The Journal of Contemporary Dental Practice

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2018 | July | Volume 19 | Issue 7

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Simpy A Mahuli, Amit V Mahuli

Plagiarism-related Dilemmas in Scientific Writing

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:3] [Pages No:753 - 755]

   DOI: 10.5005/jp-journals-10024-2331  |  Open Access |  How to cite  | 



Luiz CC Gambus, Aline CBR Johann, Patrícia VC Bettega, Edvaldo AR Rosa, Ivone MI Morimoto, Magda RR da Cruz, Luís S Nassif, Sérgio L Rocha, Sérgio O Ioshii, Andresa VS Vaz, Juliana AL Solyon, Francineo Moraes, Sérgio A Ignácio, Ana MTG Hardy

Sialometric and Sialochemical Changes in Morbidly Obese Patients before and after Bariatric Surgery

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:756 - 761]

Keywords: Bariatric surgery, Body mass index, Morbid obesity, Obesity, Saliva

   DOI: 10.5005/jp-journals-10024-2332  |  Open Access |  How to cite  | 


Aim: To evaluate the sialometric and sialochemical changes in morbidly obese patients before and after bariatric surgery. Materials and methods: A total of 74 participants were divided into three groups paired by sex and age: (a) Experimental 1 (E1)—morbid obesity (n = 40)—according to the Fobi-Capella technique, corresponding to the individuals with a body mass index (BMI) of greater than 40 kg/m2 prior to bariatric surgery; (b) Experimental 2 (E2)—the same individuals after surgery; and (c) control (C) (n = 34)—individuals with a BMI of nearly 23 kg/m2. The measure of salivary flow was carried out by collecting stimulated saliva. The pH was evaluated using the pocket pH meter, while the salivary buffer capacity (SBC) was determined by the titration method. Analyses of the salivary concentration of total proteins (TPs), amylase activity, urea, calcium (Ca++), and glucose were evaluated using the calorimetric method. Results: Group E1, as compared with group C, presented the highest pH levels (p = 0.03), amylase activity (p = 0.00), and calcium (p = 0.00). The opposite was observed for glucose (p = 0.00), TP (p = 0.04), and urea (p = 0.04). Group E2, as compared with group C, revealed higher levels of amylase (p = 0.00) and calcium (p = 0.00). The opposite was observed for SBC (p = 0.01), PT (p = 0.00), and glucose (p = 0.00). Group E1, as compared with group E2, presented higher values of SBC (p = 0.00) and urea (p = 0.00). The lowest values were found for calcium and urea (p = 0.03). Conclusion: Both weight gain and bariatric surgery are risk factors for the oral condition, causing change in some important salivary components, such as TP, amylase, calcium, and glucose. Clinical significance: This article is a valuable addition to the scientific literature, due to its novelty. There are no papers that show salivary alterations related to bariatric surgeries.



Moshabab A Asiry, Ibrahim AlShahrani, Khalid Abdelaziz, Al Jowharah A Al AlShikh, Wala AlGhamdi, Hajer A Mansour

Effects of Different Stain Removal Protocols on Bonding Orthodontic Brackets to Enamel

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:762 - 767]

Keywords: Bonding, Micro-abrasion, Stain removal, Thermocycling, Topical fluoride

   DOI: 10.5005/jp-journals-10024-2333  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of different stain removal protocols with or without topical fluoride application on the bond strength of orthodontic brackets to enamel. Materials and methods: Eighty extracted premolars were randomly assigned into four groups according to the stain removal protocol. The stain removal protocols were (1) using rubber cup with prophylaxis paste in (G1, n = 20), (2) air-abrasion with prophy-jet polishing system (G2, n = 20), (3) micro-abrasion with opalusture polishing paste (G3, n = 20), and (4) macroabrasion with ultrafine diamond finishing tips (G4, n = 20). Ten teeth in each group (SG1, n = 10) had no topical fluoride treatment after stain removal protocol, while the rest (SG2, n = 10) were subjected to topical fluoride application. After bonding the orthodontic brackets, all specimens were thermocycled before testing their bracket–enamel bond strength. The debonded bracket and enamel surfaces of each specimen were also assessed to determine the adhesive remnant index (ARI) for each subgroup. Results: Specimens in G2, G3, and G4 recorded lower shear bond strength as compared with G1 (p < 0.05). For all groups, specimens in SG2 demonstrated lower bond strength than their counterpart in SG1 (p < 0.05). No significant differences were detected between the ARIs of different subgroups (p > 0.05). Conclusion: Bonding orthodontic brackets is affected by the protocol of removing enamel stains. The use of the rubber cup with prophylaxis paste provided the highest bracket–enamel bond strength. Topical fluoride application usually complicates the bonding process of orthodontic brackets to cleaned enamel surfaces. Clinical significance: The results of the current study indicate higher bracket bond strength to enamel surfaces treated with different stain removal protocols than the clinically acceptable values (5.9-7.8 MPa). However, the more aggressive enamel pretreatment methods should not be considered unless the clinical situation necessitates such action. Postponing the topical fluoride application is advisable to follow the bracket bonding procedure. This action would prevent the negative effect of topical fluorides on bracket–enamel bond strength.



Marina Baechtold, Leonardo da Cunha, Erick Souza, Marilisa Gabardo, Kauhanna de Oliveira, Flares Baratto-Filho, Denise Leonardi

Effect of Endodontic Irrigation Protocols on Crown Fracture Resistance

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:5] [Pages No:768 - 772]

Keywords: Endodontics, Root canal irrigants, Smear layer, Sodium hypochlorite, Tooth fracture

   DOI: 10.5005/jp-journals-10024-2334  |  Open Access |  How to cite  | 


Aim: This study aimed to evaluate the fracture resistance of tooth crowns endodontically irrigated using different protocols. Materials and methods: A total of 76 bovine incisors were divided into four groups (n = 19): irrigation with distilled water (control; CON); conventional irrigation with positive apical pressure (PAP); passive ultrasonic irrigation using continuous flushing (PUI); and irrigation with PAP and heated sodium hypochlorite solution (PHS). The force required to fracture the crown was measured on a universal testing machine at an angle of 45°. Results: The CON group had higher fracture resistance (351.71 ± 58.66 N) than the PAP and PUI groups (140.96 ± 37.26 N; 167.49 ± 40.08 N respectively). The PHS group had the lowest fracture resistance value (115.15 ± 41.07 N). Irrigation protocols had a significant effect on crown resistance (p < 0.01). Conclusion: Teeth subjected to irrigation with heated sodium hypochlorite showed decreased resistance to crown fracture. Clinical significance: The contact of the irrigating solution with the root canal walls potentially can cause their weakness, determining crown fracture.



Natheer H Al-Rawi, Hibba Yousef, Muna Khamis, Ouiza Belkadi, Shaikha Ahmed, Shaikha Ali

Vertebral Malalignment among Male Dentists with Workrelated Musculoskeletal Pain in the United Arab Emirates

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:5] [Pages No:773 - 777]

Keywords: Dentists, Musculoskeletal pain, Posture screen, Vertebral malalignment

   DOI: 10.5005/jp-journals-10024-2335  |  Open Access |  How to cite  | 


Aim: Musculoskeletal pain (MSP) is a highly prevalent and debilitating disorder among dentists, often leading to early retirement. Poor ergonomics in the dental practice not only causes MSP, but can also lead to postural deviations as a result of an imbalance in muscle function. The aim of this study was to observe the relationship between MSP and vertebral deviations among male dentists in the United Arab Emirates (UAE). Materials and methods: A total of 60 male dentists participated in this cross-sectional study. Standardized Nordic questionnaire (SNQ) was used to record MSP and PostureScreen Mobile® (PSM) application was used to observe postural deviations in the vertebral regions, including the neck, shoulders, upper back, lower back, and hips. Results: About 83% of participants were suffering from MSP, with the lower back as the most commonly reported region (29%). The pain characteristics reported were chronicity (63%) and dullness (72%). As for postural deviations, the most common site recorded was the neck region (72%). The correlation between the regions of deviation and the regions of pain showed that the shoulder region was more significant than other regions. Conclusion: Musculoskeletal pain and vertebral malalignment are common among practicing dentists, probably because of bad postural habits and lack of awareness. Preventive strategies to minimize the risk of developing these health problems are highly recommended. Clinical significance: Work-related MSP (WRMSP) is a significant health problem among dentists and may be linked to the later development of vertebral deviations. Posture screen analysis is a quick, yet objective postural and movement screening tool in which findings can quickly be rendered to prospective dentists, so that custom postural and functional exercises may be correctly practiced.



PG Francis, TP Mohamed Haris, Vincy A Margaret, Vineeth Menon, Venith Jojee

Evaluation of Biomechanical Properties of Four Loops at Different Activation: A Finite Element Method Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:778 - 784]

Keywords: Biomechanical properties, Finite element analysis, Kalra Simultaneous Intrusion and Retraction loop, Omega loop, T loop, Tear drop loop, Titanium molybdenum alloy

   DOI: 10.5005/jp-journals-10024-2336  |  Open Access |  How to cite  | 


Aim: The aim of the study was to evaluate the force, moment, and moment/force ratio (M/F) generated by activating T loop, Kalra Simultaneous Intrusion and Retraction (KSIR) loop, Omega loop, and Teardrop loop made of titanium molybdenum alloy (TMA) wire with different preactivation bends at 1, 2, and 4 mm activation. Materials and methods: Finite element method (FEM) models of the four loops were created and different preactivation bends were placed. The loops were then activated and analyzed for force, moment, and M/F ratio using ANSYS software. Results: In loops without preactivation bends, highest force values were generated by Omega loop, whereas T loop had the least force value. The mean value for the M/F in the alpha segment was almost similar. In loops with preactivation bend, the force was highest in Teardrop loop, whereas T loop had the least force value. The mean value for the M/F in the alpha segment was almost similar in all the loops. Conclusion: T loop with preactivation bend shows the most favorable properties. Clinical significance: T loop is comparatively reliable for the frictionless mechanics for the space closure than the other loops evaluated in clinical use.



Abeer E El-Embaby, Jehan AlHumaid, Fahad A Al Harbi

Performance of Self-adhering Flowable Composite in Class V Restorations: 18 Months Clinical Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:785 - 791]

Keywords: Class V, Clinical performance, Flowable composite, Self-adhering composite

   DOI: 10.5005/jp-journals-10024-2337  |  Open Access |  How to cite  | 


Aim: The present randomized clinical study compared the 18 months performance of self-adhering flowable composite with a conventional flowable composite in anterior Class V restorations. Materials and methods: Totally, 20 patients, each with two moderate cervical carious lesions, participated in this singlecenter study. Forty restorations were allocated on a random basis by one examiner not involved in the restoration or the evaluation procedures, In each patient, one lesion was allocated to be restored using self-adhering flowable composite [Fusio liquid dentin (FL)] and the other to be restored using conventional flowable composite [Tetric Flow (FF)]. The allocation sequence of the restorations was concealed from the operator in sequentially numbered, opaque, sealed, and stapled envelopes. An operator restored all the preparations in accordance to the manufacturer's instructions. Finishing and polishing of the restorations were done immediately after placement. Evaluation of the restorations was done in accordance to the United States Public Health Services (USPHS), modified Ryge criteria. Statistical analysis was completed with Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Product, Chicago, USA). Results: One case could not be reassessed at 18 months follow-up in both groups. No significant differences were detected between the tested materials from baseline to those of 18 months using the modified USPHS criteria. Conclusion: Self-adhering flowable composite exhibited acceptable clinical performance comparable with the conventional flowable composite in anterior Class V restorations over an 18-month period. Nevertheless, the findings of this study must be validated by a longer clinical study. Clinical significance: Self-adhering flowable composite exhibited clinical performance comparable with the conventional flowable composite in Class V restoration.



Ramacham P Shanoj, P Abdul Razak, K Nanda Kumar, John Francis, Kavya Ashok, Kattakath KMM Sameer

Comparative Evaluation of the Strength of Denture Base Resin repaired with Glass Fiber-reinforced Acrylic Resin: An in vitro Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:792 - 798]

Keywords: Acrylic resin, Denture base, Glass fiber reinforcement, Repair, Varying gap width

   DOI: 10.5005/jp-journals-10024-2338  |  Open Access |  How to cite  | 


Aim: The present study aimed at evaluating and comparing the transverse strength of heat polymerizing acrylic resin samples repaired using glass fiber-reinforced autopolymerizing acrylic resin with varying gap widths at the fracture site. Materials and methods: Heat polymerizing acrylic resin samples of dimensions 65 × 10 × 2.5 mm each were fabricated. Ten of these were used as control. In the rest of samples, two grooves were fabricated and surface treated with ethyl acetate. The repair gap width was standardized at 4, 3, 2, and 1 mm. Totally, 80 samples were equally divided into these four groups. Glass fiber-reinforced autopolymerizing acrylic resin was used to repair these samples. The repaired samples and the control groups were subjected to three-point bending test, and the findings were analyzed statistically. Results: It was observed that with increase in gap width, their transverse strength decreased. Most of the fractures occurred at the joint interface of parent and repair material. The fracture within the repaired material occurred highest in the group that had 4 mm gap, followed by groups that had 3 and 2 mm gaps. In the group with 1 mm gap, there was no occurrence of fracture within the repaired material. Conclusion: To achieve optimum repair strength of a repaired denture, the gap width should not be greater than 1 mm. Clinical significance: The study will aid in determining the ideal gap width for denture repair to prevent fracture and also the clinical application of glass fiber-reinforced autopolymerizing acrylic resin.



Mohamed Bamashmous

Determinants of Support for a Smoke-free University Policy

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:9] [Pages No:799 - 807]

Keywords: Second-hand smoke exposure, Smoke-free policy, Tobacco control, Universities

   DOI: 10.5005/jp-journals-10024-2339  |  Open Access |  How to cite  | 


Introduction: Health care professionals have an essential role in tobacco control through supporting tobacco control policy actions by promoting smoke-free workplaces and extending tobacco cessation programs. Objective: To assess determinants of support for a smoke-free university policy among dental students. Materials and methods: A cross-sectional study of dental students was carried out. Multiple linear regression analyses assessed the determinants of support for a smoke-free policy at the university. Results: A total of 313 students completed the questionnaires. The multivariate model showed a direct relationship of support for a smoke-free university policy with being a nonsmoker [β = 1.95, 95% confidence interval (CI) = 1.37–2.52, p < 0.0001] and having greater knowledge of smoking health hazards (β = 0.26, 95% CI = 0.20–0.30, p < 0.0001). We detected an inverse relationship with being a man (β = –0.49, 95% CI = –2.73 to –0.58, p = 0.03) and with increased willingness to accept second-hand smoke (SHS) exposure score (β = –0.02, 95% CI = –0.04 to –0.01, p < 0.0001). Conclusion: This study found that a policy banning smoking would have support from those students who have knowledge of smoking health hazards and those unwilling to accept exposure to SHS.



Carla Zogheib, Sfeir Germain, Kohli Meetu, Khalil Issam, Naaman Alfred

Impact of the Root Canal Taper on the Apical Adaptability of Sealers used in a Single-cone Technique: A Micro-computed Tomography Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:8] [Pages No:808 - 815]

Keywords: Bioceramics, Micro-computed tomography, Sealer, Taper, Voids

   DOI: 10.5005/jp-journals-10024-2340  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to assess the influence of root canal taper on the apical adaptability of three root canal sealers used in a single-cone technique by measuring void's volume. Materials and methods: Thirty-six maxillary premolar root canals were divided into two groups. Eighteen root canals were shaped with iRace/FKG 0.3 to 0.04 instrument and 18 with 0.3 to 0.06 iRace/FKG instrument. Roots were then scanned using micro-computed tomography (CT). Each group was divided into three subgroups, containing six samples each, filled respectively, with AHPlus® (AH), TotalFill® (TF), and a novel bioceramic (NB) sealers. The roots were rescanned using micro-CT in order to superimpose the two scans and calculate the voids volume in the apical third. Statistical analyses were done using analysis of variance (ANOVA) test with a level of significance (p < 0.05). AH4 is for the 4% tapered root canals that are filled with AH sealer. TF4 is for the 4% tapered root canals that are filled with TF. NB4 is for the 4% tapered root canals that are filled with the NB sealer. AH6 is for the 6% tapered root canals that are filled with AH. TF6 is for the 6% tapered root canals that are filled with TF. NB6 is for the 6% tapered root canals that are filled with the NB sealer. Results: Regarding void's volume measurements, all groups filled with AH and TF sealers showed similar results for both tapers with no statistical differences (p > 0.05); 4% AH: 0.0354 ± 0.0354; 4% TF: 0.0370 ± 0.0245; 6% AH: 0.0447 ± 0.0348; 6% TF: 0.0588 ± 0.0150 (p > 0.05), whereas 6% tapered preparations showed significantly less voids compared with 4%, specifically for the NB sealer tested. 4%: 0.123 ± 0.130; 6%: 0.068 ± 0.035 (p < 0.05). Conclusion: Bioceramic (BC) sealers showed good all-round performance demonstrating good adaptability, and reduced voids while maintaining similar characteristics when compared with conventional resin sealer. Clinical significance: The conservative preparations in AH4 and TF4 did not induce less voids compared with more enlarged tapers (6%) in AH6 and TF4 groups.



Elie E Daou, Pascale Salameh, Nadin Al-Haj Husain

Comparison of Adhesion of a Novel Pre-sintered Cobalt-Chromium to Pre-sintered Zirconia and Cast Nickel–Chromium

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:8] [Pages No:816 - 823]

Keywords: Computer-aided design/computer-aided manufacturing, Pre-sintered cobalt-chromium, Shear bond

   DOI: 10.5005/jp-journals-10024-2341  |  Open Access |  How to cite  | 


Aim: This study compared the bond strength of pre-sintered Ceramill Sintron to pre-sintered zirconia and cast nickel–chromium (NiCr). Materials and methods: Specimens (n = 60) (diameter: 15 mm; thickness: 2 mm) were prepared (n = 20/group) (Ceramill Sintron, Ceramill Zi, and Wirobond 99). Disks were layered with vita VM ceramic (4 mm). Specimens were randomly divided into two subgroups. Only one subgroup was thermocycled. Specimens were tested under shear strength. Energy-dispersive X-ray (EDX) mapping was done on one disk of each material before and after ceramic layering. Results: Failure types were mostly mixed failures. Significant difference was found between the three materials for Y and Z failure types (p-values: 0.032 and 0.010 respectively). Thermocycling had no major effect on the results reported. Considering Fmax (force-inducing bonding failure) registered, significant difference was found between the control group and milled alloys groups. No significant difference was found between Ceramill Sintron and Zi. The EDX mapping showed a net increase in the control group oxide layer, whereas only slight increase and decrease were reported for Zi and Sintron respectively. Conclusion: When compared with cast NiCr, novel Ceramill Sintron has higher bond strength, comparable to Ceramill Zi. Thermocycling had no major effects on the results. Clinical significance: Ceramic–alloy bonding is a primary factor in the prosthesis’ longevity.



Fawaz Siddiqui, Kalepu Vamsi

Antimicrobial Effect of an Experimental Glass Ionomer Cement against Pathogens associated with Deep Carious Lesions

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:824 - 829]

Keywords: Actinomyces viscosus, Antibacterial, Chlorhexidine, Glass ionomer cement, Lactobacillus casei

   DOI: 10.5005/jp-journals-10024-2342  |  Open Access |  How to cite  | 


Aim: To study the antimicrobial effect of chlorhexidine diacetate (CHX-D)-modified type II glass ionomer cement (GIC) against the two predominant deep caries microorganisms, namely Lactobacillus casei and Actinomyces viscosus. Materials and methods: An experimental GIC (ex-GIC) was prepared by mixing CHX-D powder with the powder of type II GIC to obtain 1% (w/w) concentration of CHX-D in the GIC. Antibacterial activity of this ex-GIC was tested against L. casei and A. viscosus using the agar diffusion method. The ex-GIC specimens were tested in their unset and set forms for each bacterium. For the unset group, specimens were placed in each agar plate immediately after manipulation and for the set group, specimens were placed in each agar plate, 1 hour after manipulation. The inhibition zones on the agar plate were recorded in millimeters immediately on placement of the specimen in the agar plate and after 48 hours. The reading was recorded and statistically analyzed for significant difference. Results: Mann–Whitney U test showed statistically significant difference in the inhibition zones produced by ex-GIC against L. casei and A. viscosus when both were compared in unset (p-value = 0.002) and set (p-value = 0.031) groups. For both the groups, the zone of inhibition against L. casei was greater. Though the unset group recorded wider zone of inhibition, the difference was not significant when compared with the respective set group. This was true for both the bacterial groups. Conclusion: The 1% CHX-D-modified type II GIC showed antibacterial property against L. casei and A. viscosus and significantly higher activity against L. casei. Clinical significance: Addition of 1% CHX-D to type II GIC showed evidence of antibacterial activity against organisms found in deep carious lesion and therefore may exhibit superior antimicrobial efficiency when used as an intermediate therapeutic restoration in deep cavities.



Waeil Batwa, Ibtesam Alzain

Association between Ectopic Mandibular and Maxillary Canines

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:830 - 835]

Keywords: Ectopic, Mandibular canines, Maxillary canine

   DOI: 10.5005/jp-journals-10024-2343  |  Open Access |  How to cite  | 


Aim: The aims of the present study were (1) to assess the prevalence of ectopic mandibular canines and (2) to evaluate whether an association exists between maxillary and mandibular canine ectopia. Materials and methods: The records of 983 patients (males and females) were divided systematically into two groups: group I (454 patients) (control group) included patients who attended the clinic from September 2013 to August 2014, while group II (529 patients) included patients who attended the clinic from September 2014 to August 2015. Group I was used to assess the prevalence of ectopic mandibular canines in the population, while group II was used to obtain 40 radiographs of ectopic maxillary canines, which comprised group II1. To investigate any association between maxillary and mandibular canines, the prevalence of ectopic mandibular canines was assessed in group II1. Canine positions were assessed as follows: (1) amount of horizontal canine overlap with the adjacent lateral incisor root; (2) the angle between the canine and true vertical. Results: The prevalence of ectopic mandibular canines in the population (group I) was 5.3% (24 of 454 patients); in group II1, 22.5% (9 of 40) of maxillary canine cases exhibited ectopic mandibular canines. Group II1 had a significantly higher prevalence of ectopic mandibular canines than did the control group (group I) (p < 0.001). Results: The prevalence of ectopic mandibular canines in the population (group I) was 5.3% (24 of 454 patients); in group II1, 22.5% (9 of 40) of maxillary canine cases exhibited ectopic mandibular canines. Group II1 had a significantly higher prevalence of ectopic mandibular canines than did the control group (group I) (p < 0.001). Clinical significance: Dentists should be aware of all dental anomalies, particularly, impacted canines. Early and interceptive management of impacted canines increases the chance of canine eruption.



Hassan Mohajerani, Mohammad Esmaeelinejad, Mehrshad Jafari, Ehsan Amini, Somayeh P Sharabiany

Comparison of Envelope and Modified Triangular Flaps on Incidence of Dry Socket after Surgical Removal of Impacted Mandibular Third Molars: A Double-blind, Split-mouth Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:836 - 841]

Keywords: Dry socket, Mandible, Third molar, Wound healing

   DOI: 10.5005/jp-journals-10024-2344  |  Open Access |  How to cite  | 


Aim: This study aimed to investigate the impact of modified triangular flap (MTF) compared with the envelope flap (EF) on the incidence of dry socket and healing degree after lowerimpacted third molar surgery. Materials and methods: Present research was executed on 31 patients between the ages 17 and 24 years with the indication of removing impacted mandibular third molars in both sides with similar difficulty. The impacts of MTF and EF on degree of incidence of dry socket and healing on 3rd day and 1 week after surgery were recorded and investigated in a doubleblinded manner. The significant changes in mentioned indices in two groups were statistically judged using Chi-squared and Wilcoxon's statistical tests. Results: Three patients were excluded during the survey and 28 patients (56 samples) remained. The patients’ average age was 20.1 years. Totally, 19 patients were female and 11 of them had academic education. Degree of dry socket incidence in MTF group was 11.76% and it was 41.17% in EF group (p = 0.042). In the follow-up session after 3 days since the surgery, healing degree mean in MTF group was 3.16 ± 1.5 and it was 4.37 ± 1.8 in EF group (p = 0.112). In follow-up session 7 days after the surgery, mean healing degree in MTF group was 0.037 ± 0.6 and it was 0.89 ± 0.73 in EF group (p = 0.005). Conclusion: Present study indicated that application of MTF may lead to a reduction in dry socket incidence and an increase of healing after 7 days since lower-impacted third molar surgeries. Clinical significance: Reducing postsurgery complication incidences following third molar surgery is an important issue, which could easily be achieved by designing appropriate flaps.



V Deepa, Karishma Mujawar, Komal Dhillon, Premraj Jadhav, Indrani Das, Youginder K Singla

Prognostic Implication of Selective Serotonin Reuptake Inhibitors in Osseointegration of Dental Implants: A 5-year Retrospective Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:5] [Pages No:842 - 846]

Keywords: Dental implants, Selective serotonin reuptake inhibitors, Smokers

   DOI: 10.5005/jp-journals-10024-2345  |  Open Access |  How to cite  | 


Aim: Dental implants are the preferred treatment modality in the present edentulous era. Selective serotonin reuptake inhibitors (SSRIs) have detrimental effect on bone density. The present study was conducted to determine the effect of SSRIs on the success rate of dental implants. Materials and methods: The present study was conducted on 352 patients of both genders with 680 dental implants. History of depression and SSRI medication was retrieved. Patients were divided into two groups. Group I (110 patients, 230 dental implants) patients were on SSRI, while group II (242 patients, 450 dental implants) patients were non-SSRI. In all patients, the implant failure rate was recorded. Results: In group I, 35 patients were >50 years, while 75 were <50 years of age. In group II, 60 patients were >50 years, while 182 were <50 years of age. The difference was significant (p < 0.05). Group I had 45 males and 65 females, while group II comprised of 105 males and 137 females. Group I showed 25 implant failures and group II had 21 implant failures. Age group >50 years showed 12 implant failures while <50 years had 13 in group I compared with 10 in patients >50 years and 11 in patients with <50 years of age; 56% smokers had implant in group I as compared with 60% failure in group II. In group I, 27% diabetic patients had failures as compared with 13.4% in group II. The difference was significant (p < 0.05). Group I showed maximum failures in terms of loosening of screw (8) followed by fracture of implant (7), peri-implantitis (6), and fracture of screw (4), whereas in group II, 7 cases were of loosening of screw, 6 cases were of fracture of screw, 5 cases of fracture of implant, and 3 cases of peri-implantitis. The difference was nonsignificant (p > 0.05). Conclusion: Selective serotonin reuptake inhibitors cause increased osteoclastic activity, leading to bone loss and implants placed in patients with history of depression are more prone to failures. Clinical significance: Failure rates of dental implants are significantly increased in patients taking SSRIs due to depression. Careful case analysis and history of depression may minimize the failure rates.



Pritesh Jagtap, Arpita Agarwalla, Parag Wani, Karan Bhargava, Santosh Martande

Comparative Evaluation of Cytotoxicity of Root Canal Sealers on Cultured Human Periodontal Fibroblasts: In vitro Study

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:6] [Pages No:847 - 852]

Keywords: 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, Cytotoxic, Periodontal ligament fibroblasts, Root canal sealer

   DOI: 10.5005/jp-journals-10024-2346  |  Open Access |  How to cite  | 


Aim: To evaluate and compare the cytotoxic effects of different types of root canal. Materials and methods: The sealers were eluted with culture medium for 1 hour, 7 days, and 14 days. Cell viability was estimated by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and trypan blue exclusion method on human periodontal ligament (PDL) fibroblast cells. Sealers used are mineral trioxide aggregate (MTA)-based sealer (MTA Fillapex, Angelus), calcium hydroxide-based sealer (Apexit Plus, Ivoclar Vivadent), resin-based sealer (AH Plus, Dentsply), and zinc oxide eugenol-based sealer (Tubli Seal, SybronEndo). Results: The order of cytotoxicity through MTT assay, at the end of the second week, was observed as MTA Fillapex> Tubli Seal> Apexit Plus > AH Plus. The percentage cell viability obtained after trypan blue exclusion method decreased in the order of Apexit Plus> Tubli Seal> AH Plus> MTA Fillapex, which was similar to the reported cytotoxicity from the MTT assay after 1 hour. Conclusion: Each type of sealer showed moderate-to-severe cytotoxic response when compared with the control. The MTA Fillapex was found to be the most cytotoxic sealer. Use of resin-based material as a root canal sealer may result in a more favorable response to PDL fibroblasts. Clinical significance: Having knowledge of the cytotoxicity of various sealers will help in increasing patient's comfort.



Zeina Majzoub, Jihad Dagher, Charles Sfeir, Ahmad Abdallah

Sterilization and Biologic Monitoring in Private Dental Clinics in Lebanon

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:9] [Pages No:853 - 861]

Keywords: Biologic indicator, Dentists, Lebanon, Private dental clinic, Sterilization

   DOI: 10.5005/jp-journals-10024-2347  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to evaluate sterilization practices and effectiveness in the Lebanese private dental sector and identify potential factors contributing to sterilization failure. Materials and methods: A 13-item questionnaire consisting of four demographic/professional questions and nine questions related to sterilization practices along with self-contained biologic indicators (SCBIs) were delivered to a representative sample of Lebanese private offices. Univariate statistics and bivariate analyses were performed to compare sterilization failure rates according to demographic, professional, and sterilization-related conditions. Results: Out of the 560 dentists contacted, 205 dentists returned the completed questionnaires and undamaged processed SCBIs. The tested autoclaves (n = 134) were mostly dynamic air removal (69.4%) and had a mean age of 10.5 ± 6.9 years. The dry heat ovens (n = 71) were all static air and had 12.9 ± 8.1 years. The dental assistants performed the routine sterilization procedures in nearly 62% of the practices and sterilization cycles were run 4 to 6 times per week in 75% of the offices. Correct temperature/time ratios were applied in 97% of the autoclaves and 80.3% of the ovens. Few dental practices reported having preventive maintenance (17.9% for the autoclaves and 14.1% for the ovens). Routine monitoring of sterilizer efficacy was infrequently performed and was mostly conducted using physical indicators. Sterilization failure rate was higher for the ovens (16.9%) than for the autoclaves (7.5%). Incorrect temperature/time ratio was the main significant factor associated with sterilization failures. Conclusion: The present study demonstrated a relatively high rate of sterilization failures in the Lebanese private dental sector and identified the human error in setting sterilization cycle parameters as the predominant cause of failure. These findings should prompt actions toward increasing knowledge of the sterilization processes and their monitoring among dental professionals and improving the quality control of sterilization through collaborative efforts among health authorities, dental schools, and associations. Clinical significance: This study presents the first published data relative to sterilization practices and effectiveness in private Lebanese dental offices and provides a rationale to implement biologic monitoring protocols in Lebanon as long practiced in developed countries.



Jaideep Singh, Ashesh Gautam, Ashish Joshi, Thomas Manjooran, Swetha Raghav, Jaladhi H Patel

An in vitro Evaluation of Shear Bond Strength of Orthodontic Brackets after Mouth Rinse

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:5] [Pages No:862 - 866]

Keywords: Alcohol-based, Brackets, Chlorhexidine, Herbal rinse, Mouth rinse, Orthodontic, Shear bond strength

   DOI: 10.5005/jp-journals-10024-2348  |  Open Access |  How to cite  | 


Aims: The aim of the study was to evaluate the shear bond strength (SBS) of orthodontic brackets after mouth rinsing. Materials and methods: Sixty orthodontically extracted maxillary premolar teeth were used in the present study. Buccal surfaces of all the teeth were bonded with orthodontic bracket. Later, each tooth was embedded into acrylic resin and stored in distilled water. All the teeth were randomly divided into four groups (group I: Artificial saliva, group II: Alcohol mouth rinse— Listerine, group III: Chlorhexidine (CHX) mouth rinse—Hexidine, and group IV: Herbal mouth rinse—Befresh) and stored in each solution for 12 hours. Later, each tooth was subjected to SBS testing using universal testing machine. Brackets and enamel surfaces were examined under a stereomicroscope at 10× magnification for modified adhesive remnant index (ARI). The data were statistically evaluated using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 20.0 (IBM Corp., Armonk, New York, USA) and using one-way analysis of variance (ANOVA) and Chi-square test with significance of p < 0.05. Results: Highest mean SBS was observed in artificial saliva control group (14.27 ± 0.52 MPa), followed by herbal Befresh group (11.14 ± 0.72 MPa) and CHX, and least was found in alcohol-Listerine group of 8.48 ± 0.52 MPa (p < 0.001). The ARI score showed highest bond failure for group I (ARI 14) compared to group II (ARI 11) (p < 0.001). Conclusion: Alcohol-containing mouth rinses should be avoided in patients during fixed orthodontic treatment because it affects the bond strength. Clinical significance: Shear bond strength is affected with the use of alcohol-based mouth rinse compared with herbal or CHX mouth rinses.



Fawaz Alqahtani, Hosain M Almansour

The Effect of in vitro Aging and Fatigue on the Flexural Strength of Monolithic High-translucency Zirconia Restorations

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:867 - 873]

Keywords: Accelerated artificial aging, Biaxial flexural strength, Fatigue, Monolithic high-translucency zirconia

   DOI: 10.5005/jp-journals-10024-2349  |  Open Access |  How to cite  | 


Aim: The aim of this in vitro study was to evaluate the effect of accelerated artificial aging (AAA) and fatigue on the biaxial flexural strength (BFS) of three types of monolithic hightranslucency zirconia restorations compared with conventional low-translucency zirconia restorations. Materials and methods: Four groups of 20 disc-shaped specimens (10 × 1.2 mm) were made from the following computeraided design and computer-aided manufacturing (CAD/CAM) zirconia blocks: Low-translucency zirconia (Ceramill ZI-LT) as a control, and three brands of high-translucent zirconia (Lava Plus, Ceramill Zolid White, and Copran Monolithic HT). Ten discs from each group were subjected to the BFS test using the universal testing machine. The other 10 discs from each group were subjected to AAA (thermocycling, 3,500 cycles) and fatigue (250,000 cycles) before the fracture test. The definitive fracture load was recorded, and the BFS was calculated in accordance with International Organization for Standardization (ISO) 6872. The data were analyzed with one-way analysis of variance (ANOVA), Scheffe post hoc, and Mann-Whitney U test. Data analyses were evaluated at a significance level of p ≤ 0.05. Results: Significant differences were detected in the BFS among the four groups before AAA and fatigue. The mean BFS was highest with Ceramill ZI (935.3 ± 47.1 MPa), and least in Ceramill Zolid White (685.7 ± 32.6 MPa). After AAA and fatigue, significant differences were reported where the mean of BFS was highest with Copran Zr-i Monolithic HT (777.5 ± 21.2 MPa), and least in Ceramill Zolid White (576.0 ± 36.3 MPa). Furthermore, Mann–Whitney U test showed that AAA and fatigue significantly affect the BFS of each material individually. Conclusion: The AAA and fatigue significantly affected the BFS of the monolithic high-translucency zirconia restorations. Clinical significance: Although monolithic high-translucency zirconia had significantly lower BFS than conventional zirconia tested in this study, they still have sufficient strength for clinical use.



Suryakanta Narendra, Upendra K Das, Saroj K Tripathy, Nirmal C Sahani

Superoxide Dismutase, Uric Acid, Total Antioxidant Status, and Lipid Peroxidation Assay in Chronic and Aggressive Periodontitis Patients

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:874 - 880]

Keywords: Antioxidants, Blood investigation, Gingival crevicular fluid, Periodontitis, Serum

   DOI: 10.5005/jp-journals-10024-2350  |  Open Access |  How to cite  | 


Aim: It has been suggested that periodontitis may be associated with increased oxidative stress. The objective of this study is to evaluate the possible differences in antioxidant status between chronic periodontitis (CP) and aggressive periodontitis (AP), by assessing the concentrations of antioxidants with total antioxidant status (TAS) and lipid peroxidation status in serum and gingival crevicular fluid (GCF) of these patients. Materials and methods: Forty-six patients with CP, 32 patients with AP, and 50 healthy controls were included in this study. The level of enzymatic antioxidant, superoxide dismutase (SOD), nonenzymatic antioxidant uric acid, and TAS with lipid peroxidation measured in serum and GCF of patients suffering from CP and AP were compared with the healthy controls. Results: The TAS is decreased and malondialdehyde (MDA) level is increased in both serum and GCF in CP and AP compared with healthy controls (p < 0.001). Superoxide dismutase activities in GCF and serum are found to be low in both the groups of periodontitis (p < 0.001). The uric acid levels are found to be inconsistent in GCF and serum in both the groups of periodontitis. Conclusion: Lipid peroxidation and TAS were affected at systemic level in serum and in GCF of the periodontal pockets, in CP and AP. Similar comments may be made for the decrease in SOD activities and inconsistent uric acid levels. Clinical significance: Increased oxidative stress may have a role in the pathogenesis of periodontal disease activity.



Orlando Motohiro Tanaka, Joana EG Yépez, Renata M Marangon, Armando Y Saga, Key F de Lima

Miniscrew Composition, Transmucosal Profile, and Cortical Bone Thickness: A Three-dimensional Finite-element Analysis of Stress Fields

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:881 - 887]

Keywords: Dental implants, Finite-element method, Orthodontic anchorage procedures

   DOI: 10.5005/jp-journals-10024-2351  |  Open Access |  How to cite  | 


Aim: The aim of this study was to use the finite-element method (FEM) to analyze the stress fields generated in miniscrews (MSs) and surrounding bone on applying a force perpendicular to the MS according to variations in the cortical bone thickness and changes in the transmucosal profile length and MS composition. Materials and methods: Miniscrews with stainless steel (SS) and titanium alloy mechanical properties with a 1 to 2 mm transmucosal profile inserted in bone blocks with cortical bone of varying thickness (1 and 2 mm) were three-dimensionally modeled using computer-aided design (CAD) and examined using FEM. A 3.5 N force perpendicular to the long axis of the MS was applied in the four mechanical tests: EM1: SS MS and a 1 mm transmucosal profile; EM2: titanium MS and a 1 mm transmucosal profile; EM3: SS MS and a 2 mm transmucosal profile; and EM4: titanium MS and a 2 mm transmucosal profile. Results: The stress distributions in all mechanical tests were highest at the MS, especially at the MS–cortical bone interface. A greater stress concentration occurred in cortical bone measuring 1 mm thick than in the cortical bone measuring 2 mm thick. The MSs with a 2 mm transmucosal profile showed higher stress than those with a 1 mm transmucosal profile. Conclusion: The titanium alloy MSs showed higher stress fields and deflection voltages than the SS MSs at the same cortical bone thickness and with the same transmucosal profile. Clinical significance: From a mechanical perspective, this study showed the stress field generated in MSs with SS and titanium alloy (Ti) mechanical properties and surrounding bone. The stress distribution was concentrated at the MS, mainly at the interface with the cortical bone, and the difference between the stress values for the Ti and SS MSs was very small. Under this condition, the two types of MSs are suitable for orthodontic applications because their yield limits are much higher.



Juan FD Montero, Humberto CM de Souza, Mariana S Martins, Miguel N Oliveira, César AM Benfatti, Ricardo de Souza Magini

Versatility and Importance of Bichat's Fat Pad in Dentistry: Case Reports of Its Use in Occlusal Trauma

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:7] [Pages No:888 - 894]

Keywords: Adipose tissue, Bichat's fat pad, Oral lesions

   DOI: 10.5005/jp-journals-10024-2352  |  Open Access |  How to cite  | 


Introduction: The knowledge of the anatomy surrounding Bichat's fat pad, as well as its clinical applications, is essential to indicate and to safely perform its removal. This surgery is indicated not only for esthetic purposes, but also for functional reasons. When used properly, Bichat's fat pad is composed of stem cells that have a similar phenotype to adipose stem cells, useful in the treatment of pathologies and/or complications, such as maxillary sinus membrane perforation, oroantral/oronasal communications, peri-implantitis, ulcers, fibrosis of the oral mucosa, soft tissue reconstruction, among others. Due to its location, it is prone to suffer clinically significant pathologies, as well as constant trauma. Aim: The aim of this study is to report two clinical cases and subsequent follow-ups, where bichectomy was performed to avoid dental trauma to mucosal tissues during the masticatory function. Also, literature review on the application of Bichat's fat pad in dentistry is provided. Case report: Two female patients (20 and 24 years) reported discomfort and constant pain in the oral mucosa caused by dental trauma. At the clinical examination, patient presented augmented and injured mucosa. The surgical sequence of Bichat's fat pad removal, as well as the extra-/intraoral photographic follow-up (8, 15, 30, and 180 days) of the patients is described. Conclusion: In order to indicate and/or accomplish surgical procedures involving Bichat's fat pad, it is fundamental to know its anatomy and possible applications, not only for esthetic purposes, but also for functional purposes. The patients showed evident improvements following the removal of Bichat's fat pad. Clinical significance: Application of Bichat's fat and its removal should be evaluated, being an alternative in patients who constantly undergo mucosal injury during masticatory function.



Wael Ibraheem

Effect of Platelet-rich Fibrin and Free Gingival Graft in the Treatment of Soft Tissue Defect preceding Implant Placement

[Year:2018] [Month:] [Volume:19] [Number:7] [Pages:5] [Pages No:895 - 899]

Keywords: Bone graft, Dental implants, Free gingival graft, Keratinized tissue, Platelet-rich fibrin

   DOI: 10.5005/jp-journals-10024-2353  |  Open Access |  How to cite  | 


Introduction: Free gingival graft is a procedure that is used to increase keratinized tissue around teeth and edentulous sites for future dental implants. Keratinized tissue is critical for maintainability of surgical site and flap management. Platelet-rich fibrin consists of bioactive and biological components, mainly composed of growth factors. Growth factors attract stem cells to the site of release and stimulate cell proliferation. Moreover, growth factors promote angiogenesis, which accelerates wound healing. Site preparation is critical in implant dentistry, including soft tissue and hard tissue augmentation. Aim: To improve free gingival graft (FGG) healing by using platelet-rich fibrin (PRF) at the soft tissue defect area of extracted upper right first molar in order to restore keratinized tissue and prepare the site for bone grafting followed by dental implant placement. Case report: A healthy female patient, 59 years old, presented to the dental clinic at the University at Buffalo, School of Dental Medicine, seeking dental implants to restore missing teeth. The patient had an extraction for upper right first molar 4 months ago. The surgical extraction left severe soft and hard tissue defects at the site. Free gingival graft was placed at the site to increase keratinized tissue band followed by PRF to improve healing. Cyanoacrylate adhesive was used to stabilize PRF. Two months later, a full-thickness flap was reflected, and tenting screws placed with bone grafting at the site. Titanium-reenforced membrane was placed over the bone graft. Three months later, tenting screws were removed and two dental implants were placed at the site. Conclusion: The use of PRF accelerates the healing of FGG. More tissue handling could be achieved by increasing the keratinized tissue during surgical procedures. Clinical significance: The combination of PRF and FGG could help in the healing process during soft tissue procedures.


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