The Journal of Contemporary Dental Practice

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2019 | September | Volume 20 | Issue 9

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Piyush Jain

Pyroptosis and Oral Cancer

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:2] [Pages No:1001 - 1002]

   DOI: 10.5005/jp-journals-10024-2682  |  Open Access |  How to cite  | 



Khaled Azzam

Influence of Adaptation and Adhesion on the Retention of Computer-aided Design/Computer-aided Manufacturing Glass Fiber Posts to Root Canal

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1003 - 1008]

Keywords: Adhesion, Computer-aided design/computer-aided manufacturing fiber post, Friction, Pushout strength, Self-adhesive cement

   DOI: 10.5005/jp-journals-10024-2654  |  Open Access |  How to cite  | 


Aim: The study aimed to assess the effect of friction and adhesion on the pushout bond strength of CAD/CAM fiber-reinforced composite (FRC) post and cores in comparison to prefabricated fiber posts. Materials and methods: Thirty extracted single-rooted premolars were divided into three groups (N = 10): CP: CAD/CAM FRC posts (Trilor, Bioloren) cemented with self-adhesive resin cement (Rely X U200, 3M) as control group. CPL: CAD/CAM FRC composite posts cemented with the same self-adhesive resin cement after lubricating the root canal with petroleum jelly (Vaseline, Unilever) to prevent adhesion. RXP: prefabricated posts cemented with self-adhesive resin cement. Specimens were subjected to thermal cycling and then to pushout tests. The mode of failure was observed using a stereomicroscope. Results were analyzed by two-way ANOVA followed by a Tukey's post hoc test for comparison, p = 0.05. Results: Push-out bond strength was significantly lower in the RXP group (8.54 ± 3.35 MPa) in comparison to CP (12.10 ± 1.38 MPa), while no significant differences were concluded between the other groups. Failure was mostly adhesive for CPL and RXP and adhesive and mixed for CP. Conclusion: Custom made CAD/CAM posts have a positive effect on the retention of FRC posts to root canal walls while adhesion between self-adhesive cement and root dentin did not influence significantly the pushout bond strength of CAD/CAM posts to root canal. Clinical significance: The friction of well-adapted CAD/CAM fiber post and cores plays a predominant role in the success of post restorations of endodontically treated teeth.



Prevalence of Temporomandibular Joint Disorders in Adults in Jeddah, Kingdom of Saudi Arabia: A Cross-sectional Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1009 - 1013]

Keywords: Temporomandibular dysfunction, Temporomandibular joint

   DOI: 10.5005/jp-journals-10024-2648  |  Open Access |  How to cite  | 


Aim: Assess the prevalence of temporomandibular dysfunction (TMD) in adults in Jeddah, Kingdom of Saudi Arabia. Materials and methods: This was a cross-sectional study of adults aged 18 years and above during their routine visit to primary care dental centers in the city in 2018. Five-hundred participants enrolled in this study. Primary healthcare centers are clustered geographically in five areas of the city (north, south, west, east, and center) by the ministry of health. One-hundred participants were recruited from each area. The TMD/pain screener questionnaire was completed by participants. The first item used a scoring mechanism of 0–2 (a = 0, b = 1, c = 2), and the second and third items were scored 0–1 (a = 0, b = 1). A total score of 3 or more indicates the presence of TMD. t test was used to evaluate gender differences in TMD prevalence with a significance level of p < 0.05. Results: There were 250 females and 250 males participants. The mean age was 40.6 years (range: 18–89 years; standard deviation: 13.7 years). Answers to the first question showed that 52% of participants had no pain in the temple area, or jaw in the last 30 days, 46% of participants had intermittent pain, and 2% had persistent pain. Twenty-seven percent of participants had pain or stiffness in the jaw upon waking up, whereas 39% of participants had pain while chewing food, 29% experienced pain from opening the mouth or moving the jaw, 34% during jaw habits such as holding the teeth together, clenching, or chewing gum, and 18% during other jaw activities such as talking, kissing, or yawning. A total score of 3 or more was found in 175 participants, indicating a prevalence of 35%. TMD was significantly more prevalent in females (105 participants, 42%) than in males (70 participants, 28%) with p = 0.0008. Conclusion: The prevalence of TMD in adult population in Jeddah is considered high. It is significantly more prevalent in females than in males. Clinical significance: TMD prevalence is relatively high in adults of Jeddah, Kingdom of Saudi Arabia. Public health efforts should be directed at increasing TMD awareness in patients and healthcare professionals.



Yara Mohammad, Oula Yassin, Omar Hamadah, Mohammad Tamer Abbara

An Evaluation of Er:YAG Laser in an Intact Enamel Treatment on Bonding to the Resin Cement Compared to Four Traditional Techniques

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1014 - 1018]

Keywords: Acid etching, Air abrasion, Enamel treatment, Er:YAG laser

   DOI: 10.5005/jp-journals-10024-2647  |  Open Access |  How to cite  | 


Aim of study: Evaluation of the bond strength of the resin cement after enamel conditioning with erbium-doped yttrium aluminum garnet laser compared to other four different techniques. Materials and methods: The study consisted of 50 enamel specimens excluded from the smooth surfaces of newly extracted human 3rd molars. The specimens were randomly divided into five groups in terms of the enamel treatment technique. Each group (n = 10) was conditioned differently by bevel and acid etching group (I), acid etching technique group (II), double acid etching technique group (III), air abrasion followed by acid etching group (IV), and Er:YAG laser followed by acid etching group (V). After enamel treatment, a resin cylinder was installed using split Teflon matrix on each enamel specimen. Then the specimens were exposed to a shear strength device, and shear force was applied. The results were recorded with Newton. The required data were collected and statistically analyzed. A one-way ANOVA test was conducted to compare the five study groups using SPSS version 21 (p < 0.05). Results: All groups showed high shear bond strength values ranging from 19.26 MPa (for group III) to 27.05 MPa (for group V). The enamel treatment with Er:YAG laser followed by acid etching gave the best results with significant differences compared to the other groups. Conclusion: Within the limitations of the present study, it can be concluded that the combination between the Er:YAG laser and the acid etching enhances the bond strength of resin cement with the enamel. Clinical significance: The use of Er:YAG laser followed by acid etching can be a successful technique for enamel conditioning and the results showed their superiority over the other groups.



Rami Reddy, Snigdha Gowd, Bhagabati P Dash, Jasbir Meher

Comparison of Frequency of Congenitally Missing Upper Lateral Incisors among Skeletal Class I, II and III Malocclusions

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1019 - 1023]

Keywords: Lateral incisors, Space management, Tooth agenesis

   DOI: 10.5005/jp-journals-10024-2643  |  Open Access |  How to cite  | 


Aim: The present investigation aims to find out the frequency of congenitally missing upper lateral incisors among skeletal class I, II, and III malocclusions and to find out its variability among different genders. Materials and methods: The study sample included orthopantomograms (OPGs) and a lateral cephalogram of 1,000 patients retrieved from previous records. Of the selected samples, 290 were males and 710 were females. Orthopantomograms helped diagnose the presence of unilateral/bilateral maxillary lateral incisors. Results and statistics: Of the 1,000 samples, 710 (71%) were female and 290 (29%) were male patients. An estimated 37 (3.77%) patients were found to have missing maxillary lateral incisors. Of the female patients, 4.04% were having missing laterals, whereas 3.10% of the male patients were having agenesis of maxillary incisors. Totally, 0.9% of missing upper laterals were recorded in males, whereas 2.8% of missing lateral incisors in upper arch were found in females. A total of 54.16% of skeletal class I, 33.33% of skeletal class II, and 12.5% of skeletal class III cases were found to have missing upper lateral incisors. Conclusion: The prevalence rate for congenitally missing upper lateral incisors in orthodontic adolescent Odia population in Bhubaneswar is 3.77%. The females had a greater percentage of agenesis of the upper lateral incisor when compared to males. An estimated 54.16% of skeletal class I, 33.33% of skeletal class II, and 12.5% of skeletal class III cases were found to have missing upper lateral incisors. This difference might be due to genetic variations or different environmental conditions. A multidisciplinary treatment protocol must be planned to manage the missing maxillary lateral incisor and to restore the impaired esthetics and function.



Agung Krismariono

Less Invasive Vestibule Access Tunneling with Platelet-rich Fibrin Membrane for the Treatment of Gingival Recession

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1024 - 1028]

Keywords: Gingival recession, Platelet-rich fibrin, Tunnel technique, Vestibule

   DOI: 10.5005/jp-journals-10024-2638  |  Open Access |  How to cite  | 


Aim: The aim of this study was to introduce the less invasive vestibule access tunneling in combination with platelet-rich fibrin (PRF) membrane for gingival recession treatment. Materials and methods: Seven subjects with Miller's class I or II buccal gingival recession were selected for this study. All subjects were treated with mucogingival surgery using the less invasive vestibule access tunneling in combination with PRF membrane. Clinical examination performed on each subject and the height of gingival recession was recorded preoperatively (baseline), and at 1 and 3 months postoperatively. The data were statistically analyzed using analysis of variance (ANOVA) with post hoc Tukey's LSD test to determine the significant difference between groups. Statistical significance level was set at 0.05. Results: The results showed that there were significant differences in recession height between baseline and both 1 month and 3 months postoperatively (p < 0.05). Nevertheless, there was no significant difference between 1 and 3 months postoperatively (p > 0.05). All patients reported satisfactory esthetic results both at 1 and 3 months postoperatively. Conclusion: Mucogingival surgery using the less invasive vestibule access tunneling in combination with PRF membrane for gingival recession treatment provided optimal root coverage. Clinical significance: This article introduces a new tunnel technique in combination with PRF membrane for gingival recession treatment. Previous studies tried to make access using the tunnel technique performed through gingival sulcus. In this study, the access is performed through the vestibule region. Access from the vestibule can minimize the damage of gingival margin integrity, especially in patients with thin gingival biotype.



Shrikanth Muralidharan, Pramila Mallaiah, Sakharam Garale, Arunkumar Acharya

Oral Health Literacy and Oral Health Knowledge among 2,263 First-time Pregnant Urban Women: A Cross-sectional Questionnaire Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:4] [Pages No:1029 - 1032]

Keywords: Literacy, Oral health, Pregnancy

   DOI: 10.5005/jp-journals-10024-2657  |  Open Access |  How to cite  | 


Aim: The present study aimed to see the oral health literacy rate among first-time pregnant women across 12 corporate hospital setups in the city of Pune, India. Materials and methods: For the survey, the REALD 30 questionnaires were used to assess the adult literacy rate (with 0 being least score and 30 being the highest score) and the knowledge of the participants related to oral health was assessed using a set of 6 questions. The study was carried out for a period of 1 year from January 2018 to December 2018. The total participants at the end of the study were 2,263. All the women were pregnant for the first time, in their 1st trimester of pregnancy. Written consent was taken from all the participants. Epi Info was used to carry out the statistical analysis. All the p values less than 0.05 was considered to be statistically significant. Results: The mean REALD 30 score was 23.8 ± 8.34. The REALD score was higher for those with a postgraduate degree; this could be due to more number of participants in the group. There were higher percentages of women with correct answers to all the knowledge-based questions. We observed that there was a positive correlation with the REALD total scores and the correct answers provided to the questions on oral health (r = 0.76). There was a positive correlationship between the REALD scores and the oral health knowledge of the participants. Conclusion: The educated pregnant women had a high oral health literacy rate. There was a positive correlation of literacy with the REALD 30 score. Clinical significance: Healthcare providers should focus on clearing the myths and misconceptions that are still prevalent in a small portion of the urban population.



Christia Aoun, Nada El Osta, Alfred Naaman, Issam Khalil

Post-endodontic Flare-ups after a Single-visit Treatment Using the FUI Scoring Method and Associated Factors: A Clinical Prospective Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:8] [Pages No:1033 - 1040]

Keywords: Endodontic treatment, Flare-up, Pain, Single-visit RCT, Swelling

   DOI: 10.5005/jp-journals-10024-2658  |  Open Access |  How to cite  | 


Aim: Flare-ups following a root canal treatment are still a major problem both to the patient and to the clinician. Its definition, etiology, incidence, and risk factors have been the subject of long-standing debate. We conducted this study to investigate the incidence of flare-ups after a single-visit treatment and to identify the factors associated with the flare-up index (FUI). Materials and methods: All patients treated by postgraduate residents in endodontic specialty at Saint Joseph University of Beirut from June 2018 to January 2019 were invited to participate in the study. After a routine root canal treatment, patients were given a questionnaire to fill after 24 hours–48 hours–7 days, covering a postoperative assessment of symptoms using the visual analogue scale (VAS) and FUI. Patients who experienced a severe postoperative pain and/or swelling were identified and categorized as having a flare-up. Results: A total of 423 patients (age: 39.76 ± 12.428 years) were included in the study. The incidence of flare-up was 1.9%. The mean FUI was 5.94 ± 5.646 and was highly correlated with the VAS score (p < 0.001). The factors that significantly influenced the occurrence of flare-ups were: pulpal diagnosis (p < 0.001), preoperative drug intake (p < 0.001), preoperative symptoms (>24 hours) before treatment (p < 0.001), and tooth type (p = 0.013). Conclusion: FUI should be used in further studies to confirm our results since it is a valid quantitative method to assess this clinical phenomenon. Clinical relevance: Endodontists should take into consideration the diagnosis and the history of preoperative symptoms since it plays an important role in predicting the occurrence of flare-ups and the success of the treatment.



Melwin Mathew, Sultan A Almalki, Ipsita Jayanti, Macha Durgaraju

An In Vitro Evaluation of Antibacterial Efficacy of Various Concentration of Eucalyptus globulus Leaf Extract on Periodontal Pathogens

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:4] [Pages No:1041 - 1044]

Keywords: A. actinomycetemcomitans, Eucalyptus globulus, P. gingivalis, Zone of inhibition

   DOI: 10.5005/jp-journals-10024-2639  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to evaluate the antibacterial efficacy of various concentrations of Eucalyptus globulus leaf extract on periodontal pathogens. Materials and methods: Matured, healthy and disease-free leaves of Eucalyptus globulus were collected. The leaves were washed under tap water and finally dried in an oven at a temperature of 45°C for 48 hours. The dried plants were ground in an electric blender to make them into a powder. The powder was mixed with 100% ethanol and kept it inside a shaker overnight at 35°C. The mixture was centrifuged for 10 minutes at 2,500 rpm. Three different concentrations (10%, 50%, and 100% v/v) were used as antibacterial agents. Chlorhexidine (0.2%) was considered as positive control and dimethyl formamide was considered as negative control against P. gingivalis and A. actinomycetemcomitans. The disc diffusion method was used to determine the extract's antibacterial activity against the test organisms. A digital Vernier caliper was used to measure the diameter of antibacterial activity showing the zone of inhibition in millimeters. Results: Eucalyptus globulus with 100% concentration showed a maximum zone of inhibition against A. actinomycetemcomitans and P. gingivalis (5.38 ± 0.32 mm, 4.82 ± 0.11 mm) followed by 50% and 10% accordingly. The negative control of dimethyl formamide showed a zone of inhibition of 0.48 ± 0.96 mm and 0.63 ± 0.20 mm against A. actinomycetemcomitans and P. gingivalis. The positive control of 0.2% chlorhexidine showed a zone of inhibition of 8.46 ± 1.02 mm and 7.18 ± 0.54 mm against A. actinomycetemcomitans and P. gingivalis. The ANOVA test showed a highly significant antibacterial efficacy in 0.2% chlorhexidine and 100% concentration Eucalyptus globulus. Conclusion: A significant maximum zone of inhibition against A. actinomycetemcomitans and P. gingivalis was showed by 100% concentration of Eucalyptus globulus. Clinical significance: Other than the systemic diseases treatment, Eucalyptus globulus also serves as an effective promising alternative to antibiotics in the prevention of oral infections because of the natural phytochemicals existing in them.



Ugurlu Muhittin, Temel U Burak, Hepdeniz O Kam

Color Stability of Microhybrid and Nanofilled Composite Resins: Effect of Surface Sealant Agents Containing Different Filler Content

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1045 - 1050]

Keywords: Composite resin, Discoloration, Filler, Spectrophotometry, Surface sealant

   DOI: 10.5005/jp-journals-10024-2636  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of surface sealants containing different filler content on the color stability of microhybrid and nanofilled composite resins. Materials and methods: The materials evaluated as study groups were comprised a nanofilled composite resin (Filtek Ultimate, 3M ESPE) and a microhybrid composite resin (Filtek Z250, 3M ESPE). Forty-five disc-shaped specimens (10 mm × 2 mm) were prepared from each composite resin. Each study group was divided into three subgroups: control, G-Coat Plus, and Fortify Plus (n = 15). The baseline color values (L*a*b*) of each specimen were measured using a spectrophotometer according to the CIE L*a*b* color scale. Then, the specimens were immersed in red wine for a period of 3 hours per day for 15 days (3 hours/day × 15 days). After the immersion period, the color values (L*a*b*) of each specimen were measured again. The ΔL*, Δa*, and Δb* values and the color change value (ΔE) were calculated. The data were statistically analyzed with two-way ANOVA and Duncan tests (p = 0.05). Results: All the composite resin groups demonstrated/indicated much more color changes after immersion in red wine (ΔE > 3.3). The greater ΔE values were observed with the groups applied surface sealants than the control groups (p < 0.05). Fortify Plus further increased the ΔE values of both composite resins than G Coat Plus (p < 0.05). Filtek Ultimate showed higher ΔE values than Filtek Z250 in all the subgroups (p < 0.05). Conclusion: The surface sealants regardless of the filler content negatively influenced the color change of the composite resins after immersed in red wine. The microhybrid composite resin had better color stability than the nanofilled composite resin. Clinical significance: There is no favorable effect of using surface sealants on composite resins to prevent discoloration; besides, the sealants can also increase the color alteration.



Pramod Shetty, Reena Ranjeet Kumar, Dhirendra Pratap Singh, Prakrathi Shetty

Comparative Evaluation of Nemoceph and Foxit PDF Reader for Steiner's Cephalometric Analysis

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1051 - 1055]

Keywords: Cephalometry, Digital imaging, Onscreen tracing

   DOI: 10.5005/jp-journals-10024-2645  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate and compare the values of Steiner's cephalometric analysis using Nemoceph and Foxit PDF Reader. No significant difference between the two methods will result in that Foxit PDF Reader can be used as a cost-effective alternative. Materials and methods: This study was conducted on 100 digital lateral cephalograms taken from the same machine. The samples were collected by nonprobability convenience sampling procedures. These images were analyzed for Steiner's cephalometric analysis using two software packages. Results: The skeletal and dental values showed no statistically significant difference in the majority, except for the L1-NA (linear) and L1-NB (linear). Conclusion: Results showed that there is a high agreement between the two methods. Clinical significance: This article provides a simple and cost-effective method of onscreen cephalometric analysis. This technique uses the inbuilt measurement tools in the tool bar of our daily use software. The method can be used independently anywhere without any internet connection and software subscription.



Mohammed Alkhurays

Influence of Different Luting Cements on the Shear Bond Strength of Pretreated Lithium Disilicate Materials

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1056 - 1060]

Keywords: Adhesion, Lithium disilicate, Luting, Microetching, Resin cements

   DOI: 10.5005/jp-journals-10024-2641  |  Open Access |  How to cite  | 


Aims: The aim of the study was to examine the shear bond strength of different luting cements bonding to pre-treated lithium disilicate materials. Materials and methods: Sixty A2 shade lithium disilicate discs were subjected to either micro-etch with aluminum trioxide and etching by 10% hydrofluoric acid (micro-etch group; n = 30); or etching with 10% hydrofluoric acid (acid-etch group; n = 30) before cementation. Three dual-cure Variolink Esthetic (VDC), RelyX Ultimate (RUT), and RelyX Unicem (RUC) and three light-cure Variolink Veneer (VV), Variolink Esthetic (VLE), RelyX Veneer (RV) resin cements were used for cementation. The specimens from each group were tested for shear bond strength (SBS). The data were analyzed using two-way ANOVA; p < 0.05 is considered statistically significant. Results: For all resin cements tested with different surface treatments, there was a statistically significant difference within resin cements per surface treatment (p < 0.05). The SBS in the micro-etch group was significantly higher across all the cements tested when compared to the acid-etch group (p < 0.05), thus suggesting that surface treatment affects the SBS largely irrespective of the resin cement. Their interaction between cement and the surface treatment was significantly different across groups (p < 0.001). Conclusion: Under the limitations of the present study, it can be concluded that surface treatment influences the bond strength irrespective of the resin cement (light/dual-cure) used for indirect restorations’ cementation. The shear bond strength in the sand blast/acid etch group was significantly higher across all the cements tested when compared to the acid-etch alone. Clinical significance: The surface treatment of porcelain veneer hugely influence the SBS, which will directly affect the veneer clinical success rate. The micro-etching recorded a higher shear bond strength when compared to those with acid-etch only.



Rahul G Padala, Revathi Peddu, Bhargavi Nuvusetty, Kalyani Mallavarapu, Santosh Reddy Banswada, Thirumal Naik Mood

Effect of Fluoride-releasing Elastomers on Mutans Streptococci in Dental Plaque: An In Vivo Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1061 - 1066]

Keywords: Demineralization, Elastomeric modules, Fluoride, Streptococcus mutans, Sustained release

   DOI: 10.5005/jp-journals-10024-2650  |  Open Access |  How to cite  | 


Aims: The purpose of this study was to evaluate the effect of fluoride-releasing elastomeric modules in the control of Streptococcus mutans levels in the oral cavity. Materials and methods: The study consisted of 30 patients, with two experimental periods of three weeks and a three-week washout period between experimental periods. At the first visit, fluoridated modules were placed around brackets on 12 11 33 and non-fluoridated ones on 21 22 43. During the 2nd visit, the modules were removed and sent for a microbiological analysis. Non-fluoridated modules were placed on all brackets for one visit to allow for a washout period. At the 3rd visit, fluoridated elastomeric modules were placed around brackets on 21 22 43 and non-fluoridated on 12 11 33. At the 4th visit, the procedures at the 2nd visit were repeated. Results: A mean comparison between bacterial counts of fluoride-releasing and non-fluoridated elastomeric modules in both the trials were done by the Mann–Whitney U test, which showed the result to be significant (p < 0.001). The mean comparison of bacterial counts between fluoride-releasing and non-fluoridated elastomeric modules in a specific area was done by the Wilcoxon signed rank test, which showed the result to be significant (p < 0.001). A comparison between bacterial counts of fluoride-releasing elastomeric modules in both trials were done by the Mann–Whitney U test, which also showed a significant result (p < 0.001). Conclusion: The sustained-release fluoridated elastomeric modules are effective in reducing the levels of Streptococcus mutans in dental plaque around the brackets for a time period of 21 days. Clinical significance: The sustained-release fluoridated modules were effective in reducing the CFU of S. mutans and are also stable at the end of 21 days of the experimental period. But the action of fluoride released from the modules is localized, temporary, and requires constant maintenance of these modules over the brackets throughout the treatment period.



Kaushik Haridas, Madhu Hariharan, Prabath Singh, Anju Varughese, Arjun B Ravi, K Ravi Varma

Effect of Instrumentation Techniques and Kinematics on Apical Extrusion of Debris: An In Vitro Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:4] [Pages No:1067 - 1070]

Keywords: Debris extrusion, Forward reciprocation, Kinematics, ProTaper next files system, WaveOne gold

   DOI: 10.5005/jp-journals-10024-2656  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of instrumentation kinematics on debris extrusion by comparing the amount of apically extruded debris after canal preparation using ProTaper next in continuous rotation as well as forward reciprocating motion and WaveOne gold in reverse reciprocating motion. Materials and methods: We randomly divided ninety buccal roots of maxillary bicuspids with fully formed apices into three groups. After achieving the coronal access, the patency of the root canals was established with a size 10 K file. The canals were then instrumented using ProTaper next in continuous rotation or in a forward reciprocating motion and WaveOne gold in reverse reciprocating motion. Eppendorf tubes were used to collect the debris extruded through the apical foramen. The tubes were placed in a −80° freezer for 8 hours and then in a lyophilizer for 24 hours. The quantity of the apically extruded debris was assessed by subtracting the weights of Eppendorf tubes before and after instrumentation. The analysis was done using a one-way ANOVA test and the Bonferroni test to compare the groups. Results: The mean weight of extruded debris with WaveOne gold in reverse reciprocation was significantly lower than ProTaper next in forward reciprocation and ProTaper next in continuous rotation (p value = <0.001). Conclusion: WaveOne gold in reverse reciprocation was associated with a significantly lower amount of apical extrusion of debris than ProTaper next rotary files in forward reciprocation and continuous rotation. Clinical significance: According to the results of this study, reciprocating instrumentation technique was associated with a less amount of debris extrusion compared to continuous rotation.



Limly Bal Thaliyadeth, Dhanavel Chakravarthy, Padmaraj Santhanamurthy Neelamurthy, Vijayaraja Selvapandiane, Ambily Jayadevan, Nandini Dimple

Comparative Evaluation of Color Stability of Nanohybrid Direct and Indirect Resin-based Composites to Indian Spices: An In Vitro Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1071 - 1076]

Keywords: Color stability, Indirect resin composites, In vitro experimental study, Nanohybrid, Reflectance spectrophotometer, Resin composite, Spices, Turmeric

   DOI: 10.5005/jp-journals-10024-2644  |  Open Access |  How to cite  | 


Aim: This study aimed to evaluate the color stability of nanohybrid direct resin-based composites and indirect resin-based composites to Indian spices. Materials and methods: Fifty samples of the nanohybrid resin-based composite (G-aenial) and the indirect resin-based composite (Adoro) were prepared using an acrylic template of dimension 8 mm × 3 mm. All the samples were polished with the Sof-Lex polishing kit. They were randomly divided into five groups and immersed in solutions of turmeric powder, tamarind extract, paprika powder, and saffron extract. Artificial saliva was used as the control group. Color values (L*a*b*) were measured by a reflectance spectrophotometer using the Commission Internationale de l'Eclairage (CIE) L*a*b* system before and after 24 hours, 48 hours, 72 hours, and 1 month of immersion. Color differences ΔE*ab were statistically analyzed by the two-way repeated measures ANOVA and the post hoc Tukey test using IBM SPSS v19.0. Results: The results exhibited statistical significance between all five solutions and two groups at each time point considered (p < 0.05). From the mean, it is evident that in both indirect and direct composite groups, turmeric solution is having the highest mean when compared to other four solutions. Conclusion: Indirect resin-based composites (Adoro) show less stainability when compared to direct resin-based composites (G-aenial). In both groups, turmeric showed maximum discoloration. Clinical significance: Both the direct and indirect composites have a tendency to get stained with Indian spices. Indirect composites stain lesser to Indian spices when compared to direct composites. Thus, indirect composites are recommended for esthetic restorations.



Farahnaz Sharafeddin, Mina Safari

Effect of Papain and Bromelain Enzymes on Shear Bond Strength of Composite to Superficial Dentin in Different Adhesive Systems

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1077 - 1081]

Keywords: Adhesive system, Bromelain, Papain, Shear strength

   DOI: 10.5005/jp-journals-10024-2646  |  Open Access |  How to cite  | 


Aim: The aim of this study was to compare different dentin treatments and adhesive systems on shear bond strength (SBS) of composite to superficial dentin. Materials and methods: In this in vitro experimental study, 60 extracted human upper premolars were cut 0.5 mm deep under occlusal DEJ and were randomly divided into six groups (n = 10) based on the method of dentin treatment and adhesive system: (A) two steps self-etch adhesive system (Clearfil SE bond) and (B) two steps of total etch bonding system (Adper single bond 2). (C) 10% papain + Clearfil SE bond. (D) 10% papain + Adper single bond 2. (E) 6% bromelain + Clearfil SE bond. (F) 6% bromelain + Adper single bond 2. Then, a plastic mold was placed on dentin and filled with resin composite. Shear bond strength (MPa) was tested by a universal testing machine (Zwick/Roell Z020, Germany), and the data were statistically analyzed by two-way ANOVA and Tukey's test (p < 0.05) and were applied for mean comparison. Results: A significant difference was detected in the SBS evaluation between the applied adhesive systems (p = 0.0007). The SBS was also significantly affected by the interaction of treatment and etching techniques (p = 0.028). The group with 10% papain as a deproteinizing agent before the self-etching adhesive system showed the highest SBS (p = 0.029). There were no significant differences considering the specimens exposed to papain before the total etch adhesive system (p = 0.13), and the specimens were exposed to bromelain enzyme before self-etch and total etch adhesive systems (p = 0.25, p = 0.84, respectively). Conclusion: Papain enzyme treatment with the self-etch adhesive system increased the SBS value. Additionally, the application of bromelain enzyme as dentin treatment before two adhesive systems and papain before total etch adhesive system had no effect on the SBS of composite to superficial dentin. Clinical significance: Application of adhesive systems and dentin treatment can influence the bond strength.



Parag Kasar, Anil Patil

Effect of CO2 Laser and 1.23% Acidulated Phosphate Fluoride on Acid Resistance and Fluoride Uptake of Human Tooth Enamel: An In Vitro Assessment

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:8] [Pages No:1082 - 1089]

Keywords: 1.23% Acidulated phosphate fluoride, Acid resistance, CO2 laser, Fluoride uptake, Human tooth enamel

   DOI: 10.5005/jp-journals-10024-2684  |  Open Access |  How to cite  | 


Aim: To evaluate the effectiveness of CO2 laser treatment before applying 1.23% acidulated phosphate fluoride (APF), through topically applied 1.23% APF solution, and after applying 1.23% APF on acid resistance and fluoride uptake of the enamel. Materials and methods: Sixty non-carious human premolars were extracted due to the orthodontic reason and stored in distilled water solution under refrigeration. Using a water-cooled diamond disc, enamel slabs of 4 mm × 4 mm × 1.5 mm were cut from the buccal surface of each tooth. Sixty samples were randomly divided into one control group and five test groups of 10 premolars each. Solution was prepared for wet chemical analysis followed by fluoride analysis that was carried out using a fluoride ion selective electrode (Thermo Scientific Orion 4-Star Plus ISE Meter). The weight of enamel (WE) was determined from the amount of calcium (Ca) etched away considering the fact that the Ca content of the human enamel is 37.4 wt%. The subgroups were statistically analyzed using ANOVA for fluoride determination and evaluation of acid resistance. Results: There was a significant increase in acid resistance of enamel slabs when treated individually or in combination of a low-power CO2 laser and 1.23% APF solution. Application of 1.23% APF solution after low-power CO2 laser treatment showed maximum increase in acid resistance. Conclusion: Application of a low-power pulsed CO2 laser through topically applied 1.23% APF solution resulted in a detrimental effect of the human tooth enamel with resultant decrease in acid resistance. High fluoride uptake does not necessarily indicate increased acid resistance. Clinical significance: The present study provides evidence that a low-power CO2 laser can be used effectively in combination with topically applied 1.23% APF solution in order to make the enamel more resistant to acid attack, thereby helping in controlling dental caries.



Anchu R Thomas, Tripuravaram VK Reddy, Ashwin Ravichandran, Murali Sivakumar, Shobana Krishnakumar

Evaluation of the Antibacterial Efficiency of a Combination of 1% Alexidine and Sodium Hypochlorite on Enterococcus faecalis Biofilm Models: An In Vitro Study

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:5] [Pages No:1090 - 1094]

Keywords: Alexidine, Biofilm, Confocal laser scanning microscope, Enterococcus faecalis

   DOI: 10.5005/jp-journals-10024-2640  |  Open Access |  How to cite  | 


Aim: The aim of the study was to assess the antibacterial efficiency of a combination of 1% alexidine (ALX) and 5.25% sodium hypochlorite (NaOCl) against E. faecalis biofilm using a confocal scanning electron microscopy. Materials and methods: An estimated 120 human root dentin disks were prepared, sterilized, and inoculated with E. faecalis strain (ATCC 29212) to develop a 3-weeks-old biofilm. The dentin discs were exposed to group I—control group: 5.25% sodium hypochlorite (NaOCl) (n = 20); group II—1% ALX + 5.25% NaOCl (n = 40); group III—1% alexidine (ALX) (n = 40) (Sigma-Aldrich, Mumbai, India); group IV—negative control: saline (n = 20). After exposure, the dentin disks were stained with the fluorescent live/dead dye and evaluated with a confocal scanning electron microscope to calculate the proportion of dead cells. Statistical analysis was done using the Kruskal–Wallis and Mann–Whitney U test (p < 0.05). Results: The maximum proportion of dead cells were seen in the groups treated with the combination of 1% ALX + 5.25% NaOCl (94.89%) and in the control group 5.25% NaOCl (93.14%). The proportion of dead cells presented in the 1% ALX group (51.79%) and negative control group saline (15.10%) were comparatively less. Conclusion: The antibacterial efficiency of a combination of 1% ALX and 5.25% NaOCl was more effective when compared with 1% ALX alone. Clinical significance: Alexidine at 1% could be used as an alternative endodontic irrigant to chlorhexidine, as alexidine does not form any toxic precipitates with sodium hypochlorite. The disinfection regimen comprising a combination of 1% ALX and 5.25% NaOCl is effective in eliminating E. faecalis biofilms.



Hasna Ghaleb, Roula Akl, Elie Khoury, Joseph Ghoubril

Estimation and Comparison of the Duration of the Pubertal Peak in Skeletal Class II and Class I Subjects Using the Cervical Vertebrae Maturation Index Method

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:7] [Pages No:1095 - 1101]

Keywords: Cervical vertebrae maturation, Class I and class II subjects, Pubertal peak, Retrospective cross-sectional study, Skeletal age

   DOI: 10.5005/jp-journals-10024-2637  |  Open Access |  How to cite  | 


Aim: The purpose of this study is to estimate and compare the duration of the pubertal peak in skeletal class II and class I subjects and to detect any difference between boys and girls or between hypo-, normo-, and hyperdivergent subjects for skeletal maturation indicator (CVM) in white Caucasians. Materials and methods: 346 subjects were selected from 3,119 examined files. Pretreatment lateral cephalometric records were hand-traced and divided following the anteroposterior skeletal relationship, the gender, the vertical pattern, and the skeletal maturation. The duration of the pubertal peak was calculated based on the chronological age interval according to each group. The age of onset of the active growth and the duration of the pubertal peak were compared between the different groups studied. Results: Pubertal peak had a mean duration of 13 months in skeletal class I subjects, 19 months in skeletal class II subjects, 15 months in girls, 20 months in boys, 13 months in normodivergent and hypodivergent subjects, whereas in hyperdivergent subjects, it lasted 18 months. Conclusion: The growth interval corresponding to the pubertal growth spurt (CS3–CS4) was (1) significant between skeletal class I and class II subjects, (2) longer in boys, and (3) longer in hyperdivergent subjects. Clinical significance: Orthodontic treatments can start earlier for girls in class I or class II relationship and for hyperdivergent subjects as well. Furthermore, boys and subjects in class II skeletal relationship have a significantly longer duration of the pubertal peak and consequently a much efficient orthopedic and orthodontic treatment.



Bruno L Minervino, Maurício Barriviera, Marcelo de Morais Curado, Luiz G Gandini

MARPE Guide: A Case Report

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1102 - 1107]

Keywords: MARPE, Midpalatal suture, Rapid palatal expansion, Surgical guide

   DOI: 10.5005/jp-journals-10024-2649  |  Open Access |  How to cite  | 


Aim: This paper presents a prototyped surgical guide for placement of MARPE—mini-implant-assisted rapid palatal expander. Background: Investigations conducted in the last decades have increased the technological resources used in orthodontics. This scientific advance applies to several clinical procedures, including the planning of devices used in guided surgeries, using computed tomography images and intraoral scanning. Case description: This case report presents maxillary expansion in an adult patient (18 years and 5 months), using the MARPE technique, by virtual planning and fabrication of a surgical guide (laser-printed on a 3D printer MoonRay D225—SprintRay, 2014), after merging of 3 files: digital file of the expander (.stl), computed tomography of the suture, and intraoral scanning of the patient, using the planning software NemoStudio (version 20122, Conclusion: Fabrication of a surgical guide for the MARPE technique provides an accurate transfer of the virtual planning to the surgical procedure. It allows three-dimensional orientation of the expander position and perforations of mini-implants, which are necessary to establish anchorage in areas with sufficient bone, assuring the system stability and a successful procedure. Clinical significance: The mini-implant assisted rapid palatal expansion (MARPE) has been investigated as a promising option for correction of malocclusion related with maxillary atresia in adult patients and is an option to orthognathic surgery. Digital treatment planning is fundamental to establish individual, reproducible, and accurate parameters, as in the present case, which evidenced significant benefits in both occlusal and respiratory aspects.



Rola Al Habashneh, Maher A Walid, Tahani Abualteen, Mohammad Abukar

Socket-shield Technique and Immediate Implant Placement for Ridge Preservation: Case Report Series with 1-year Follow-up

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:10] [Pages No:1108 - 1117]

Keywords: Immediate implant, Ridge preservation, Socket-shield technique

   DOI: 10.5005/jp-journals-10024-2642  |  Open Access |  How to cite  | 


Aim: To evaluate the role of socket-shield technique for ridge preservation in immediate implant placement sites. Background: The socket-shield technique seems to be beneficial for ridge preservation despite its insufficient documentation. In this case report series, implants were placed immediately after extracting a hopeless teeth using this technique and then were followed up for 1 year to document functional and esthetic outcomes. Cases description: Five patients presented with a non-restorable teeth were treated using the socket-shield protocol and immediate implant placement. Roots were dissected in a mesiodistal direction along the long axis down to the apex; a periotome was later used to detach the palatal fragment of the root, while keeping the buccal one. Following sequential osteotomy drilling, implants were placed. The gap between the implant and the shield was filled with a synthetic bone grafting material. A customized healing abutment with an S-shaped emergence profile was prepared to support a coronal emergence profile of the tooth. Patients had follow-up visits after 6 weeks and 5 or 6 months before proceeding to prosthetic reconstruction phase. Screw-retained porcelain fused to metal crowns and titanium abutments were inserted intraorally with 35 N cm torque and screw-access holes were restored. Conclusion: The socket-shield technique along with immediate implant placement is a minimally invasive approach that can preserve the hard and soft tissue contour of the ridge and can be implemented in areas of high esthetic demands for better esthetic outcomes.



Janki Amin, Jordan Lines, Maxim P Milosevic, Andrew Park, Amar Sholapurkar

Comparison of Accuracy and Reliability of Working Length Determination Using Cone Beam Computed Tomography and Electronic Apex Locator: A Systematic Review

[Year:2019] [Month:September] [Volume:20] [Number:9] [Pages:6] [Pages No:1118 - 1123]

Keywords: Cone beam computed tomography, Endodontics, Odontometry, Root canal therapy

   DOI: 10.5005/jp-journals-10024-2651  |  Open Access |  How to cite  | 


Aim: To compare the accuracy and reliability of cone beam computed tomography (CBCT) and electronic apex locator (EAL) in determining the working length (WL). Background: A comprehensive literature search was conducted across several databases and gray literature. A total of 1,358 potentially relevant journal articles were identified with publication dates ranging from 1996 to 2017. After screening and applying the inclusion and exclusion criteria, five studies were identified as eligible for review. Data extraction was completed in two blinded pairs, cross-referenced and subsequently merged. Discrepancies were resolved through collaborator mediation. Meta-analysis was not undertaken due to heterogeneity between included studies. Review results: In all five studies, no statistically significant difference was found between CBCT and EAL measurements of WL. The reliability of CBCT compared with EAL was not determined. Conclusion: Due to significant heterogeneity between the included studies, the accuracy of CBCT compared to EAL couldn't be determined. Based on limited evidence, CBCT appeared to be as accurate as EAL. There was weak evidence suggesting that CBCT was reliable. Also the superiority of one method over the other could not be determined. These results should be interpreted judiciously. Further research is required to conclusively evaluate the accuracy and reliability of CBCT compared with EAL. Clinical significance: Preexisting CBCT scans may be appropriate for WL determination but acquiring a new CBCT for endodontic treatment is inadvisable due to cost and the as low as reasonably achievable (ALARA) principle.


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