How to cite this article: Mahendra L. Aligners: the Invisible Corrector—A Boon or Bane. J Contemp Dent Pract 2018;19(3):247.

The aim of this study is to assess marginal microleakage of cervical cavities restored with composite resins and two different adhesive techniques subjected to at-home and in-office bleaching.

In this randomized, blind laboratory experiment, 60 bovine teeth recently extracted were collected and divided into six groups (n = 10 each group). The teeth received cervical cavity preparations (2 mm × 3 mm × 1 mm) with enamel margins. Two different adhesive systems were used (Single Bond 2 and Clearfil SE Bond), in addition to composite resin (Z250). Restored teeth received two different bleaching gels (Opalescence PF and Opalescence Boost). Teeth were thermocycled and analyzed under confocal laser scanning microscopy.

No significant differences were observed (p > 0.05) in microleakage scores between the two groups not subjected to bleaching nor between the four groups that received bleaching treatment (p > 0.05), regardless of the gel and adhesive system employed. However, when comparing nonbleached with bleached teeth, those not subjected to bleaching showed statistically lower marginal microleakage scores (p < 0.05). Data were statistically analyzed using the Kruskal–Wallis test followed by Student–Newman–Keuls post hoc test, with significance set at 5%.

Marginal microleakage in composite resin restorations is influenced by the action of bleaching agents used both at-home and in-office, regardless of the adhesive system employed (total-etch or self-etch).

Both at-home and in-office bleaching agents have an influence on the adhesive interface of resin restorations, producing changes and inducing marginal leakage.

Klein Jr CA, da Silva D, Reston EG, Borghetti DLB, Zimmer R. Effect of At-home and In-office Bleaching on Marginal Microleakage in Composite Resin Restorations using Two Adhesive Systems. J Contemp Dent Pract 2018;19(3):248-252.

One of the common practices observed in many parts of the world is smoking, of which tobacco forms an important constituent which is burned and inhaled. Smoking is known to have potential effect on body’s immune system, antioxidants level, and salivary cotinine levels. Hence, we planned the present study to evaluate the impact of cigarette smoke on salivary antioxidant levels and cotinine levels in smokers and nonsmokers.

The present study included assessment of salivary parameters of smokers and nonsmokers. A total of 400 subjects were analyzed, of which 200 were active smokers and 200 were nonsmokers. Unstimulated salivary samples were taken and assessment of α-amylase levels was done using biochemical kit and spectrophotometer. Assessment of salivary catalase (CAT) activity was done using Luck method. For the determination of cotinine levels, Bioassay Technology Laboratory kit was used using enzyme-linked immunosorbent assay (ELISA) technique. After the assessment of levels of all the salivary parameters, all the data were recorded, compiled, and analyzed.

α-Amylase in smokers and nonsmokers group was found to be 206.25 and 169.85 U/mL respectively. Nonsignificant results were obtained while comparing the salivary α-amylase levels among the two study groups. Nonsignificant results were obtained while comparing the salivary CAT levels among the smokers and nonsmokers group. We observed statistically significant results while comparing mean cotinine levels among smokers group and nonsmokers group.

Alteration in cotinine levels occurs in smokers in comparison to nonsmokers.

Smoking can cause harmful effect on the oral mucous membrane by altering salivary defense components.

Singh S, Sharma M, Rohilla N, Salgotra V, Kumar V, Sharma RK. Assessment of Salivary Catalase, α-Amylase, and Cotinine Levels in Chronic Smokers: A Comparative Study. J Contemp Dent Pract 2018;19(3):253-256.

The aim of this study is to assess the Arab society’s knowledge, awareness, and attitudes toward dental veneers.

A cross-sectional study was performed by collecting data through an online questionnaire created using the Survey Monkey website and distributed among Middle Eastern societies through social media to ascertain participants’ knowledge and awareness regarding dental veneers. The sample included Arab laypeople who were over 18 years old, to represent the awareness of the majority regarding dental veneers.

The sample of this study included 1,332 subjects from different Middle Eastern nationalities, mainly Saudis, Kuwaitis, and Emiratis (15.6% of males and 84.4% of females). The results of this study showed that the total knowledge of dental veneers is 50.12%. The respondents with the highest level of knowledge acquired their information mainly from newspapers and magazines, followed by the Internet, then dentists, then social media, and, finally, friends and relatives.

Cost was the only factor limiting 38.4% of subjects from receiving veneers, and 56% of the subjects would receive veneers if they were free of cost. In total, 72.6% of the respondents believed that veneers are currently overused.

The knowledge and awareness of dental veneers were below a satisfactory level. Participants who relied on social media as a source of information had lower knowledge levels.

This study emphasized the need for continual societal education regarding dental veneers.

Alfouzan A, Al-Sanie AA, Al-Dhafiri RA. Arab Societal Awareness of Dental Veneers. J Contemp Dent Pract 2018;19(3):257-261.

Silver colloidal nanoparticles have been incorporated into acrylic resins to induce antimicrobial properties. However, as additives, they can influence the mechanical properties of the final product. Mechanical properties are also dependent on different curing cycles. The aim of this study was to evaluate flexural strength of a denture base resin incorporated with different concentrations of silver colloidal nanoparticles subjected to two different curing cycles.

Lucitone 199 denture base resin was used into which silver colloidal nanoparticles were incorporated at 0.5 and 5% by polymer mass. Specimens devoid of nanoparticles were used as controls. A total of 60 specimens were fabricated and divided into two groups. Each group was divided into three subgroups consisting of 10 specimens each. The specimens were fabricated according to American Dental Association (ADA) specification No. 12 and tested for flexural strength using universal testing machine.

Silver colloidal nanoparticle incorporation at 0.5% concentration increased the mean flexural strength in both curing cycles by 7.5 and 4.4%, respectively, when compared with the control group.

The study suggested that the mean flexural strength value of 0.5% silver colloidal nanoparticles in denture base resin was above the value of the control group both in short and long curing cycles, which makes it clinically suitable as a denture base material. However, at 5% concentration, the statistically significant amount of decrease in flexural strength compared with the value of control group both in short and long curing cycles gives it a questionable prognosis.

The specimens incorporated with the antimicrobial agent 0.5% silver colloidal nanoparticles and processed by long curing cycles showed significant increase in its flexural strength compared with the control group, which makes it clinically suitable as a denture base material.

Munikamaiah RL, Jain SK, Pal KS, Gaikwad A. Evaluation of Flexural Strength of Polymethyl Methacrylate modified with Silver Colloidal Nanoparticles subjected to Two Different Curing Cycles: An in vitro Study. J Contemp Dent Pract 2018;19(3):262-268.

The overall rehabilitation of women in sex work is unfortunately limited most of the time only to moving them to another profession, but it should be focused on including health as an important factor. Factors that restrict regular dental care include misconceptions, dental fear and expense of dental care, unpleasant dental experiences, and socioeconomic factors, but such a direct correlation cannot be made in the case of such women. Until now, no study has been conducted related to the complete dentition status and treatment needs of women in sex work.

The aim of our survey was to evaluate the dentition status and treatment needs among the brothel-based women engaged in sex work.

A pilot study was conducted on 30 women and the final sample size was estimated to be 350. All the women were above 18 years old. Systematic random sampling method was followed after line listing of the brothels. The dentition status and treatment needs were recorded using the World Health Organization assessment form, 1997. The data collected were tabulated and analyzed using Statistical Package for the Social Sciences (SPSS), version 16.0. The Chi-squared test was carried out to check the association, and all p-values below 0.05 were considered to be statistically significant.

The mean number of decayed teeth per person was 5.05 (±4.81), missing teeth per person was 0.96 ± 2.71, filled teeth per person was 0.04 (±0.34), and the mean of decayed missing filled permanent teeth per person was 6.05 (±5.84). There was a significant association between dental caries and age, using finger to clean the teeth, and not visiting the dentist.

Due to different risk factors, such as diet, improper oral hygiene maintenance, and substance abuse, the overall dental health was found to be compromised in this population. Economic burden is an important factor that influences their attitude toward oral health and is likely to be inherited by their next generation also.

Muralidharan S, Acharya AK, Sevekari T, Margabandhu S, Rupawat D, Khan R, Desale M. Dentition Status and Treatment Needs among Women involved in Sex Work as a Profession in the Red Light District of Pune, Maharashtra, India: A Cross-sectional Study. J Contemp Dent Pract 2018;19(3):269-272.

The present study aimed to obtain information about knowledge, execution, and attitude toward biomedical waste (BMW) and its management.

In the present study, a self-administered closed-ended questionnaire was designed to conduct a cross-sectional survey. It was distributed among 614 dentists (institution associated or private practitioners) in the cities of North India. The questionnaire comprised 36 questions regarding knowledge, execution, and attitude toward BMW and its management. Frequency distribution and chi-square test along with paired t-test were used to compare the data obtained between the private practitioners and institution-associated dentists.

The study showed that 80% private practitioners were aware of the categories of BMW as compared with 100% of institution-associated dentists. However, 41% dentists associated with institution were disposing the chemical waste directly into sewer and a surprising high number of private practitioners were discarding directly without any treatment. Furthermore, regarding the mandatory maintenance of BMW records, 100% institution-associated respondents were aware, whereas only 6.5% private practitioners knew about it. Regarding BMW management not frequently being followed, 78% of private practitioners believed extra burden as the reason.

Most of the dentists had adequate knowledge regarding BMW policies and its management. Although it was being practiced in mostly all the institutes on a regular basis, the majority of private practitioners were not practicing it due to various reasons, such as financial burden, lack of availability of service, and poor attitude toward its management.

There is a need to make it compulsory and organize training sessions to educate the dental personnel and to establish the importance of proper management.

Raghuvanshi M, Sinha S, Mohiddin G, Panda A, Dash KC, Bhuyan L. Awareness of Biomedical Waste Management among Dentists associated with Institutions and Private Practitioners of North India: A Comparative Study. J Contemp Dent Pract 2018;19(3):273-277.

This study aims to evaluate the effect of erbium: Yttrium–aluminum–garnet (Er:YAG) laser irradiation on the enamel microshear bond strength (µSBS), followed by the utilization of etch-and-rinse and universal adhesive systems.

A total of 32 molars were sectioned in the mesiodistal direction producing 64 samples that were randomized into two groups (n = 32): single bond 2 (SB2) (etch-and-rinse system; 3M), SB universal (SBU) (universal etching system; The SB2 and SBU groups were then divided into two subgroups (n = 16): (i) enamel was irradiated with an Er:YAG laser (λ = 2.94 μm, 60 mJ, 10 Hz), and (ii) enamel served as a control. The samples were restored with TPH3 (Dentsply), stored in artificial saliva for 24 hours, and subjected to a microshear test.

Kruskal–Wallis (p < 0.05) and Mann–Whitney U tests indicated no significant differences in μSBS between the groups, and the fractures were predominately at the resin–enamel interface.

The previous irradiation of enamel with Er:YAG laser does not interfere with the performance of simplified two-step etch-and-rinse and universal adhesive systems.

The increasing use of Er:YAG laser is important to evaluate the influence of this irradiation on the adhesion of restorative materials. Thus, to obtain the longevity of the restorative procedures, it is necessary to know the result of the association of the present adhesive systems to the irradiated substrate.

De Jesus Tavarez RR, Rodrigues LLC, Diniz AC, Lage LM, Torres CRG, Bandeca MC, Firoozmand LM. Does Erbium:Yttrium–Aluminum–Garnet Laser to Enamel improve the Performance of Etch-and-rinse and Universal Adhesives? J Contemp Dent Pract 2018;19(3):278-282.

Orthodontic treatment these days is increasing in demand, and therefore, it is relatively imperative for the orthodontist to prescribe the use of fluoride-containing products, such as mouthwashes and gels, to help prevent dental caries and maintain healthy oral health. The aim of the study was to assess and evaluate the effects of fluoride prophylactic agents on mechanical properties of nickel titanium (NiTi) wires during orthodontic treatment using scanning electron microscope (SEM).

We used the commercially available round preformed NiTi orthodontic archwire (3M company) and three different mouthwash solutions, i.e., Phos-Flur gel (1.1% sodium acidulated phosphate fluoride, APF, 0.5% w/v fluoride, pH = 5.1; Colgate Oral Pharmaceuticals) and Prevident 5000 (1.1% sodium fluoride neutral agent, 0.5% w/v fluoride, pH = 7; Colgate Oral Pharmaceuticals). All the specimens were subjected to a three-point bending test on a universal testing machine. To observe the surface morphological changes, one wire from each group was randomly selected and observed under a SEM.

It was observed that there was not much difference in the values of both modulus of elasticity and yield strength obtained after loading of stress on the wires in all the three experimental conditions. A significant difference in both modulus of elasticity and yield strength was observed during unloading of stress. Further, when the surface characteristics were observed for all the specimens using SEM images, it was observed that NiTi wires treated with Phos-Flur showed large surface defects which appeared as round, pitted areas depicting corrosion, numerous white inclusions, and overall damaged surface structure of the wire as compared with the control.

Thus, fluoridated mouthwashes are essential to maintain good oral hygiene and decrease instance of caries in patients undergoing orthodontic treatment. The prophylactic usage of topical fluoride agents on NiTi wire seems to diminish the mechanical properties of the orthodontic wire that could significantly affect future treatment outcomes.

It has been proved that fluoride mouthwashes/gels do affect the structural surface qualities and strength of wires used during the orthodontic treatment irrespective of the composition of the wires. Therefore, it is the responsibility of the clinician to prescribe these prophylactic agents carefully while keeping in mind their pH so that the overall result of the treatment may not be hampered and delayed due to change in properties of the wires used.

Gupta AK, Shukla G, Sharma P, Gupta AK, Kumar A, Gupta D. Evaluation of the Effects of Fluoride Prophylactic Agents on Mechanical Properties of Nickel Titanium Wires using Scanning Electron Microscope. J Contemp Dent Pract 2018;19(3):283-286.

Periodontitis is a common problem affecting a significant population of the world. For the assessment of oxidative stress of an individual, total oxidation status (TOS) and total antioxidant capacity (TAOC) are the significant biomarkers. Hence, we planned the present study to assess malondialdehyde (MDA), TOS, TAOC levels, and oxidative stress index (OSI) in generalized aggressive periodontitis (GP) and chronic periodontitis (CP) patients.

The present study included assessment of 40 CP patients, 40 GP patients, and 40 healthy controls. Clinical assessment of all the subjects was done by measuring the probing depth (PD), clinical attachment (CL), gingival index (GI), gingival bleeding index (GBI), and plaque index (PI). Salivary and serum samples were taken and assessed by standard procedures as described previously in the literature. All the values were assessed and compared.

Significant results were obtained while comparing all the periodontal parameters in between various study groups. Mean serum MDA levels in the CP, GP, and control group were found to be 0.68, 0.65, and 0.61 µM respectively. Statistically nonsignificant results were obtained while comparing the serum MDA levels in between the three study groups. Significant results were obtained while comparing the mean serum and salivary TOS values, TAOC values, and OSI in between various study groups.

In periodontitis patients, oxidative stress was significantly higher in comparison with healthy subjects.

Oxidative parameters do play a significant role in the pathologic profile of periodontitis.

Tripathi V, Singh ST, Sharma V, Verma A, Singh CD, Gill JS. Assessment of Lipid Peroxidation Levels and Total Antioxidant Status in Chronic and Aggressive Periodontitis Patients: An in vivo Study. J Contemp Dent Pract 2018;19(3):287-291.

The purpose of the study is to evaluate the bacterial microleakage of three different materials, mineral trioxide aggregate (MTA), resin-modified glass ionomer cement (RMGIC), and flowable composite, as a coronal barrier against Enterococcus faecalis.

A total of 100 human extracted single-rooted teeth were selected. Access opening done, working length determined, and canals were cleaned and shaped with ProTaper F3 and obturated with AH26 and gutta-percha (GP) using lateral condensation technique. Samples were divided into three experimental and two control groups. Approximately 3 mm GP was removed from the coronal orifice and restored with one of the test materials. Teeth were suspended in glass tubes containing brain heart infusion (BHI) broth and equipped with microcaps, which were used to check bacterial leakage. A 24-hour broth of E. faecalis was placed in the pulp chamber. Tubes were incubated and checked for turbidity for 90 days. Data were analyzed using chi-squared test between the test and control groups and Fisher test between the test groups.

Significantly lesser number of samples turned turbid in the RMGIC group followed by MTA group and the maximum number of samples turned turbid in the flowable composite group.

The RMGIC is a better coronal sealer, followed by MTA and flowable composite.

Coronal sealing ability of RMGIC is more promising in comparison with the other agents.

Rashmi N, Shinde SV, Moiz AA, Vyas T, Shaik JA, Guram G. Evaluation of Mineral Trioxide Aggregate, Resin-modified Glass Ionomer Cements, and Composite as a Coronal Barrier: An in vitro Microbiological Study. J Contemp Dent Pract 2018;19(3):292-295.

This study aims to determine the role of mixing techniques of polyether impression materials and efficacy of disinfection on microbial colonization of these impression materials.

Polyether impression material was mixed using two methods: First by hand mixing (group I) and second using an automixer (group II) with a total of 100 samples. Four microbial strains were studied, which included Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. After incubation, the bacterial colonies were counted, and then, disinfectant solution was applied. The effect of disinfection solution was evaluated for each specimen.

The surface of polyether impression materials mixed with an automixer has less number of voids and overall a smoother surface as compared with the hand-mixed ones. On comparing the disinfection procedures, i.e., specimens without any disinfection and specimens after disinfection, statistically highly significant difference was seen between all the groups.

We can conclude that impression mixing procedures are important in determining the surface characteristics of the impression and ultimately the colonization of bacteria and also determine the importance of disinfection on microbial colonization.

This study emphasises the deleterious role of nosocomial infections and specific measures that should be taken regarding the prevention of such diseases. Dental impressions are proved to be a source of such infections and may lead to transmission of such diseases. Thus, proper measures should be taken right from the first step of impression taking to minimizing and preventing such kind of contaminations in clinical practice.

Singla Y, Pachar RB, Poriya S, Mishra A, Sharma R, Garg A. Evaluation of the Efficacy of Different Mixing Techniques and Disinfection on Microbial Colonization of Polyether Impression Materials: A Comparative Study. J Contemp Dent Pract 2018;19(3):296-300.

The aim of this study is to assess the morphology of nasopalatine canal (NPC) with cone beam computed tomo-graphy (CBCT).

A total of 460 subjects of both genders were subjected to CBCT with NewTom machine, and sagittal and coronal sections were used for evaluation of the shape of NPC and width of buccal cortical plate. Types of NPC were also assessed.

Of 460 subjects, males were 210 and females were 250. The difference was nonsignificant (p = 0.1). Type III canals were mostly seen in both males and females, followed by types I and II. The mean length of NPC in males and females showed statistical significant difference (p < 0.05). Males showed significantly higher diameter of nasal opening, oral opening, and width of the buccal bone plate over the oral opening as compared with females.

The exact location, morphology, and dimensions of NPC can be well visualized with CBCT. All findings were higher in males as compared with females.

The success of dental implant in maxillary anterior region may be affected by the approximation with NPC. The exact location and morphology play an important role for the correct placement of implant. Cone beam computed tomography is a useful tool providing three-dimensional images in all sections.

Rao JB, Tatuskar P, Pulla A, Kumar N, Patil SC, Tiwari I. Radiographic Assessment of Anatomy of Nasopalatine Canal for Dental Implant Placement: A Cone Beam Computed Tomographic Study. J Contemp Dent Pract 2018;19(3):301-305.

The aim of this study was to compare the effectiveness of nano-hydroxyapatite (nano-HAP) paste and fluoride varnish in remineralizing initial enamel lesion in young permanent teeth and their ability to resist secondary caries under dynamic pH cycling quantitatively and qualitatively.

Initial caries-like lesions were artificially developed on 45 specimens. Specimens were divided into three groups: (1) Control (without treatment), (2) fluoride varnish (3M ESPE), and (3) nano-HAP paste (Desensibilize Nano P). The nano-HAP paste was applied twice separated by one pH cycle, and the varnish was applied only once followed by 7 days of pH cycling. All specimens were examined using DIAGNOdent^® pen (KaVo, Germany), and a representative specimen was randomly selected from each group for qualitative evaluation using scanning electron microscope (SEM) at four stages: Baseline, after lesion formation, immediately after remineralization, and after pH cycling. Data were statistically analyzed with Statistical Package for the Social Sciences (SPSS), version 20.

The degree of demineralization was significantly elevated in control group; however, no significant difference was found between fluoride varnish group and nano-HAP paste group (p < 0.001).

Nano-HAP paste showed promising long-term protective effect in terms of surface depositions and maintaining a smooth surface compared with fluoride varnish.

Based on the findings of this study, nano-HAP paste might be recommended as alternative remineralizing agent with lower fluoride concentration than fluoride varnish that could be beneficial for children, pregnant females, and those who are at high risk of dental fluorosis.

Daas I, Badr S, Osman E. Comparison between Fluoride and Nano-hydroxyapatite in Remineralizing Initial Enamel Lesion: An in vitro Study. J Contemp Dent Pract 2018;19(3):306-312.

Proper anesthesia and pain management during treatment are most important concerns in dentistry for people of all ages, especially children. This study compared the success rate of lidocaine block with articaine buccal infiltration during anesthesia of the primary mandibular second molars in children aged 6 to 8 and 8 to 10 years.

The present clinical trial was conducted on 40 children aged 6 to 8 and 8 to 10 years who were referred to the Department of Pediatrics of the Faculty of Dentistry at Shahid Sadoughi University of Medical Sciences in Yazd (Islamic Republic of Iran) and needed to be treated with pulpotomy on both primary mandibular second molars. The patients were randomly divided into two groups. At the first session, a group received articaine buccal infiltration and the other group experienced inferior alveolar nerve (IAN) block. At the next visit, this trend was reversed. Visual analog scale (VAS) was used to evaluate the pain during pulpotomy.

Data were analyzed by Statistical Package for the Social Sciences (version 17) software using Mann–Whitney test. According to the results of this test, the pain during pulpotomy was significantly lower in the articaine group (p < 0.001).

Articaine buccal infiltration can be employed for pulpotomy treatment in primary mandibular second molars.

This research will eliminate block injection of lidocaine in children and utilize infiltration of articaine for pulpotomy treatment of mandibular teeth, hence preventing lingual nerve damage and prolonging paresthesia of IAN, lip, and cheek bite due to IAN block anesthesia.

Alinejhad D, Bahrololoomi Z, Navabazam A, Asayesh MA. Comparison of Visual Analog Scale Scores in Pain Assessment during Pulpotomy using Different Injection Materials in Children Aged 6 to 8 and 8 to 10 Years. J Contemp Dent Pract 2018;19(3):313-317.

Ceramics are widely applied in dentistry owing to their excellent mechanical and physical attributes. The most popular ceramics are Lava^™, KaVo Everest, and Cercon. However, it is unclear whether or not a different surface treatment along with low-temperature aging and mechanical loading (ML) affects the physical properties of computer-aided design (CAD)/computer-aided manufacturing (CAM)-machined yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) ceramic.

The objective of this research was to assess the impact of various surface treatments as air-particle abrasion, ML, low-temperature degradation (LTD), and their cumulative effects on biaxial flexural properties of Y-TZP.

Totally, 50 specimens were fabricated by CAD–CAM machining from Cercon^® and divided into five groups following different surface treatments as control (C), air-particle abrasion (Si), ML, LTD, and cumulative treatment (CT) group. Results were investigated by two-way analysis of variance (ANOVA) and Tukey honest significant difference (HSD) test.

The highest biaxial flexural strength was observed in the Si group (950.2 ± 126.7 MPa), followed by the LTD group (861.3 ± 166.8 MPa), CT group (851.2 ± 126.5 MPa), and the least with ML (820 ± 110 MPa). A significant difference was observed in the two-way ANOVA test. X-ray diffraction (XRD) analysis showed that the control group consists of 100% tetragonal zirconia and the maximum amount of monoclinic phase was obtained after LTD.

No negative effect on biaxial flexural strength was observed; indeed, it increases the biaxial strength. Hence, these surface treatments can be done in routine clinical practice to improve the performance of ceramic restoration.

Jain T, Porwal A, Babu S, Khan ZA, Kaur C, Jain RB. Effect of Different Surface Treatments on Biaxial Flexural Strength of Yttria-stabilized Tetragonal Zirconia Polycrystal. J Contemp Dent Pract 2018;19(3):318-323.

Periodontitis, a chronic infectious disease, affects most of the population at one time or the other and its expression is a combination of hosts, microbial agents, and environmental factors. Extensive literature exists for the relationship between periodontal disease and diabetes mellitus, cardiovascular diseases, and adverse pregnancy outcomes. Only a few studies performed in a limited number of patients have reported periodontal health status in chronic renal failure patients. Hence, the aim of the present study is to assess and compare the periodontal status of patients with chronic renal failure undergoing dialysis, predialysis with systemically healthy individuals.

A total of 90 patients were divided into three groups. Group I: 30 renal dialysis patients. Group II: 30 predialysis patients. Control group comprised 30 systemically healthy patients who formed group III. Periodontal examination was carried out using oral hygiene index-simplified (OHI-S), plaque index (PI), gingival index (GI), probing depth, and clinical attachment loss.

The results of the study showed that the periodontal status of patients with chronic renal failure undergoing dialysis (dialysis group) and patients with chronic renal failure not undergoing renal dialysis (predialysis) when compared with systemically healthy subjects showed significantly higher mean scores of OHI-S, PI, and clinical attachment loss.

Thus, patients with chronic renal failure showed poor oral hygiene and higher prevalence of periodontal disease.

The dental community’s awareness of implications of poor health within chronic renal failure patients should be elevated.

Gupta R, Kumar U, Mallapragada S, Agarwal P. Comparative Evaluation of Periodontal Status of Chronic Renal Failure Patients and Systemically Healthy Individuals. J Contemp Dent Pract 2018;19(3):324-330.

The aim of this study was to explore the patients’ perspectives about the impact of oral submucous fibrosis (OSF) on life quality.

Thirty clinically diagnosed OSF patients with a wide degree of disease severity and diverse range of sociodemographic profile were included in this study. Fourteen participants were interviewed and four focus group discussions were conducted in nonclinical settings. The audio recordings were anonymized, transcribed, and translated in English from Marathi language. Data were analyzed using an in-depth narrative thematic analysis method.

Four main themes evolved from the interviews: (1) discomfort and functional impairment; (2) psychological wellness; (3) physical wellness, and (4) social wellness. Majority of the participants discussed about discomfort and functional impairment. Participants also reported greater impact of OSF on psychological and social wellness.

This study demonstrated the impact of OSF on different aspects of participant’s life. “Discomfort and functional impairment” was noticed to be the most recognized theme by our participants. However, OSF also has impacts on other important domains, namely psychological, social, and physical wellness.

The patient-reported outcome (PRO) measure (PROM) reflects an integral aspect of general health and well-being and thus can be used to elucidate the impact of OSF on the quality of life (QoL) of affected individuals. These patients’ perspectives should be taken into consideration along with thorough clinical examination to decide and effectively manage the overall health care needs of the OSF patients.

Gondivkar SM, Bhowate RR, Gadbail AR, Sarode SC, Gondivkar RS, Yuwanati M, Patil S. Quality of Life-related “Patient-reported Outcome Measures” in Oral Submucous Fibrosis Patients. J Contemp Dent Pract 2018;19(3):331-338.

The purpose of the study was to evaluate and compare the flexural strength of nano-reinforced zirconia feldspathic porcelain, lithium disilicate ceramics, and zirconia.

Ten bar-shaped specimens of computer-aided design (CAD)/computer-aided manufacturing (CAM) zirconia, reinforced feldspathic porcelain, and reinforced lithium disilicate were fabricated in accordance to International Organization for Standardization (ISO 6872; n = 10). Feldspathic porcelain and lithium disilicate ceramic specimens were reinforced with 5, 10, 15, and 20% of zirconia nanoparticles through a customized technique. The specimens were subjected to three-point flexural strength test using universal testing machine (UTM) and examined for crack propagation using a scanning electron microscope (SEM). One­way analysis of variance (ANOVA) and Tukey test were used to analyze the data (p < 0.05).

The flexural strength of feldsphatic porcelain increased with the increase in the concentration of zirconia particles. The mean flexural strength of 5, 10, 15, and 20% nano-zirconia-incorporated lithium disilicate was 93.8, 97.1, 100.6, and 100.8 MPa respectively, and was lower than the control group (221.7 MPa). A significant difference in the flexural strength was found with the incorporation of nano-zirconia particles.

The flexural strength of zirconia-integrated feldspathic porcelain increased and lithium disilicate ceramics decreased with the nano-zirconia reinforcement.

The simplified approach of reinforcing feldspathic porcelain with zirconia nanoparticles can be adapted in clinical situations of higher masticatory forces.

Sasikala C, Chander NG. Comparative Evaluation of Flexural Strength of Nano-zirconia-integrated Pressable Feldspathic and Lithium Disilicate Ceramics. J Contemp Dent Pract 2018;19(3):339-344.

Debriding and disinfecting complex anatomies within the root canal system pose a major challenge during root canal therapy. Even with current chemomechanical techniques, debris and bacterial remnants are commonly left behind, which are generally believed to increase the risk of endodontic failure. This case details the use of a new technique to debride complex apical anatomy in a maxillary molar.

A 48-year-old female presented to the clinic with a chief complaint of increasing pain in her tooth. Clinical examination of the right first maxillary molar (#3) revealed moderate sensitivity to percussion and mild sensitivity to palpation. A pulpal diagnosis of symptomatic irreversible pulpitis and a periapical diagnosis of symptomatic apical periodontitis were made. Mechanical instrumentation was performed using rotary file size #25/.04 for the mesiobuccal and distobuccal canals and size #25/.06 for the palatal canal to create a fluid path and enable obturation of the root canal system following the GentleWave^® Procedure. The GentleWave Procedure was completed using Multisonic Ultracleaning™ for complete debridement and disinfection of the root canal system. The tooth was obturated using a warm vertical continuous wave obturation technique. Postoperative radiographs revealed complex anatomy within the apical third that was undetected both during pre-operative radiography and mechanical instrumentation. The palatal canal exhibited a complex apical delta with multiple points of exit, and the mesiobuccal canal revealed an undetected lateral canal within the apical third that had a separate and distinct egress.

It is important for the clinician to debride and disinfect complex anatomy within the root canal system to reduce the risk of endodontic failure. This case report highlights the clinical significance of utilizing the GentleWave Procedure for detecting complex apical anatomy during endodontic therapy.

Ford MW. Utilizing the GentleWave^® System for Debridement of Undetected Apical Anatomy. J Contemp Dent Pract 2018;19(3):345-351.

Odontogenic infections originate from a tooth or from its supporting structures, generally secondary to a pulp necrosis, periodontal disease, pericoronitis, apical lesions, or complications of dental procedures, which can be restricted to the alveolus or can reach the jaws and face through maxillofacial spaces. These are the most common conditions which affect the head and neck regions.

The aim of this study is to report a severe case of a cervicofacial odontogenic infection while discussing the most relevant aspects.

A 47-year-old female patient with a background of diabetes mellitus (DM) had a cervicofacial infection presenting edema and erythema in the left hemiface extending from the frontoparietal to cervical region and was submitted to extensive surgical treatment combined with antibiotic therapy.

Although the prevalence and complication rates of odontogenic infections had decreased with the advancement of diagnostic techniques, availability of effective antibiotics, and improvement in oral hygiene, still there are conditions that require attention and accurate treatment to prevent the progression of the pathology to deeper fascial spaces.

Odontogenic infections can be treated with fewer complications if approached earlier when diagnosed while their premature clinical manifestations. However, if the treatment is postponed and the infection spreads into deeper fascial spaces, it can damage vital structures, and, consequently, threaten the patient’s life. In these cases, extensive and aggressive therapy should be performed.

Tormes AKM, De Bortoli MM, Junior RM, Andrade ESS. Management of a Severe Cervicofacial Odontogenic Infection. J Contemp Dent Pract 2018;19(3):352-355.