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2019 | February | Volume 20 | Issue 2

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Plagiarism, P-hacking, and Predatory Journals: Toxic Triple Ps of Scientific Publications

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:2] [Pages No:129 - 130]

Keywords: Ethics, P-hacking, Plagiarism, Predatory journals, Publications, Research

   DOI: 10.5005/jcdp-20-2-129  |  Open Access |  How to cite  | 



An In Vivo Study: Location and Instrumentation of the Second Mesiobuccal Canal of the Maxillary Second Molar

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:131 - 135]

Keywords: Endodontic anatomy, Maxillary second molars, Second mesiobuccal canal

   DOI: 10.5005/jp-journals-10024-2487  |  Open Access |  How to cite  | 


Aim: The first purpose of this retrospective observational in vivo study was to determine the incidence of the second mesiobuccal canal (MB2) in maxillary second molars. The second purpose was to propose a modern shaping procedure able to transform a difficult canal, like MB2, into a normal canal. Materials and methods: This study was led from September 2016 to December 2017, for 15 months. It was conducted on fifty-seven successive cases of root canal therapy on maxillary second molars. All procedures were done in conformity with the current state of the art practices in endodontics. These included rigorous clinical and radiographic pre-access analysis, appropriate tooth restoration to ensure watertight rubber dam installation, surgical microscopic manipulations for precision, the systematic use of ultrasonic endodontic tips to manage the access cavity preparation, and a modern step down technique to shape MB2. Results: Fifty-seven maxillary second molars were treated: 3.5% had one canal, 7.0% two canals, 24.6% three canals; 64.9% four canals (MB2 presence). Weine's method was used to classify mesiobuccal root canal morphology: 27.4% had a type I canal configuration, 35.3% type II, 37.2% type III canal configuration. Conclusion: The perfect knowledge of endodontic anatomy, a painstaking pre-access analysis of the preoperative radiographs, the systematic identification of the CEJ, using a periodontal probe, the use of surgical microscope coupled with the use of specific endodontic ultrasonic tips and the use of a modern step-down technique allows a high accuracy of the access cavity preparation, canal localization and instrumentation. Clinical significance: The rate of MB2 localization and instrumentation on maxillary second molars by our surgical protocol is high. The clinician should take the necessary time to locate and negotiate the MB2. The lack of its location can provoke the failure of endodontic treatment.



Afif Tabbara, Dan Grigorescu, Mohammed A Yassin

Evaluation of Apical Dimension, Canal Taper and Maintenance of Root Canal Morphology Using XP-endo Shaper

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:9] [Pages No:136 - 144]

Keywords: Endodontics, Microcomputed tomography, Root canal preparation, Three-dimensional shaping

   DOI: 10.5005/jp-journals-10024-2488  |  Open Access |  How to cite  | 


Aim: To evaluate the shaping ability of the XP-endo shaper file system in maxillary molars, representing root canals with variation in morphology. Materials and methods: Twenty maxillary molars were instrumented according to recommended protocols. Pre- and postoperative microcomputed tomography (CT) scans were performed and the root canals classified according to canal type and curvature. The volume change, number of strokes needed to prepare the canals and the size of the 0.04-tapered gutta-percha cone that was adapted in the canal were recorded. Results: XP-endo shaper created a significant change in volume after instrumentation in all the canals, with the biggest change found in the DB canals, followed by the MB1 and the P canals, both at full length and in the apical 4 mm. The number of strokes needed to achieve working length and final shape did not differ between the various root canals. Although not significant, the number of strokes needed to prepare the root canal increased with severity of the curvature, but the severity of the curvature did not result in increased removal of dentin in the apical 4 mm. It was possible to achieve a final root canal size where a 0.04-tapered gutta-percha cone could be adapted. Conclusion: The XP-endo shaper was a safe and effective instrument to achieve a root canal preparation of at least size 30 and a 0.04 taper. Clinical significance: The clinical performance of XP-endo shaper was to some extent dependent on preoperative volume and curvature of the root canal.



Adrián Calderon, Julio Salas, Giannina Dapello, Eloy Gamboa, José Rosas, Juana Chávez, Fernando Retuerto, Frank Mayta-Tovalino

Assessment of Antibacterial and Antifungal Properties and In Vivo Cytotoxicity of Peruvian Passiflora mollisima

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:145 - 151]

Keywords: Antibacterial activity, Antifungal activity, Cytotoxicity, Passiflora mollisima, Zone of inhibition

   DOI: 10.5005/jp-journals-10024-2489  |  Open Access |  How to cite  | 


Aim: The antimicrobial activity of Passiflora mollissima is largely due to its aliphatic and aromatic hydrocarbons, terpenes, alkaloids, ketones, esters, alcohols, and lactones. The objective of this research was to evaluate the antimicrobial activity of the compounds in the Passiflora mollissima (Tumbo) fruit and leaves included also on cultured strains of the microorganisms Streptococcus mutans, Streptococcus oralis, Streptococcus sanguinis and Candida albicans. Materials and methods: Antimicrobial activity was analyzed by the disk diffusion method and evaluated in terms of their zones of inhibition. The cytotoxic activity of these compounds was determined in a bioassay involving sea urchin eggs (Tetrapygusniger) in which the inhibition percentage of artificially fertilized ovules was equivalent to their cytotoxic activity after 26 hours. Results: This study demonstrated the antimicrobial activity of ethanolic Passiflora mollissima extract against the cultured strains of Streptococcus mutans, Streptococcus oralis, and Streptococcus sanguinis with zones of inhibition after the incubation period. Conclusion: There was no evidence of activity against the pathogenic Candida albicans, which demonstrates a null antifungal capacity of the evaluated extracts. However, cytotoxic activity was found, and the compounds led to the complete inhibition of 100% of sea urchin ovules after 26 hours of exposure. Clinical importance: The results of the study serve as a guide. in the industrial use of this natural resource “tumbo” due to the discovery of a potential medicine based on this plant that would be a great development in the field of antimicrobial therapies.



Roshan Uthappa, Gaurav Garg, Asha Reddy, Sreeja Janardhanan

An In Vitro Evaluation of Apical Leakage in Gutta-percha/AH Plus and Resilon/Epiphany-filled Root Canals Using Two Dye Penetration Techniques

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:6] [Pages No:152 - 157]

Keywords: Apical sealing, AH Plus, Clearing technique, Longitudinal splitting, Resilon-epiphany

   DOI: 10.5005/jp-journals-10024-2490  |  Open Access |  How to cite  | 


Aim: Aim of the present study was to evaluate the apical leakage in gutta-percha/AH plus and resilon/epiphany filled root canals using two dye penetration techniques. Materials and methods: Sixty freshly extracted human single-rooted teeth were collected. The crown portion of each tooth was sectioned from the cementoenamel junction using a diamond disk. The canals were instrumented using Step back technique up to a caliber of 40. The roots were randomly divided into four experimental groups of 15 sample units each. All the groups are obturated using lateral compaction technique. Samples were placed in India ink and stored in an incubator for 7 days after which they were thoroughly washed under tap water and dried. The roots were divided into longitudinal splitting technique with diamond disks and using clearing technique was checked for linear dye penetration using stereomicroscope. The surfaces were scanned and surfaces with greatest dye penetration were measured by using De winter Biowizard software system. Results: The mean leakage for groups I, II, III, and IV are 2.31980, 2.68140, 4.11567, and 4.21047 respectively. One-way ANOVA was applied to the mean leakage scores of different groups, found a significant difference between mean leakage scores. F value of 3.266 and it was found to be significant with a p value of 0.028. Significant differences were obtained for mean comparisons of groups I and III, groups I and IV and groups III and IV. Further, between groups I and II, groups II and III, and groups III and IV no significant differences were observed. Conclusion: In conclusion, gutta-percha/AH Plus sealed root canals showed lesser leakage than the Resilon Epiphany groups and there was no significant difference in the two different methodologies used for dye penetration. Clinical significance: Tightly adapted endodontic filling material is one of the goals in successful clinical endodontics and Improvements in the adhesive technology have fostered attempts to reduce apical and coronal leakage by bonding to the root canal walls to obtain a solid monoblock.



Elsayed AM Mohamed, Shakeri M Fathieh, Taqipour A Farzaneh, Barani A Homeira

Effect of Different Irrigation Solutions on the Apical Sealing Ability of Different Single-cone Obturation Systems: An In Vitro Study

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:8] [Pages No:158 - 165]

Keywords: AH Plus, Irrigating solutions, Microleakage, MTA Fillapex, Realseal SE, Single-cone obturation

   DOI: 10.5005/jp-journals-10024-2491  |  Open Access |  How to cite  | 


Aim: The aim of this study was to assess the effect of three root canal irrigants on the apical sealing ability of three single-cone obturation systems. Materials and methods: One hundred maxillary central incisors were selected and their crowns were cut. The roots were divided into three experimental groups of 30 samples each, and one control group of 10 samples (5 positives and 5 negatives). Each experimental group was divided equally into three subgroups according to the obturation system. All root canals were instrumented using ProTaper Universal rotary system and irrigated with 3% sodium hypochlorite (Group 1), 2% chlorohexidine (Group 2), 3% hydrogen peroxide (Group 3). Finally, root canals were irrigated with 17% EDTA followed by distilled water, then obturated with a single-cone technique using gutta-percha/MTA Fillapex (Subgroup A), gutta-percha/ AH Plus (Subgroup B), and Resilon/Relseal SE (Subgroup C). The microleakage was assessed using linear dye penetration method and data were statistically analyzed. Results: Significant differences were found between all groups and subgroups (p < 0.005). When 3% of hydrogen peroxide was used, no leakage was observed with AH Plus sealer, and a high amount of leakage (5.82 ± 0.47 mm) was observed with Realseal SE. MTA Fillapex (0.49 ± 0.08 mm) and Realseal SE (1.11 ± 0.50 mm) showed the lowest amounts of leakage when 2% chlorohexidine and 3% sodium hypochlorite were used, respectively. Conclusion: The type of irrigating solution and obturation system could affect the apical leakage value when single-cone obturation technique was used. AH Plus/gutta-percha obturation system showed no apical leakage when root canals were irrigated with 3% hydrogen peroxide. The using of 2% chlorohexidine improved sealing ability of MTA Fillapex/gutta-percha. The apical sealing ability of Realseal SE/Resilon decreased when 3% hydrogen peroxide or 2% chlorhexidine was used. Clinical significance: Proper selection of irrigating solutions may positively influence the apical sealing ability of single-cone obturation systems.



Abhinay Sorake, Unnikrishnan Jayakrishnan, Ridhima Suneja, Subin Sam, Terrance Abraham, Anjali Jayaraj, Sivasuthan L Govind

Lingual Bracket Systems with Self Etching Primers—An In Vitro Study to Evaluate Shear Bond Strength

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:166 - 172]

Keywords: Self-etching primers, Self-ligating lingual brackets, Shear bond strength, Tooth surface demineralization

   DOI: 10.5005/jp-journals-10024-2492  |  Open Access |  How to cite  | 


Aim: To evaluate the shear bond strength of orthodontic lingual bracket systems bonded to extracted premolar teeth (Reliance self-etching primer, Clearfil Protect Bond) and self-etching primer (Clearfil SE Bond) Materials and methods: A total of 160 extracted human first premolars were selected and divided into four groups of 10 for each bracket system to be used with four different primers. Each sample was then embedded in an acrylic block, till the coronal portion. Instron testing machine model LR LOYD 50 K was used for testing the shear bond strength. Results: The results obtained, suggested that all the primers had clinically acceptable shear bond strength with all the bracket system considered in the study. However, there were statistically significant differences in the shear bond strength in intergroup comparisons. Conclusion: T he R eliance S elf-Etching p rimer s howed t he highest bond strength with Alias lingual bracket system by Ormco, followed by clearfil protect bond, clearfil SE bond, and transbond, with the Alias lingual bracket system in the same order. Clinical significance: This study was initiated to understand the shear bond strength of self-etching primer and its efficacy over the conventional primer, which will be of use to the clinician while selecting the primer for bonding of the bracket systems and overcome debonding of brackets encountered during the treatment progress.



Shaifulizan Ab Rahman, Hazelina Muhammad, Sanjida Haque

Periodic Assessment of Peri-implant Tissue Changes: Imperative for Implant Success

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:6] [Pages No:173 - 178]

Keywords: Implant stability, Osseointegration, Peri-implant, Resonance frequency analysis

   DOI: 10.5005/jp-journals-10024-2493  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate the changes in the peri-implant hard and soft tissues and implant stability and to assess the correlation of bone loss and peri-implant probing depth with implant stability. Materials and methods: Twenty-one patients with implants were included in this study and implants were assessed by resonance frequency analysis (RFA). Bone levels of the implants were assessed by measuring mesial and distal bone levels from the periapical radiograph, and soft tissue was assessed from probing depth using a periodontal probe. Implants were assessed for stability and probing depth at pre-loading, at 3 months and 6 months post-loading. RFA and probing depth were statistically compared from different time points. Correlation of probing depth and marginal bone loss with implant stability was also determined. Results: The average change in implant stability quotient (ISQ) measurements from pre-loading to 6 months post-loading was found to be statistically significant (p <0.005). The average probing depth reduced from 1.767 mm at pre-loading to 1.671 mm at post-loading 3 months, and 1.600 mm at post-loading 6 months. At 6 months of function, radiographic examination yielded 0.786 mm mesial bone loss and 0.8 mm distal bone loss. It was found to be statistically significant (p <0.005) but within an acceptable range. No significant correlation was found between implant stability and bone loss; and implant stability and probing depth. Conclusion: The study revealed an increasing trend in implant stability values with the time that indicates successful osseointegration. Increasing mean values for mesial and distal bone loss were also found. Clinical significance: The success of dental implants is highly dependent on the quality of bone and implant-bone interface, i.e., osseointegration. The most important factors that influence the survival rate of an implant is initial stability. The present study found the changes in the peri-implant hard and soft tissues and implant stability. This article, while being a prospective study, may show the evidence of successful osseointegration by increasing trend in implant stability (RFA) values with time which can help to the clinician in the long-term management of implants.



Asha Reddy, Vineesh Krishnan, CV Renjith Raj, Harikaran Jayakkodi, Sona Joseph

Assessment of Antimicrobial Activity of Different Intracanal Medicaments against Enterococcus faecalis and Candida albicans: An In Vitro Study

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:179 - 183]

Keywords: Candida albicans, Enterococcus faecalis, Intracanal medicaments, Zone of inhibition

   DOI: 10.5005/jp-journals-10024-2494  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to compare the antimicrobial efficacy of various intracanal medicaments against Enterococcus faecalis (E. faecalis) and Candida albicans (C. albicans). Materials and methods: Sixty single rooted, non-carious, permanent mandibular premolars with no developmental defects that were previously extracted for the orthodontic purpose were included in this study. E. faecalis and C. albicans strains were cultured on brain heart infusion (BHI) and sabouraud dextrose (SD) agar plates respectively. Sixty specimens were divided into two main groups and three subgroups with 10 teeth receiving a medicament; group I: E. faecalis (Subgroup Ia: BioPure MTAD, Subgroup Ib: propolis, Subgroup Ic: Triple antibiotic paste), group II: C. albicans (Subgroup IIa: BioPure MTAD, Subgroup IIb: propolis, Subgroup IIc: Triple antibiotic paste). The antimicrobial activity of the intracanal medicaments against E. faecalis and C. albicans were assessed at the end of 2nd and 7th day. The mean zones of inhibition were analyzed with a one-way ANOVA test. Results: After 2 days, the mean zone of inhibition of E. faecalis and C. albicans was maximum for triple antibiotic paste (24.74 ± 0.622 mm, 28.22 ± 0.489 mm), followed by BioPure MTAD (19.58 ± 1.734 mm, 24.75 ± 0.954 mm) and propolis (13.10 ± 0.278 mm, 17.96 ± 0.163 mm). Similarly, the mean zone of inhibition of E. faecalis and C. albicans was maximum for triple antibiotic paste (26.86 ± 0.112 mm, 32.10 ± 0.908 mm), followed by BioPure MTAD (20.13 ± 1.842 mm, 27.22 ± 1.977) and propolis (14.11 ± 0.101 mm, 19.90 ± 0.742 mm) after 7 days. Statistically significant differences (p <0.0001) were found between the groups. Conclusion: Present study concluded that the antimicrobial effectiveness of triple antibiotic paste was significantly more than BioPure MTAD and propolis against E. faecalis and C. albicans at the end of 2nd and 7th day. Clinical significance: An endodontic treatment is considered successful only when the root canals are completely eradicated of microorganisms. As the morphology of the root canals is complex, mechanical instrumentation alone cannot completely debride them. Thus, the role of intracanal medicaments in complementing the mechanical instrumentation becomes important.



Elijah Olufemi Oyetola, Omotoyosi O Awosusi, Ekhosueh T Agho, Mohammed AS Abdullahi, Ibrahim K Suleiman, Sola Egunjobi

Salivary Bacterial Count and its Implications on the Prevalence of Oral Conditions

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:6] [Pages No:184 - 189]

Keywords: Bacterial count, Periodontitis, Saliva

   DOI: 10.5005/jp-journals-10024-2495  |  Open Access |  How to cite  | 


Aim: To determine the relationship between salivary bacterial count and some oral lesions. Materials and methods: This research was designed as a crosssectional study assessing the mean bacterial count in the saliva of Nigerians in Ile-Ife who has no history of medical illness. Subjects were randomly selected from consenting staffs and students of Obafemi Awolowo University, Ile-Ife, Nigeria. Oral examinations were done and their saliva collected using spitting method. The bacterial count was determined in the laboratory by culture the bacteria after which the counting was done using colony counter. Data analysis was done using STATA 13 software. Results: A total of sixty participants were recruited for the study, 41 males and 19 females, their mean age was 23.12+3.8 years. The mean salivary bacteria count among the participants was 8.41 x 108 + 1.06x 109 per mL. The salivary bacterial count is highest among those with poor oral hygiene (1.89 x 109) and also increases with age. Males have a higher bacterial load compared to female. Subjects with periodontitis have the highest bacterial load and are significantly higher in patients with periodontitis in comparison with those who do not have periodontitis p = 0.03 Conclusion: Periodontitis is associated with the significantly higher salivary bacterial load. Male sex and increasing age were also associated with increased bacterial load in saliva. Clinical significance: This study showed another potential role of saliva as a reliable diagnostic tool to monitor the severity of oral infections. It also showed the association between salivary bacterial count and some oral lesions further substantiating the possibility of using saliva to monitor disease progression and treatment responses.



Saee Deshpande, Usha Radke, Tapasya Karemore, Rohit Mohril, Sudhir Rawlani, Pranav Ingole

A Novel Mobile App for Oral Cancer Awareness amongst General Population: Development, Implementation, and Evaluation

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:190 - 196]

Keywords: Mobile app, Oral cancer, Tobacco deaddiction

   DOI: 10.5005/jp-journals-10024-2496  |  Open Access |  How to cite  | 


Aim: To develop a mobile app for education and screening regarding oral cancer in the general population. Materials and methods: A mobile app titled Prayaas-Oral Cancer Prevention, Treatment, and Rehabilitation was designed and developed to be installed on a basic mobile handset with or without internet. It was aimed for the common public, patients as well as healthcare providers. The contents included all information in the pictorial format as well as videos regarding oral cancer awareness, tobacco de-addiction, self-oral examination, various surgeries, and rehabilitation options. It was pilot tested in 50 factory workers of rural set-up. Participants' feedback was recorded using a selfreport questionnaire. Results: Overall feedback was very positive, they found the app easy to operate, enhancing knowledge regarding oral cancer and they recommended this to be used for the general population. Conclusions: Within limitations of this pilot study, it can be inferred that mobile technology can be successfully used to reach out to bottom of the pyramid population residing in inaccessible rural population for creating public health issues such as oral cancer. Clinical significance: Oral cancer is preventable through risk factor intervention especially tobacco de-addiction. The selforal examination can be a very critical factor in early diagnosis of oral cancer. Access to care is a major issue in our country owing to low levels of education, lower income and exposure to risk factors such as tobacco. The fact that today there is widespread use of mobile technology by people belonging to all socioeconomic groups can be harnessed for this public health awareness initiative. This app can be used as a tool for patient education for prevention as well as early detection of oral cancer, both of which can be key to reduce oral cancer morbidity and mortality in India.



S Gayathri, PR Arunima, K Jaya Kumar

Effect of Initial Periodontal Therapy on Serum Nitric Oxide Levels in Chronic Periodontitis Patients with or without Type 2 Diabetes Mellitus

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:197 - 203]

Keywords: Chronic periodontitis, Initial periodontal therapy, Serum NO, T2DM

   DOI: 10.5005/jp-journals-10024-2497  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of initial periodontal therapy on serum NO levels in chronic periodontitis (CP) patients with or without type 2 diabetes mellitus (T2DM) Materials and methods: A total of 90 subjects (group I-30 healthy controls, group I-30 CP and group III-30 CP with T2DM) participated in this study. Groups II and III subjects received initial periodontal therapy. Clinical periodontal parameters (OHI-S, GI, PPD, and CAL) and serum NO levels were evaluated at baseline and 4 weeks after initial periodontal therapy. Serum NO levels were determined by the Spectrophotometric assay based on the Griess colorimetric reaction. Results: Four weeks after initial periodontal therapy both groups II and III exhibited improvement in clinical periodontal parameters (OHI-S, GI, PPD, CAL) and reduction in serum levels of NO from its baseline values (Baseline-Group II: 3.64 ± 0.53, 1.93 ± 0.30, 3.29 ± 0.42, 3.60 ± 0.42, 89.21 ± 1.46 respectively, group III: 3.66 ± 0.44, 2.03 ± 1.32, 3.57 ± 0.40, 3.65 ± 0.45, 85.54 ± 1.54 respectively. Post-treatment-Group II: 1.73 ± 0.42, 1.27 ± 0.23, 3.16 ± 0.46, 3.47 ± 0.58, 70.91 ± 1.68 respectively, group III: 2.39 ± 0.49, 1.71 ± 0.33, 3.44 ± 0.42, 3.61 ± 0.48, 68.69 ± 1.17 respectively). However, statistically significant differences were observed only with OHI-(S) and serum NO values in both groups II and III (p < 0.05). When the baseline values of groups II and III were compared the differences were non-significant except for GI (p < 0.05). However, when the post-treatment clinical periodontal parameters and serum NO level of groups II and III were compared, statistically significant differences (p < 0.05) were observed except for PPD and CAL between the groups. Conclusion: NO can be utilized as a good indicator of the inflammatory status of the periodontium. Initial periodontal therapy is effective in reducing serum levels of NO in CP patients with or without T2DM. Clinical significance: A bidirectional relationship exists between periodontal disease and diabetes mellitus. NO is found to play a significant role in the pathobiology of both CP and T2DM. Initial periodontal therapy seems to be beneficial in reducing serum NO levels along with periodontal parameters in CP patients with or without T2DM. However further studies are warranted to enhance our knowledge about the role of NO in periodontal diseases in the course of diabetes.



André LF Briso, Ticiane C Fagundes, Morganna B de A Souza, Bruna de Oliveira-Reis, Paulo H Dos Santos

Influence of Light-curing Units on Surface Microhardness and Color Change of Composite Resins after Challenge

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:204 - 210]

Keywords: Composite resin, Curing lights, Dental, Photoinitiators

   DOI: 10.5005/jp-journals-10024-2498  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate microhardness and color change (ΔE) of composite resins, light cured with different light emission diodes (LEDs) and submitted to artificial accelerated aging (AAA). Materials and methods: Two composite resins with lucirin- TPO photoinitiator were selected: Tetric N-Ceram (Ivoclar Vivadent, A1) and Vit-l-escence (Ultradent, WO).A resin with the only camphorquinone photoinitiator was chosen as a negative control: Filtek Z350XT (3M ESPE, WD). Disc-shaped specimens were prepared (5 mm diameter; 1.5 mm thick) and photopolymerized with an LED with one wavelength (Radii-Cal, SDI) or multiple wavelengths (Valo, Ultradent), for each composite resin (n = 10). Surface microhardness and color evaluations were performed immediately after specimen preparation and after AAA. Microhardness results were analyzed using Kruskal-Wallis and Mann-Whitney tests for multiple comparisons. To compare the evaluation of microhardness at different times, the Wilcoxon test was used. Mean values of ΔE, ΔL, Δa, and Δb were evaluated using two-way analysis of variance (ANOVA), and Tukey test for multiple comparisons (α = 0.05). Results: Regarding microhardness, a statistically significant difference between the two LEDs was observed for Vit-lescence after AAA. When comparing composite resins that were light-cured with the same device, FiltekZ350XT obtained the greatest microhardness. All groups presented a statistically significant decrease in microhardness from the initial time to the AAA. Regarding ΔE, no statistically significant difference between the two LEDs was observed. When comparing composite resins, FiltekZ350XT showed the highest ΔE values. Conclusion: In general, an LED with multiple wavelengths influenced the microhardness of only one resin containing lucirin-TPO after AAA. The ΔE was more influenced by the composite resin than the LED device. Clinical significance: The knowledge of composite resin with deficiencies in the polymerization mechanism could contribute to preventing restorations to become more susceptible to color change and reduction of the mechanical strength.



Pavan G Kulkarni, Smita Bussari, Manish Sarode, Prabhakar A Jeergal, Anjum Deshmukh, Nasim AK Namazi

Evaluation of Proliferative Marker Ki-67 in Adenoid Cystic Carcinoma: A Retrospective Study

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:211 - 215]

Keywords: Adenoid cystic carcinoma, Ki-67, Immuno-histochemistry

   DOI: 10.5005/jp-journals-10024-2499  |  Open Access |  How to cite  | 


Aim: Adenoid cystic carcinoma (ACC) is a malignant tumor of salivary gland origin. Although the histologic appearance of ACC is low grade, management of this malignancy is a distinct therapeutic challenge because of its tendency for perineural involvement and potential for distant metastasis. Ki-67 antigen is expressed during the G1, S, G2 and M phases in the cell cycle but is absent in the quiescent G0 phase in tissue sections. Aim of the study was to review hematoxylin and eosin stained slides in order to confirm the previous histopathological diagnosis as per the criteria given by World Health Organisation (WHO) and to evaluate the expression of cell proliferation marker, Ki-67 antigen in Adenoid cystic carcinoma and correlate the expression of Ki-67 antigen histopathologically with different grades in Adenoid cystic carcinoma. Materials and methods: Tissue samples of 32 cases (12 males and 20 females) were selected from minor salivary glands with age range from 21 to 70 years. Two paraffin-embedded sections of these total 32 cases each of 4 μm thick were cut on a rotary microtome. One section was stained using hematoxylin and Eosin (H&E) and the other was used for Immunohistochemical staining with Ki-67 antigen. Results: Among these 32 cases of Adenoid cystic carcinoma, Histologically 14 (43.75%) tumors were classified in grade I, 8 (25%) were in grade II, and 10 (31.25%) were in grade III. The average percentage of Ki-67 expression was 27.12% in grade I, 34.43% in grade II and 38.45% in grade III. Conclusion: Ki-67 immunoreactivity increased with increase in histopathological grades of ACC. Clinical significance: Since Ki-67 is a useful marker for assessing the proliferative potential of tumors, the prognosis of patients can definitely be predicted.



Gabriela CD Santos, Juliana CP Baia, Mara ES Ribeiro, Rafael R Lima, Mário H Silva e Sousa Júnior, Sandro C Loretto

Influence of Prolonged Bleaching with 4% Hydrogen Peroxide Containing Calcium and Different Storage Times on the Bond Strength to Enamel

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:216 - 220]

Keywords: Dental Enamel, In vitro, Hydrogen Peroxide, Shear Strength, Tooth Bleaching

   DOI: 10.5005/jp-journals-10024-2500  |  Open Access |  How to cite  | 


Aims: To assess the influence of different bleaching protocols on the bond strength to enamel. Materials and methods: In this laboratory experiment were used forty sound bovine incisors were divided into five groups. G1: No bleaching (control). G2: 14 days bleaching with 4% hydrogen peroxide containing calcium (4% HP+Ca2+) (2 hours/ day) and 24 hours of artificial saliva (AS) storage. G3: 14 days bleaching with 4% HP+Ca2+ (2 hours/day) and 7 days storage in AS. G4: 28 days bleaching with 4% HP+Ca2+(2 hours/day) and 24 hours storage in AS. G5: 28 days bleaching with 4% HP+Ca2+ (2 hours/day) and 7 days storage in AS. Following storage times, composite resin cylinders were built upon the enamel surfaces and tested for micros hearing. For statistical analysis, two-way ANOVA and Tukey's test was applied to the data (p ≤0.05), for it was evaluated different times of bleaching and stored in artificial saliva. Results: The highest mean was observed in G1 (14.61 MPa), and the lowest in G4 (9.22 MPa). Compared to the negative control (G1), no differences were found in 14 days bleaching and the same between G2 and G3 (p ≥0.01). However, in 28 days bleaching, the effects of the storage periods (24 hours and 7 days) were significantly different (p ≤0.05), besides G4 and G5 were statistically different from G1. Conclusions: Extended bleaching time (28 days) decreased the bond strength, independently of storage time in AS. Clinical significance: If adhesive procedures are required after extended at-home bleaching they may need to be delayed for at least for 7 days for the enamel adhesion ability to recover.



Anurag Sarin, Prashant Bhasin, Mohit Sharma, Deepti Bindal, Deepak Tomar

An In Vitro Evaluation of Antimicrobial Effects of Three Different Root Canal Irrigating Solutions against Enterococcus faecalis and Streptococcus mutans

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:221 - 225]

Keywords: Chlorhexidine, Confocal laser scanning microscopy, Irrigating solution, Streptococcus mutans

   DOI: 10.5005/jp-journals-10024-2501  |  Open Access |  How to cite  | 


Aim: The present study was conducted to evaluate and compare antimicrobial effect of 5.25% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) and N-Acetylcysteine (NAC) irrigating solutions against Enterococcus faecalis (E. faecalis) and Streptococcus mutans (S. mutans). Materials and methods: The present study was conducted on 40 freshly extracted noncarious permanent mandibular incisors teeth of both genders (males-12, females-14). In all teeth, root canal preparation was done up to size 40 K-file. Roots were sterilized and microbial suspension of mixed culture of the tested microorganisms was inoculated into canals and incubated for 48 h. Teeth were divided into four groups, group I (5.25% sodium hypochlorite), group II (2% chlorhexidine), group III (200 mg/mL N-Acetylcysteine NAC) and group IV (sterile distilled water). The antimicrobial effect in each group was compared. Results: Statistical evaluation was completed using statistical software Statistical Package for the Social Sciences (SPSS). Planktonic S. mutans bacterial count was lowest in group III followed by group I, group II and group IV. E. faecalis count was 6.14 ± 0.12 in group I, 5.76 ± 0.44 in group II, 3.88 ± 0.08 in group III and 11.98 ± 1.04 in group IV. The difference was significant (p < 0.05). The proportion of dead cell found to be 0.04± 0.01, 0.72 ± 0.06, 0.01 ± 0.06 and 1.02 ± 0.11 in groups I, II, III and IV respectively. The difference was significant (p < 0.05). Conclusion: NAC proved to be effective against E. faecalis and S. mutans. This solution can be considered alternative in root canal infections in addition with CHX and NaOCl. Clinical significance: Effectiveness of three different irrigating solutions was compared and NAC found to be more efficient in decreasing bacterial count. Hence, NAC can be precisely used in irrigating root canals to achieve optimal clinical outcomes particularly regarding reoccurrences of infections. Furthermore, NAC could be proved as a promising innovation in future endodontic methodologies.



MV Sumanthini, Vanitha U Shenoy, Rohini P Mahajan, Pranjal S Walzade, Harsha P Mahajan, Rajan Mangrolia

Comparative Evaluation of the Discoloration of Microhybrid and Nanohybrid Composite Resins by Different Beverages: A Spectrophotometric Analysis

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:226 - 230]

Keywords: Discoloration, Microhybrid, and nanohybrid composite resins, Spectrophotometer, Test solutions

   DOI: 10.5005/jp-journals-10024-2502  |  Open Access |  How to cite  | 


Background: Composite resins are choice of restorations due to their lifelike characteristics. Recently “microhybrid “and “nanohybrid” composites have been introduced. Microhybrids and Nanocomposites have a small particle size and possess better qualities as compared to traditional composite resins. The intake of beverages like black tea, coffee green tea has increased in the community. The beverages cause discoloration with time on the composite restorations making it aesthetically unacceptable. Aim: Aim is to evaluate discoloration of microhybrid and nanohybrid composite resins by black tea, black coffee, green tea and distilled water at 0, 3, 6, 9, and 12 days. Methodology: 160 samples were fabricated in molds from two nanohybrid composite and two microhybrid composites. They were light cured and allocated into four groups were stored in an incubator throughout the experiment at 37° C. Initial baseline color was recorded by a spectrophotometer. These samples were immersed in vials containing black tea, black coffee, green tea and distilled water for three, six, nine, 12 days. Color analysis was done at each interval. Statistical analysis: Data was tabulated and the readings after immersion and baseline were compared between four composite resins. Data were analyzed using the appropriate test by testing normality. A p value <0.05 was considered to be significant. Results: Significant discoloration was observed in all four composite resins. Discoloration increased from the third day to 12th day. Maximum discoloration was observed on the 12th day. Conclusion: The order of discoloration in the beverages was: Flash > Tetric n ceram > matrix > tetricceram. The order of discoloration caused by test solutions on composite resin was: Black coffee>black tea>green tea > distilled water.



Mosa A Shubayr, Leah R Alexander, Mohammed A Tabatabai, Dania E Alagili

Knowledge, Attitude and Practice of Oral Health Promotion among Oral Health Providers in Kingdom of Saudi Arabia

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:8] [Pages No:231 - 238]

Keywords: Attitude, Knowledge, Oral health promotion, Oral health providers, Practice

   DOI: 10.5005/jp-journals-10024-2503  |  Open Access |  How to cite  | 


Aim: This study was to establish a baseline level of knowledge, attitude, and practice (KAP) of oral health promotion (OHP) among oral health providers in Kingdom of Saudi Arabia. The study also described and evaluated the factors that facilitate or limit the practice of OHP and examined the relationship between the level of knowledge and attitude that practitioners have of OHP and their OHP practice. Materials and methods: A cross-sectional questionnaire included demographic questions and questions on the KAP of oral health promotion. Out of 365 questionnaires that were disseminated, 106 questionnaires were fully completed. Crosstabulation was conducted to establish factors associated with KAP scores. Logistic regression analysis was conducted to determine the factors that were associated with the practice of OHP. Results: The baseline level of oral health providers' knowledge and attitude toward OHP was fair. Only a few providers have integrated OHP into their practice. Age of participants was significantly associated with knowledge of OHP among the providers. Also, there was a significant difference in mean attitude scores toward OHP by education level. The practice of OHP was significantly related to education level and facility type. Conclusion: Further research focusing on different cities or geographical regions in the KSA is needed to validate this finding. Also, the finding supports the need for continuous training in OHP to ensure that health providers understand and apply OHP practices in their work. Clinical significance: Due to the scarcity of data that measure OHP among oral health providers in the KSA, proper education and training programs by governmental authorities are difficult to implement. This study will provide baseline measures for future investigations for academicians and practitioners, alike.



Saurabh Chaturvedi, Adel M Abdelmonem, Satheesh Haralur, Ghazala Suleman, Muhammad I Majeed, Mohammed A Alfarsi

An In Vivo Study to Compare Location of Neutral Zone Recorded with Two Materials

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:8] [Pages No:239 - 246]

Keywords: Low fusing impression compound, Neutral zone, Resorbed ridge, Tissue conditioners

   DOI: 10.5005/jp-journals-10024-2504  |  Open Access |  How to cite  | 


Aim: To establish a relationship between the crest of the alveolar ridge and neutral zone and to compare its location recorded by two different material. Methods and materials: Thirty subjects were selected, and the location of the neutral zone was compared with the mandibular alveolar ridge crest. For each subject neutral zone was recorded by two different recording materials-Low fusing impression compound and tissue conditioner. After neutral zone recording, the relation between mandibular ridge crest and neutral zone location examined radiographically. The data so collected were checked for normality, descriptive statistics and the Mann-Whitney U test was used. Results: Position of neutral zone was found towards lingual in the posterior, labial side in anterior and almost near to the alveolar ridge crest in premolar region. The thermoplastic flow of the material effects the position of neutral zone but no significant difference was noted in the positions of neutral zone recorded by the two materials in relation to the alveolar ridge crest. Conclusion: Location of the neutral zone is not affected by the material used in recording it. Clinical significance: The location of the neutral zone varies from subject to subject and mainly depends upon their musculature and can be recorded accurately by using correct technique irrespective of the materials used.



Aminah M. El Mourad

Stability of Bonded Resin Composite Restorations to Enamel after Bleaching with 20% Carbamide Peroxide

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:11] [Pages No:247 - 257]

Keywords: Bleaching, Carbamide peroxide, Resin composite, Shear bond strength

   DOI: 10.5005/jp-journals-10024-2505  |  Open Access |  How to cite  | 


Aim: This study aimed to examine the effect of postoperative home bleaching using 20% carbamide peroxide on the shear bond strengths of different adhesives to enamel and to verify the failure mode for each test specimen. Materials and methods: One hundred sound human molars were used in this study. Bonding procedures were performed on the flattened buccal enamel surfaces according to the manufacturer's instructions. Opti Bond Solo Plus adhesive (Kerr), Single Bond Universal adhesive (3M ESPE) applied with both the total-etch and self-etch techniques, and Tetric N-Bond Universal adhesive (Ivoclar Vivadent) applied with both the total-etch and self-etch techniques were used, followed by resin composite post fabrication (Filtek Z350 XT; 3M ESPE). All specimens were thermo-cycled for 5000 cycles and then divided into the control (non-bleach) and postoperative bleaching groups (20% carbamide peroxide). The shear bond strength values were measured and compared between the two groups. Data were analyzed using one-way analysis of variance with Tukey's test (p ≤ 0.05). The failure modes of debonded specimens were evaluated using a digital microscope (50×). The bonding interfaces of the resin composite posts to different enamel conditions (control and postoperative bleaching) were observed by a scanning electron microscope (SEM) before the shear bond test. Results: The shear bond strength values of all tested adhesives were lower in the postoperative bleaching group than they were in the control (non-bleach) group, particularly the bond strength values of self-etch adhesives. Conclusion: The stability of bonded resin composite restorations to enamel, using different dental adhesives, could be compromised after the bleaching procedure at varying sensitivity levels. Clinical significance: Replacement of bonded resin composite restorations to enamel might be considered after bleaching procedures, especially if these restorations were previously bonded with self-etch adhesives.



Aiman O Johar

Incidence of Accidental Pulp Exposure During Tooth Preparation by Undergraduate Students for Fixed Partial Dentures

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:5] [Pages No:258 - 262]

Keywords: Fixed partial dentures, Incidence, Pulp exposure, Tooth preparation

   DOI: 10.5005/jp-journals-10024-2506  |  Open Access |  How to cite  | 


Aim: To identify the incidence of accidental pulp exposure during the preparation of vital abutment tooth for porcelainfused- to-metal (PFM) fixed prosthesis when prepared by undergraduate students. Materials and methods: A cohort study was conducted on 471 teeth, which were prepared to received PFM fixed partial denture, in patients between the age group of 20-40 years for 72 months. All the teeth were vital and healthy periodontally; preoperative radiographs were recorded. Measurements were taken from cone beam computed tomography (CBCT) scans of human extracted teeth for reference of the pulpal depths. Teeth with endodontic pulp exposure were documented and referred to the endodontic department. Results: In multivariate regression, when all variables were simultaneously considered and accounted for, tooth factors (arch and whether the tooth is anterior or posterior) and the distance between pulpal wall and cusp tip were significantly associated with odds of exposure (p = 0.006, 0.03 and < 0.0001). Maxillary and anterior were associated with higher odds of lateral exposure compared to mandibular and posterior teeth (OR = 10.34 and 3.53). Conclusion: The present study draws the attention of the clinician towards the detrimental effect of tooth preparation on the vital pulp. The study concluded that maxillar and anterior teeth exposure has higher odds than mandibular and posterior teeth. Clinical significance: The undergraduate students must be trained to be extra careful while preparation of anterior and maxillary teeth for fixed partial dentures (FPD) to avoid pulpal exposure.



Rémy Balthazard, Pascale Corne, Marin Vincent, Eric Mortier

Methodological Approach to the Endodontic Treatment of First Premolars with Three Root Canals: Two Case Reports

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:263 - 269]

Keywords: Additional root canals, Mandibular first premolar, Maxillary first premolar, Root canal treatment

   DOI: 10.5005/jp-journals-10024-2507  |  Open Access |  How to cite  | 


Aim: The aim of this article was to promote a methodology in the endodontic management of complex premolars with multiple root canals Background: The success of endodontic treatment depends on a meticulous clinical and radiographic analysis, the creation of a suitable access cavity and chemical and mechanical preparation, followed by three-dimensional filling of the entire root canal system. Consequently, it is essential to look for the presence of additional root canals to prevent endodontic treatment failure Case description: Two cases are presented. The first case concerned a 50-year-old male patient of North African origin who consulted in the context of a global prosthetic restoration including endodontic treatment of the maxillary left first premolar (tooth no. 24). The second case concerned a 29-year-old male patient of North African origin who was referred to us by his primary care practitioner in an urgent context of pain and infection present for two weeks (tooth no. 44). In both cases, it was the in-depth radiographic analysis, combined with manual exploration under the surgical microscope, that led to the relatively rare identification of a third root canal. Shaping, disinfection and three-dimensional filling of the entire root canal system were then performed in accordance with widely validated protocols. Conclusion: The maxillary and mandibular premolars, due to their highly variable root canal system configuration and a number of root canals and roots, appear to be teeth for which treatment is potentially complex. The acuteness of digital-tactile sense and the advent of 3D imaging and optical aids optimize the treatment of all the root canals of a tooth Clinical significance: These case reports demonstrate the importance of clinical and radiographic inspections to guide practitioners in the search for additional root canals in premolars and promote a methodological approach.



Gianluca Porcaro, Ernesto Amosso, Marco Baldoni

Treatment of Osteoradionecrosis of the Jaw with Ozone in the Form of Oil-based Gel: 1-year Follow-up

[Year:2019] [Month:February] [Volume:20] [Number:2] [Pages:7] [Pages No:270 - 276]

Keywords: Osteoradionecrosis, Ozone, Radiotherapy, Medical oncology, Radiation

   DOI: 10.5005/jp-journals-10024-2508  |  Open Access |  How to cite  | 


Aim: Osteoradionecrosis of the jaws (ORNJs) is aseptic bone necrosis that develops in post-irradiated bone tissue of patients who underwent radiotherapy for head-neck tumors. The present study aims to clinically assess the regenerative ability of the ozone in the form of oil-based gel applied to the exposed bone area in the treatment of ORNJ. Materials and methods: Eight patients who underwent radiotherapy for the treatment of cervical or neck cancer were diagnosed with ORN of the jaws at our Department, for a total of 11 sites of necrotic bone exposure (3 patients were diagnosed with more than one site of osteoradionecrosis). In the therapeutic protocol, the exposed bone lesion and osteomucosal margin were cleaned with manual debridement. Then the ORN lesion was treated with topical applications of ozone delivered as oil suspension (Ozosan® - Sanipan, Clivio, Italy) on the exposed bone for 10 minutes. The application was repeated each week until movement of the necrotic fragment was noted Results: In six patients on 8 (75%) lesions resolved with complete mucosal healing with 3 to 19 ozone applications. Total sequestration of the necrotic bone with spontaneous expulsion was observed. One patient improved his conditions shifting from a stage B2S1 to B1S1 according to He et al. classification. A patient only worsened his conditions with treatment. No toxicity was reported or observed. Conclusion: These results showed the efficacy of ozone oil suspensions in the non-invasive treatment of ORN, probably related to its properties of stimulation of local revascularization and antibacterial activity, and the good tolerability of the related protocol used. Clinical significance: The use of this kind of medication should be included in ORNJ treatments as effective, noninvasive and self-administered.


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