 10.5005/jp-journals-10024-2437  |  Open Access |  How to cite  | 


Purpose: The aim of this study was to compare and evaluate the retention of two new attachment systems used for implant-supported overdentures subjected to insertionremoval cycles. Materials and methods: Twenty custom-manufactured polyvinyl chloride models mimicking implant-retained overdentureresin blocks were fabricated and divided into two groups (n = 10): group 1 (‘Kerator’ attachment) and group 2 (‘Emi’ attachment). Each model received two parallel implants (JD evolution®) 20 mm apart and was subjected to cyclic retention forces of 10, 100, 1000, 5000, 10000 and 14600 cycles using a universal testing machine in a 0.9% sodium chloride water solution at 22° C. Data were analyzed using one-way analysis of variance; the level of significance was set at α ≤ 0.05. Results: The ‘Kerator’ and ‘Emi’ attachment systems reported a significant decrease in retention (64 and 56.6% respectively) after 14600 insertion-removal cycles (p < 0.001). The ‘Emi’ attachment showed significant higher loss of retention than the ‘Kerator’ attachment all along the 14600 cycles (p < 0.05) except for cycles 100 and 5000 (p > 0.05). Conclusion: Within the limitations of this in vitro study, both attachments reported satisfactory retentive values during the 14600 cycles, the ‘Kerator’ attachment showed better retention than the new ‘Emi’ attachment. The initial retentive force of both attachments has gradually decreased. Clinical significance: Both attachment systems evaluated in this study can be used in clinical practice for implant-supported overdentures.



Gopal S Narayan, Padmaraj S Neelamurthy, Ramachandran A Kumar, Balakrishnan Venkatesh, Sokkalingam M Venkatesan, Karthikeyan I

Revascularization in Immature and Mature Teeth with Necrotic Pulp: A Clinical Study

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1394 - 1400]

Keywords: Blood clot, Mineral trioxide aggregate (MTA), Revascularization, Triple antibiotic paste

   DOI: 10.5005/jp-journals-10024-2438  |  Open Access |  How to cite  | 


Aim: The aim of this in vivo study was to evaluate the revascularization procedure both in immature and mature teeth with necrotic pulp and open apices, disinfected with triple antibiotic paste followed by inducing blood clot in the root canal. Materials and methods: Fifteen patients were selected who presented with immature and mature permanent teeth with pulpal necrosis and open apices. In the first visit, the root canal was accessed with LA and rubber dam isolation; then the canal was disinfected using triple antibiotic paste containing ciprofloxacin, metronidazole, and clindamycin in the ratio of 1:1:1 and closed with IRM. In the second visit, after administering local anesthesia and isolating with a rubber dam, the triple antibiotic paste was washed out by saline irrigation, and apical papilla beyond the confines of the root canal was stimulated with sterile H file to produce a blood clot. Finally, the access was closed using a double seal with mineral trioxide aggregate (MTA) placed apical to cementoenamel junction and resin bonded cement over the MTA. Radiographic examination and pulp sensibility test was done during the follow-up period of 2,4,6,8 and 10 months. Result: After 10 months follow-up, 10 out of 13 patients showed root development and apical closure. The eight patients out of 13 showed root development, apical closure and lateral thickening of radicular dentin and 2 out of 13 patients showed a positive response to electric sensibility test. Conclusion: Within the limitation of this study, it can be concluded that there is evidence of root development, increase in lateral wall thickness, apical closure and positive response to pulp sensibility test in both mature and immature teeth with necrotic pulp. Clinical significance: The conventional approach for management of teeth with necrotic pulp and the open apex is altered with the possibility of tissue regeneration within the pulp space and continued root development through revascularization procedures. It also re-establishes the vitality in a previously nonvital and necrosed tooth.



Hytham Al-Rabadi, Luai K Daklalah, Mashoor Alwreikat, Mohammad Alqudah, Moath Momani, Hind F Nsour

Bisphosphonate Induced Osteonecrosis of the Jaws: Our Clinical Experience at King Hussein Medical Center, Amman, Jordan

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:4] [Pages No:1401 - 1404]

Keywords: Bisphosphonates, Mandible, Osteonecrosis, Retrospective study

   DOI: 10.5005/jp-journals-10024-2439  |  Open Access |  How to cite  | 


Aim: To describe and analyze the clinical characteristics of bisphosphonate induced osteonecrosis of the jaws (BIONJ) patients diagnosed and treated at King Hussein Medical Center (KHMC), Amman, Jordan. Patients and methods: A series of 12 patients with BIONJ was studied and analyzed retrospectively regarding age, gender, underlying disease, type, route and duration of bisphosphonate (BP) administered, site of osteonecrosis, initiating factor and treatment outcome were recorded. Follow-up period ranged from 6 months to 3 years. Results: Patient's age ranged from 45 to 76 year old. Female to male ratio was 2:1. Most patients received IV BP as a part of the therapeutic protocol of their malignant disease; only two patients received oral BP. Mandible was more commonly involved compared to maxilla with a ratio of 5:1. In most patients the exposed necrotic bone was subsequent to an oral surgical intervention; However, in two cases the disease was initiated spontaneously. Complete wound healing was achieved in most of cases within a period ranged from 4 to 8 weeks. Two patients needed a second surgical intervention; However one patient was refractory to treatment and no wound healing achieved. Conclusion: Bisphosphonate (BP) induced osteonecrosis of the jaws is a rare complication of bisphosphonates (BP) therapy. Oral surgical intervention and female gender increase the risk of the disease. Early diagnosis and cessation of BP are essential to achieve success. Clinical significance: It seems that some cases of BIONJ are refractory to the known treatment modalities. However, evaluation of treatment protocols may be needed in the future.



Fatemeh Koohpeima, Zahra Jowkar, Nazbanoo Farpour, Mohammad J Mokhtari, Fereshteh Shafiei

Effect of Silver Nanoparticles, Zinc Oxide Nanoparticles and Titanium Dioxide Nanoparticles on Microshear Bond Strength to Enamel and Dentin

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:8] [Pages No:1405 - 1412]

Keywords: Adhesive bonding, Laboratory research, Microshear bond strength, Nanoparticles

   DOI: 10.5005/jp-journals-10024-2440  |  Open Access |  How to cite  | 


Aim: This study was aimed to evaluate whether antibacterial pretreatment of enamel and dentin with silver nanoparticles (SNPs), zinc oxide nanoparticles (ZNPs) and titanium dioxide nanoparticles (TNPs) has any effect on the microshear bond strength of an etch-and-rinse adhesive system. Materials and methods: Eighty human third molars were randomly assigned to eight subgroups (n = 10). Enamel groups included no pretreatment (E), pretreatments with SNPs (ESNP), ZNPs (EZNP) and TNPs (ETNP) before acid etching and adhesive application. Dentinal groups included no pretreatment (D), pretreatments with SNPs (DSNP), ZNPs (DZNP) and TNPs (DTNP). The specimens were bonded by Adper Single Bond and polyvinyl chloride microtubes and were restored with Z250 composite. The bonded surfaces underwent microshear bond strength (ìSBS) test. Data in megapascal (MPa) were analyzed with the Kruskal–Wallis test and the Mann–Whitney test (p = 0.05). Results: There was not a significant difference among the groups in enamel (p > 0.05). There was no significant difference between the application of three nanoparticles and the control group in dentin. However, DSNPs had a higher ìSBS (25.60 ± 14.61) than that of the DZNPs and DTNPs groups (p = 0.03 and p = 0.001, respectively). Also, the mean ìSBS value was lower in dentin groups compared to the respective enamel groups (p < 0.05) except for groups DSNPs and ESNPs in which no significant difference was found (p > 0.05). Conclusion: Pretreatment with SNPs, TNPs, and ZNPs can be suggested to achieve potent antibacterial activities without compromising the bond strength. The best result was obtained for pretreatment with SNPs compared to pretreatment with TNPs or ZNPs in dentin and enamel, albeit the differences were not significant in the enamel groups. Clinical significance: Effective antibacterial treatment prior to adhesive bonding application is desirable to provide successful restoration if it would not adversely affect the bond strength of the adhesive system. Nanoparticles can be applied to meet this goal.



Moshabab A Asiry

Anterior Open Bite Treated by Maxillary Posterior Teeth Intrusion Using Zygomatic Miniplates: A Case Report

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:5] [Pages No:1413 - 1417]

Keywords: Miniplate, Open bite, Temporary anchorage device

   DOI: 10.5005/jp-journals-10024-2441  |  Open Access |  How to cite  | 


Aim: This case report aims to demonstrate the successful utilization of zygomatic miniplates in the treatment of an adult patient with anterior open bite (AOB). Background: During treatment of anterior open bite, incisor extrusion may compromise facial esthetics in cases with long facial height and/or sufficient incisor exposure at rest and smile. The intrusion of posterior teeth has the advantage of correcting vertical dimension and maintaining proper incisors show. Case description: The patient, a 22-year-old boy, had an anterior open bite of 4.5 mm with increased lower facial height, bilateral posterior crossbite, and two different occlusal planes in the upper arch. Titanium miniplates were used to intrude maxillary posterior teeth with a trans-palatal arch appliance to limit buccal tipping. The intrusive force was then applied through elastomeric chains placed bilaterally in the maxillary arch between the miniplate and posterior teeth. The anterior open bite was corrected within 7 months of intrusion with decreased lower facial heightand significant improvement in anteroposterior jaw relationship. Conclusion: This r eport emphasizes the significant r ole of facial appearance and smile. Clinical significance: Most of the non-surgical approaches are not suitable for open bite correction in cases with long facial height and/or sufficient incisor exposure at rest and smile because of their extrusive mechanics which compromise the facial and smile esthetics. The intrusion of posterior teeth using min iplates allowing a counterclockwise rotation of the mandible to correct anterior open bite without compromising facial esthetic and smile.



Rohit Shetty, Ipsha Singh, Naufil Chida

Prefabricated Laser Sintered Composite Veneers and Occlusal Vertical Dimensions: Case Reports

[Year:2018] [Month:November] [Volume:19] [Number:11] [Pages:7] [Pages No:1418 - 1424]

Keywords: Aesthetics, Full mouth rehabilitation, Laser sintered, Nanohybrid composite, Prefabricated veneer

   DOI: 10.5005/jp-journals-10024-2442  |  Open Access |  How to cite  | 


Aim: To highlight the concept of prefabricated veneers and occlusal vertical dimension (OVD) and series of case report using edelweiss prefabricated veneer system. Background: Edelweiss prefabricated veneer system presents a concept of biofunctional esthetics using laser sintered composite resins. The system`s biofunctionality and versatile area of application combined with its time and cost saving procedure make the edelweiss veneer and occlusion system a sound investment for the future. Case description: A series of case reports treated using prefabricated laser sintered composite veneer system has been presented. Conclusion: Prefabricated veneer is a milestone in operative dentistry, as it contributes tremendously to direct composite application, helping a larger number of our patients to receive esthetic restorations that are more conservative and affordable. Clinical significance: The prefabricated composite veneering technique provides a minimally invasive, chair-side technique for esthetic and full mouth rehabilitation.


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