The Journal of Contemporary Dental Practice

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2020 | May | Volume 21 | Issue 5

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H. K. Ramya, Shankaragouda Patil

Depression, Anxiety, and Psychological Distress among Health-care Providers During the Outbreak of the Life-threatening Coronavirus Disease (COVID-19)

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:2] [Pages No:471 - 472]

   DOI: 10.5005/jp-journals-10024-2836  |  Open Access |  How to cite  | 



Andrea Del Giudice

Possible Complications of Endodontic Treatments

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:2] [Pages No:473 - 474]

   DOI: 10.5005/jp-journals-10024-2811  |  Open Access |  How to cite  | 



Yiming Li, Elvin M Walemba, Krassimir N Bozhilov, Christopher Perry

Potential Penetration of CTAB- and MUDA-coated Gold Nanorods into Tooth Enamel

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:475 - 480]

Keywords: Confocal laser scanning microscopy, Enamel, Gold nanorods, Penetration, Scanning transmission electron microscopy

   DOI: 10.5005/jp-journals-10024-2834  |  Open Access |  How to cite  | 


Aim: Gold nanorods (GNRs) have gained interest as a promising carrier for antibiotics. Gold nanorods may reduce the development of antimicrobial resistance in certain microbial species. Although applications of GNRs to mitigate oral biofilms are under development, their use in the oral cavity may have adverse effects. The aim of this study was to evaluate the potential penetration of GNRs into the tooth enamel structure using confocal laser scanning microscopy (CLSM) and scanning transmission electron microscopy (STEM). Materials and methods: Our approach was to synthesize GNRs with cationic [cetyltrimethylammoniumbromide (CTAB)] and anionic [11-mercaptoundecanoic acid (MUDA)] surface coatings. We hypothesized that penetration would be surface coating-dependent. Results: Regardless of the chemical modification of the GNRs of size ∼20 nm × 8 nm, exposure of these materials did not result in superficial penetration into the enamel. Conclusion: Within the limitations of this study, it is concluded that the use of CLSM and STEM is a feasible approach to investigate the penetration of nanomaterials into the tooth structure. Clinical significance: Exposure of the enamel with chemically modified GNRs of size ∼20 nm × 8 nm will not result in superficial penetration into the enamel.



Thaís P Leandrin, Cristiane M Alencar, Keli R Victorino, Andrea AR Dantas, Reinaldo O Lima, Júlia C Martins, Joissi F Zaniboni, Edson A de Campos, Milton Carlos Kuga

Is α-Tocopherol or Sodium Ascorbate Effective as Antioxidant on Fracture Resistance of Bleached Teeth?

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:5] [Pages No:481 - 485]

Keywords: α-Tocopherol, Antioxidants, Hydrogen peroxide, Sodium ascorbate, Tooth bleaching

   DOI: 10.5005/jp-journals-10024-2831  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of two antioxidant formulations (sodium ascorbate and α-tocopherol) on fracture resistance of endodontically treated teeth. Materials and methods: Sixty human premolars were endodontically treated and divided into six groups (n = 10): G1 (negative control)—unbleached and restored with composite resin; G2 (positive control)—bleached in three sessions, using hydrogen peroxide (15 H2O2) plus titanium dioxide (TiO2) nanoparticles, photoactivated by LED laser system and restored with composite resin; G3—bleaching similar to G2, after the use of 10% sodium ascorbate gel for 24 hours and restored with composite resin; G4—similar to G3, but with the use of 10% sodium ascorbate solution and restored with composite resin; G5 and G6—similar to G3, but with the use of 10% α-tocopherol in alcohol or carbopol, respectively, and was also restored. A mechanical fracture resistance test was performed and the Kruskal-Wallis test was used to evaluate the results (α = 0.05). Results: No statistical difference was observed in fracture resistance between groups (p > 0.05). Regarding the antioxidant and pharmaceutical formulation applied, no statistical difference was detected in any comparison (p > 0.05). The frequency of fractures considered favorable was higher in G1 and G3 compared to the other groups. Conclusion: The endodontically treated teeth bleached with 15 H2O2 plus TiO2 nanoparticles and photoactivated with the LED laser did not decrease the fracture resistance and the use of sodium ascorbate or α-tocopherol did not increase the crown fracture resistance. Clinical significance: The literature reports a significant reduction in the bond strength of restorations on the bleached dentin. Therefore, the use of antioxidant agents may have a promising effect on fracture resistance of endodontically treated teeth.



Amol R Gadbail, Shailesh Gondivkar, Rahul Anand

Transverse Ridge of Premolars and Oblique Ridge of Maxillary Molars are in Divine Golden Ratio

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:486 - 489]

Keywords: Golden ratio, Maxillary molars, Oblique ridge, Premolars, Tooth morphology, Transverse ridge

   DOI: 10.5005/jp-journals-10024-2783  |  Open Access |  How to cite  | 


Aims: In premolars and molars, transverse ridge (TR) and oblique ridge (OR) play major roles in providing strength and stability to the cusps in particular and tooth as a whole. Hence, they could be divided at the central groove or the transverse groove in a divine golden ratio. Materials and methods: Twenty pairs of maxillary and mandibular casts were retrieved from the Department of Orthodontics. The lengths of buccal triangular ridge (BTR), lingual triangular ridge (LTR) and TR of maxillary and mandibular first and second premolars were measured. Similarly, lengths of distal cuspal ridge of mesiopalatal cusp, triangular ridge of distobuccal cusp (DBTR) and OR of the maxillary first and second molars were measured using a brass wire and a Vernier caliper. The TR:BTR, BTR:LTR, OR:distal ridge of mesiopalatal cusp (MPDR), and MPDR:DBTR ratios were calculated to find out the possibility of golden ratio. Results: Transverse ridges of the premolars and OR of the maxillary first and second molars were divided at the central groove in a divine golden ratio. The mean TR/BTR ratio for maxillary first premolar was 1.61 ± 0.007, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. The mean TR/BTR ratio for maxillary second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.62 ± 0.04. The TR/BTR and BTR/LTR ratios for mandibular first premolar were 1.6 ± 0.008 and 1.64 ± 0.02, respectively. Similarly, the mean TR/BTR ratio for mandibular second premolar was 1.61 ± 0.01, whereas the mean BTR/LTR ratio was 1.63 ± 0.02. Conclusion: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. Clinical relevance: The ORs of maxillary first molar ridge and TR of maxillary and mandibular premolars are divided into two parts at transverse and central grooves, respectively, in a divine ratio. This signifies the strength and stability of the occlusal table in the posterior teeth, as the golden ratio is the mark of functional excellence. Golden ratio should be taken into consideration while restoration or fabrication of the posterior teeth.



Yasser T Mohammed, Iman M Al-Zaka

Fracture Resistance of Endodontically Treated Teeth Obturated with Different Root Canal Sealers (A Comparative Study)

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:490 - 493]

Keywords: AH Plus, Bioceramic, Fracture resistance, GuttaFlow 2, MTA-Fillapex, Root

   DOI: 10.5005/jp-journals-10024-2841  |  Open Access |  How to cite  | 


Aim: The aim of this study is to compare the effect of different root canal sealers on the fracture resistance of endodontically treated teeth using AH Plus, GuttaFlow 2, MTA-Fillapex, and TotalFill® BC™ sealers. Materials and methods: Sixty single-rooted mandibular premolar teeth were used in the study. After the decoronation of the crowns of the teeth, we got a 13 mm root length. All samples instrumented using ProTaper Next system reaching file size ×4 as the final master apical file. Gutta-percha (GP) with single cone as obturation technique was carried out to all experimental teeth. Then, the teeth was divided into five groups (n = 12) based on the type of sealer to be used. Group I: AH Plus sealer + GP, Group II: GuttaFlow 2 sealer + GP, Group III: MTA-Fillapex sealer + GP, Group IV: TotalFill BC sealer + GP, and Group V: control (instrumented but unobturated teeth). Embedding all teeth in acrylic resin blocks was carried out and fracture force was measured using a universal testing machine (Instron Corp., Canton, MA, USA) by using metal-like spreader tip on 0.5 mm/m speed. Then, the data were statistically evaluated using one-way analysis of variance (ANOVA) and post hoc test (Tukey's test). Results: Group IV showed higher resistance to fracture than other groups significantly. There was a nonsignificant difference in fracture force between Group I, Group II, and Group III. Group V showed the least fracture resistance than other groups. Conclusion: Based on this in vitro study, TotalFill bioceramic-based sealer was more effective when compared with other sealers and the unobturated group showed the lowest mean fracture resistance. Clinical significance: The use of bioceramic sealer with BC cones enhanced the fracture resistance of endodontically treated teeth.



Mallapragada Siddharth, Radhika Gupta, Shanta Shree, Komal Sharma

Comparative Evaluation of Subgingivally Delivered 2% Curcumin and 0.2% Chlorhexidine Gel Adjunctive to Scaling and Root Planing in Chronic Periodontitis

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:494 - 499]

Keywords: Chlorhexidine gel, Chronic periodontitis, Curcumin gel, Local drug delivery

   DOI: 10.5005/jp-journals-10024-2828  |  Open Access |  How to cite  | 


Aim: This study aimed to compare the effects of subgingival delivery of 2% curcumin gel and 0.2% chlorhexidine gel as an adjunct to scaling and root planing (SRP) on clinical and microbiological parameters in the management of patients with chronic periodontitis. Materials and methods: In total, 25 systemically healthy individuals with age group ≥30 years diagnosed with chronic periodontitis were included in the study. The study was a double-blind split-mouth randomized control clinical trial. Two sites were selected in each patient and were randomly allocated to experimental and control sites. At baseline, measurements of site-specific periodontal parameters and collection of subgingival plaque sample were done. After full-mouth SRP, subgingival delivery of 2% curcumin gel in experimental sites and 0.2% chlorhexidine gel in control sites was done. At 1 and 3 months, subgingival plaque samples were collected again and site-specific periodontal parameters were measured. Results: The experimental group (2% curcumin gel) showed statistically significant improvements in periodontal [i.e., sulcus bleeding index (SBI), probing pocket depth (PPD), and relative attachment level (RAL)] and microbiologic parameters in the form of colony forming units (CFUs) in comparison with control group (0.2% chlorhexidine gel). Conclusion: Subgingival delivery of curcumin has shown effective anti-inflammatory and antibacterial properties. Since it is biologically accepted by the patients and its delivery in periodontal pockets can be recommended as an adjunct to SRP therapy for the treatment of patients with localized, moderate chronic periodontitis and in patients under the periodontal maintenance phase. Clinical significance: Curcumin being a herbal agent may be excellent alternative to chlorhexidine. It is biologically accepted by the patients and can be recommended as an adjunct to SRP in the treatment of localized moderate chronic periodontitis and periodontal maintenance patients.



Eman Abu-obaid, Fouad Salama, Ala’a Abu-obaid, Fars Alanazi, Mounir Salem, Sayed Auda, Thamer Al Khadra

Comparative Evaluation of the Antimicrobial Effects of Different Mouthrinses against Oral Pathogens: An In Vitro Study1

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:9] [Pages No:500 - 508]

Keywords: Chlorhexidine, Lactobacillus, Microbiology, Mouthrinses, Streptococcus mutans

   DOI: 10.5005/jp-journals-10024-2832  |  Open Access |  How to cite  | 


Aim: To assess the antimicrobial effects of natural and semi-natural mouthrinses on isolates of Streptococcus mutans, Lactobacillus fermentum, and Lactobacillus casei obtained from the saliva samples and their reference strains. Materials and methods: Natural and semi-natural mouthrinses included in this study were herbal mix mouthrinse, cranberry mouthrinse, chlorhexidine digluconate mouthrinse, cranberry extract mixed with chlorhexidine digluconate mouthrinse, chlorhexidine digluconate mouthrinse with alcohol (positive control), and distilled water (negative control). The microbiological examination tests were minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and zone of inhibition test for the saliva isolates of S. mutans, L. fermentum, and L. casei while zone of inhibition test only for their reference strains. Result: Compared with distilled water, herbal mix, cranberry, cranberry mixed with chlorhexidine, chlorhexidine with alcohol (+), and chlorhexidine mouthrinses were associated with a significant increase of the zone of inhibition 34.354, 34.255, 34.219, 10.801, and 9.386, respectively. Both MIC and MBC were significantly higher in the cranberry mixed with chlorhexidine than in chlorhexidine with alcohol. The MIC and MBC of mouthrinses were significantly lower in the S. mutans and L. fermentum than in L. casei. Conclusion: Herbal mix and cranberry mouthrinses could be effective natural alternative to chlorhexidine mouthrinse with or without alcohol in improving oral health. Clinical significance: Different mouthrinses proposed in this study showed antimicrobial effects against the tested oral pathogens, and possibly the tested mouthrinses will lead for future formulation of natural or semi-natural pharmaceutical mouthrinses.



Monica Loyaga-Castillo, Roger D Calla-Poma, Rubén Calla-Poma, Margarita F Requena-Mendizabal, Pablo A Millones-Gómez

Antifungal Activity of Peruvian Banana Peel (Musa paradisiaca L.) on Candida albicans: An In Vitro Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:509 - 514]

Keywords: Antifungal, Banana, Candida albicans, Hydroethanolic extract, Musa × paradisiaca, Oral candidiasis

   DOI: 10.5005/jp-journals-10024-2827  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to compare the antifungal activity of three concentrations of a hydroethanolic extract of the Musa × paradisiaca peel against Candida albicans strain ATCC 10231. Materials and methods: The agar diffusion method was used, and the culture medium used was Sabouraud agar. Petri dishes were prepared with concentrations of 10, 30, and 50% of hydroethanolic extract of the M. × paradisiaca peel; nystatin was used as a positive control, and 96% ethanol was used as a negative control. After 24 hours of incubation, each plate was examined, and the diameters (mm) of the growth inhibition halos were measured around each well using a digital vernier caliper. Results: The results showed that the antifungal activity of the extract varied, depending on the concentration, as shown using analysis of variance (ANOVA; p < 0.05). When comparing the different concentrations, it was found by Duncan test that the greatest activity was obtained at 50%. Conclusion: It was concluded that the hydroethanolic extract of M. × paradisiaca at 50% exerted a greater antifungal effect on the strain of C. albicans than did the extract at lower concentrations. Clinical significance: By knowing the antimicrobial effect of M. × paradisiaca, this substance can be effectively used in products aimed to cure candidiasis infection.



Abdulelah M BinMahfooz, Mohammed A Sindi, Tala H Alsohaibi, Hala H Jabbad, Aiman O Johar

Effect of Apical Root Canal Perforation Size on Push-out Bond Strength of Glass Fiber Dowels

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:515 - 520]

Keywords: Adhesive resin cement, Fiber post, Mineral trioxide aggregate, Root canal treatment

   DOI: 10.5005/jp-journals-10024-2793  |  Open Access |  How to cite  | 


Aim: To evaluate in vitro the effect of apical root canal perforation size on push-out bond strength of glass fiber dowels cemented to sound or perforated root canals using two different adhesive systems. Materials and materials: A total of 120 human-extracted intact upper central incisors were selected. Teeth were sectioned 3 mm coronal to cement enamel junction, and the remaining root received endodontic root canal therapy. The roots were divided into two experimental groups according to the root condition: either sound (n = 40) or apically perforated (n = 80). Dowel spaces were prepared for all specimens to a depth of 10 mm. Roots were restored with glass fiber dowels. The experimental group was further subdivided into four subgroups (n = 20) according to the adhesive system used and apical perforation size: group I, perforated root 2 mm apically, dowel cemented using total-etch adhesive cement; group II, perforated root 2 mm apically, dowel cemented using self-etch adhesive cement; group III, perforated root 4 mm apically, dowel cemented using total-etch adhesive cement; and group IV, perforated root 4 mm apically, dowel cemented using self-etch adhesive cement. The control group, sound root, was divided into two subgroups: group I, sound root, dowel cemented using total-etch adhesive cement, and group II, sound root, dowel cemented using self-etch or total-etch adhesive cement. Each root was then cut horizontally, and root segments were prepared to be tested. The bond strength between dowel and dentin was measured with universal testing machine using a push-out test. The two-way analysis of variance (ANOVA) was used to analyze the data and post hoc Tukey's test (α = 0.05). Results: Root canal perforation and the type of adhesive system used resulted in significant differences in push-out bond strength (p < 0.05). Regardless of root canal perforation size, glass fiber dowels in normal root canals had significantly higher mean bond strength values (9.2 ± 1.4 MPa) compared with perforated root canals (6.1 ± 1.4 MPa). Also, self-etch protocol had significantly higher mean bond strength values (9.1 ± 1.3 MPa) compared with total-etch protocol (6.2 ± 2.1 MPa). Conclusion: The apical root perforation size caused a direct effect on the bond strength of the glass fiber dowels cemented to dentin by reducing the bond strength values to the root dentin regardless of the adhesive system used. Clinical significance: Prior to perforation repair, dentist or endodontist should evaluate the perforation size to predict the treatment outcome.



Mellekatte C Neetha, Mamatha G Panchaksharappa, Shashikala Pattabhiramasastry, Nandish V Shivaprasad, Usha G Venkatesh

Chemopreventive Synergism between Green Tea Extract and Curcumin in Patients with Potentially Malignant Oral Disorders: A Double-blind, Randomized Preliminary Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:11] [Pages No:521 - 531]

Keywords: Chemoprevention, Curcumin, Green tea extract, Oral potentially malignant disorders, Randomized preliminary study, Synergistic effect

   DOI: 10.5005/jp-journals-10024-2823  |  Open Access |  How to cite  | 


Aim: The aim of the study was to assess the synergistic effect of green tea extract and curcumin in patients with oral potentially malignant disorders (OPMDs) and to ascertain the mechanism of action of these chemopreventive agents through assessment of suitable biomarkers. Materials and methods: Subjects with OPMDs (n = 60) were randomized to receive green tea extract [topical + systemic (800 mg/day)] or curcumin [topical + Systemic (950 mg/day)] or a combination therapy with 20 patients in each group for 3 months. Biomarkers (Ki67, cyclin D1, and p53) were evaluated in baseline and 12-week biopsies. Results: The clinical response rate observed in OPMDs was higher in the combination group (n = 13; 65%) as compared to the curcumin (n = 11; 55%) and the green tea extract group (n = 7; 35%) and was statistically highly significant. Treatment medications also improved histological grades, although not statistically significant. All the study drugs were well tolerated by patients and did not raise any safety concerns. There was statistically significant (p < 0.01) downregulation of p53, Ki67, and cyclin D1 expression at 3 months as compared to baseline in the combination group. Conclusion: Treatment of OPMDs with curcumin and green tea extract combination demonstrated a significant clinical response supported by downregulation of molecular biomarkers in the short-term (12 weeks). The present results warrant a long-term clinical testing of green tea and curcumin combination for oral cancer prevention. Clinical significance: Chemoprevention is a promising treatment strategy to reverse, stabilize, or arrest progression of these OPMDs. Use of natural dietary agents like green tea and curcumin, which are readily available, have low toxicity, and more importantly demonstrate a synergistic effect, is an attractive alternative in the chemoprevention of oral cancer. The assessment of biomarkers has helped us to understand the mechanism of action of these chemopreventive agents.



Mohammed S Al-Akhali

Performance of Dental Students and Interns in the Motivation and Verbal Delivery of Oral Hygiene Instructions in Dental Practice

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:7] [Pages No:532 - 538]

Keywords: Delivering, Dental hygiene, Motivation

   DOI: 10.5005/jp-journals-10024-2819  |  Open Access |  How to cite  | 


Aim: The aim of this survey was to evaluate the ability of dental students and interns to deliver oral hygiene instructions. Materials and methods: This survey targeted patients aged 17–67 years who sought different dental treatments performed by final (sixth)-year dental students or dental interns. Both patients and therapists participated in filling out the questionnaire. The questionnaire included an exploration of the ability of therapists to prescribe dental hygiene aids commonly used in oral hygiene dentistry. Results: In total, 150 patients and 150 therapists of both genders participated in this survey. The results showed that 47.3% of all therapists taught the patients the brushing technique; however, only 20% of the therapists reinforced oral hygiene instructions. Similarly, only 26% of therapists instructed their patients to renew their toothbrushes regularly, and 34% of the therapists instructed the patients on using dental floss. Only 32% of therapists prescribed a mouthwash to their patients, and 40.7% of the therapists used a disclosing agent. The difference was highly significant between students and interns in all the above activities, in favor of the dental students. Conclusion: The result shows a low level of therapist's performance, both students and interns, in delivering oral hygiene instructions to their patients. Clinical significance: Dental students and interns take a big responsibility in motivation and delivery of oral hygiene instructions in dental clinics to their patients. Evaluate the performance of students and interns in delivering oral health instructions in dental clinics will facilitate establish oral health programs to ensure improve the performance of therapists in motivation and delivering the oral hygiene instructions and therefore increase the ability of patients to respond.



Marco Seracchiani

Centering Ability of a New Nickel–Titanium Rotary Instruments with a Peculiar Flat-side Design: An In Vitro Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:539 - 542]

Keywords: Canal centering ability, Canal transportation, Endodontics, NiTi rotary instrument, Root canal shaping

   DOI: 10.5005/jp-journals-10024-2829  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to investigate the role of the flat design compared with a non-flat designed instrument on the centering ability in a simulated root canal system. Materials and methods: Two file systems were chosen: the F-One (Fanta Dental, Shanghai, China) and a prototype with the same design but without the flat-side design. A total of 50 simulated L-shaped root canals in resin blocks were shaped with a new instrument each. Pre- and post-canal preparation images were captured and superimposed to measure and compare the canal transportation and evaluate the centering ability of each file. The t test was performed and the level of significance was set at p < 0.05. Results: Prototype files removed significantly less resin from the inner and the outer parts of the canal and showed significantly higher mean transportation values. Conclusion: It can be concluded that the F-One file system demonstrated better shaping ability compared with the prototype file system in L-shaped resin-simulated canals. Clinical relevance: The present study showed the safety of the flat-side design, minimizing the risk of iatrogenic errors such as ledging, perforation, or zipping of the root canal.



Bashaer Altwaim, Fouad Salama, Shahad Alogayyel

Effect of Probiotic Mouthrinses on Surface Microhardness of Esthetic Restorative Materials

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:543 - 548]

Keywords: Laboratory research, Microhardness, Mouthrinse, Probiotic, Restorative materials

   DOI: 10.5005/jp-journals-10024-2809  |  Open Access |  How to cite  | 


Aim: To assess the influence of three probiotic mouthrinses on the microhardness of three esthetic materials used for teeth restorations. Materials and methods: Thirty specimens of each material: conventional glass ionomer cement (GIC), resin-modified glass ionomer, and resin composite were randomly assigned to three groups. Surface microhardness was measured at baseline. The specimens were immersed in probiotic mouthrinses, group I: (P2 probiotic power), group II: (Probioclean), and group III (BōKU natural). Microhardness was measured after 21 and 63 minutes of immersion which is comparable with 3 and 9 weeks of mouthrinse use every day, respectively. Measurements of microhardness were completed using Micro Vickers testing machine with a 200 g load applied for a duration of 15 seconds. Results: The microhardness change of the three restorative materials reveled statistically significant differences in all mouthrinse groups (p = 0.001). BōKU natural mouthrinse decreased microhardness significantly in all restorative materials (p < 0.05). However, Probioclean mouthrinse was associated with an increase in microhardness in all restorative materials. The effect of P2 probiotic power mouthrinse varied depending on time cycles and the restorative material. The mean difference in mouthrinse groups of resin composite was highest in BōKU natural at immersion time of 63 minutes. While no mean difference was seen in P2 probiotic power group at immersion time of 21 minutes which had no effect on the microhardness of resin composite. Conclusion: Surface microhardness was affected by immersion in probiotic mouthrinses. The BōKU natural mouthrinse had the highest reduction, while resin composite showed the least change in surface microhardness. Clinical significance: There is lack of studies that investigated the effect of probiotics mouthrinses on the surface properties of restorative materials. This study showed evidence that some of the tested probiotic mouthrinses in this study decreased the microhardness of the tested tooth-colored restorative materials after immersion for 21 and 63 minutes which is equivalent to 3 and 9 weeks of everyday use.



Dunia Al Hadi, Sana Parekh, Warda Naeem, Alexander , Simy Mathew

Detection of Vertical Root Fractures Using Three Different Imaging Modalities: An In Vitro Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:5] [Pages No:549 - 553]

Keywords: Cone beam computed tomography, Laboratory research, Root canal treatment, Vertical root fractures

   DOI: 10.5005/jp-journals-10024-2839  |  Open Access |  How to cite  | 


Background: The diagnosis of nondisplaced longitudinal fractures [vertical root fractures (VRFs)] is challenging in clinical practice. Radiographic techniques showed a difficulty in detection of VRFs. Cone beam computed tomography (CBCT) is a new diagnostic imaging modality that provides high-quality three-dimensional (3D) images for dental diagnosis. Aims: The aim of this in vitro study is to compare accuracy of three different imaging modalities: conventional periapical radiographs, digital radiographs, and CBCT in detecting VRFs in teeth that are endodontically as well as non-endodontically treated. Materials and methods: An in vitro model consisting of 60 recently extracted human mandibular lower premolars were used. Root canal treatment was carried out for 30 teeth. Root fractures were created in 30 teeth (15 root canal treated and 15 non-treated) by mechanical force. Other 30 teeth remain intact. The teeth were mounted and images were taken with a periapical, digital, and CBCT X-ray unit. Three endodontists separately evaluated the images. Results: Interobserver κ values showed a very good interobserver agreement (0.98 for CBCT, 0.88 for digital, and 0.93 for conventional periapical X-rays). There was an overall statistically significant difference (p = 0.00) in detecting of root fracture among the three imaging modalities and the highest accuracy with CBCT images. Conclusions: In in vitro model, CBCT scan appears to give the highest accuracy in detecting VRFs when compared with the periapical systems in both endodontically and non-endodontically treated teeth. Clinical significance: The CBCT scan shows higher sensitivity in detection of VRFs in comparison with periapical images.



Rohit Singh, Prabu Mahin Syed Ismail, Vinod Kambli, Khaidem Deba Singh

Evaluation of Hydroxyapatite Granules, CERAMENT™, and Platelet-rich Fibrin in the Management of Endodontic Apical Surgery

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:554 - 557]

Keywords: Apical surgery, CERAMENT™, Hydroxyapatite, Platelet-rich fibrin

   DOI: 10.5005/jp-journals-10024-2825  |  Open Access |  How to cite  | 


Aim: The present study compared hydroxyapatite granules, CERAMENT™, and platelet-rich fibrin (PRF) in the management of endodontic apical surgery cases. Materials and methods: The present study was conducted on 126 patients requiring apical surgery of both genders. Patients were treated with hydroxyapatite granules, CERAMENT™, and PRF and were recalled regularly for assessment of pain, mobility, presence or absence of sinus, and healing site. Results: The mean days taken for the disappearance of pain in group I was 51.2 days, in group II was 52.3 days, and in group III was 44.7 days. The difference was significant (p < 0.05). There was a less number of draining sinuses in II and III groups. This was statistically significant (p < 0.05). Significantly less area remained after surgical intervention in groups II and III compared to group I recorded at follow-up period. The difference was significant (p < 0.05). Conclusion: Authors found PRF superior in terms of reducing pain, mobility, and sinus and improving the healing site as compared to hydroxyapatite and CERAMENT™. Clinical significance: Platelet-rich fibrin is considered more superior in terms of reducing pain, mobility, and sinus and improving the healing site, and it can be advised in clinical practice for endodontic management.



Reem A Alansari, Abdullah S Kaki

Knowledge of Signs, Symptoms, Risk Factors, and Complications of Obstructive Sleep Apnea among Dental Interns

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:558 - 561]

Keywords: Awareness, Dental interns, Obstructive sleep apnea, Saudi

   DOI: 10.5005/jp-journals-10024-2801  |  Open Access |  How to cite  | 


Dentists are uniquely positioned to identify patients at risk of obstructive sleep apnea (OSA) and its complications. However, previous reports have shown that the average general dentist possesses insufficient knowledge about the clinical manifestations and complications of OSA. Aim: The purpose of this study was to examine Saudi dental interns’ knowledge related to the clinical manifestations and impact of OSA. Materials and methods: This was a cross-sectional study using a self-administered questionnaire to assess the interns’ knowledge related to the symptoms, signs, diagnosis, risk factors, and complications of OSA in adults and children. Results: The average of the proportions of factually correct participant responses of the questionnaire categories was 47%. Participants did best in the category of questions related to predisposing factors (50% of questions were answered correctly), but less than 50% of questions were answered correctly in other OSA-related areas. Most participants scored 49% or lower in this questionnaire. Conclusion: Saudi dental interns had poor knowledge related to OSA. This may relate to the insufficiency of teaching sleep-related topics in dental curricula, among other reasons. Clinical significance: Given the potential impact of OSA on cardiovascular health, metabolic syndrome, and other public health problems, it is important to remedy this knowledge gap and empower future physicians with the knowledge required to participate in detecting OSA patients and referring them for evaluation.



Sharashchandra M Biradar, Ambika Y Patil, Santosh S Kotnoor, Shraddanand Bacha, Shobha C Bijjaragi, Puttaraj Tukaram Kattimani

Assessment of Diverse Frenal Morphology in Primary, Mixed, and Permanent Dentition: A Prevalence Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:6] [Pages No:562 - 567]

Keywords: Labial frenum, Mixed dentition, Permanent dentition, Primary dentition, Syndromes

   DOI: 10.5005/jp-journals-10024-2794  |  Open Access |  How to cite  | 


Aim: The maxillary labial frenum is a normal anatomic structure with inherent morphological variations. It has various morphologies and types depending on the attachment of fibers. This study was conducted to access the frenal morphology and frenal attachment in primary, mixed, and permanent dentition. Materials and methods: This study includes 1,800 patients, in which 969 were males and 831 females, with 3–17 years of age and is equally divided into primary, mixed, and permanent according to age and dentition of patients. Morphology of maxillary labial frenum was examined and classified according to Sewerin's frenum typology and type of frenal attachment according to Placek's attachment. Data collected were entered into SPSS version 16 and were subjected to statistical analysis. Results: Simple frenum is most prevalent in all the age groups followed by persistent tectolabial frenum (PTF) in primary dentition, frenum with a nodule in mixed dentition, and frenum with an appendix in permanent dentition. Type III frenal attachment is found in primary dentition followed by type II and type I in mixed and permanent dentition, respectively. There is a highly statistically significant difference in the type of frenal morphology and frenal attachment in all groups of dentition. Conclusion: The prevalence of simple frenum is increasing from primary dentition to permanent dentition, whereas PTF decreases as age increases. This study reveals a high prevalence of gingival attachment followed by papillary attachment. Clinical significance: The examination of frenal morphology and attachment is important before planning for any dental procedures to rule out the misdiagnosis and unnecessary surgical interventions.



Mohammed A AlSarhan

Knowledge and Prescription Habits Toward Preoperative Antibiotics in Implant Dentistry: A Survey Analysis in a Subset of Dentists in Saudi Arabia

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:7] [Pages No:568 - 574]

Keywords: Antibiotics, Habits, Implants, Preoperative, Saudi Arabia

   DOI: 10.5005/jp-journals-10024-2798  |  Open Access |  How to cite  | 


Aim: To investigate and evaluate current knowledge and habits in prescribing preoperative antibiotic, and toward specific practice situations, in a subset of dental practitioners performing routine dental implant surgery in Saudi Arabia. Materials and methods: A cross-sectional questionnaire-based study was developed, and relevant information was gathered through a web-based survey from a dentist who performed surgical implant placement. Participant demographics, clinical experience, and educational background were obtained. Factors related to knowledge and practice of preoperative antibiotics prescription and relevant information were collected. Descriptive statistics (frequencies and percentages) were used to describe the categorical variables. Pearson's Chi-square test was used to compare the distribution of the categorical responses across specific survey variables. A p value of ≤ 0.05 was used to report the statistical significance of the responses relative to prescription habits. Results: A total of 156 dentists participated in this study. Majority of the study sample was periodontists (70.5%, n = 110). About 63.5% of the study subjects do not prescribe prophylactic antibiotics. Private practitioners prescribed more antibiotics preoperatively (p = 0.019), while public and academic practitioners were in favor of developing guidelines toward antibiotics prescriptions (p = 0.009). Furthermore, a statistically significant difference was found between private and no private practitioners toward possible adverse complications when prescribing multidose antibiotics (p = 0.014). Conclusion: Various factors influence the knowledge and prescription habits toward prophylactic antibiotics among dental practitioners in routine dental implant procedures. The variability and conflicting practices require the attention of health-care legislations and stakeholders, locally and globally, to improve antibiotics prescription habits. Furthermore, large-scale interventions, prescription stewardship programs, and collaborative work between professional and scientific organizations may be beneficial to address areas of concern. Clinical significance: Strategic policies and stewardship programs toward antibiotic prescription among dental practitioners may benefit in reducing the unjustified or misuse of these medications. Subsequently, this could minimize the potential development of bacterial resistance and unwanted events that might complicate the management of straightforward dental implant cases.



Avanindra Kumar, Tanoj Kumar, Abhinav Jha, Jay Kishore, Akash D Barua, Priyadershini Rangari

Cariostatic Efficacy of Aqueous and Ethanolic Extracts of Liquorice in the Schoolchildren: In Vivo Comparative Study

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:5] [Pages No:575 - 579]

Keywords: Antimicrobials, Glycyrrhiza glabra, Hexigel, Liquorice gel, Streptococcus mutans

   DOI: 10.5005/jp-journals-10024-2792  |  Open Access |  How to cite  | 


Aim: The present study was done to evaluate the in vivo cariostatic efficacy of aqueous and ethanolic extracts of liquorice to ascertain whether it could be developed into a caries-preventive regimen basically targeted for use in the pediatric population. Materials and methods: Thirty schoolchildren of 6–12-year-old were selected for the study. Powder of Glycyrrhiza glabra is used to prepare the gel with various concentration of aqueous and ethanolic liquorice gel. The preweighed dose was delivered through the vials. The drug concentrations were based on their respective minimum bactericidal concentration (MBC) values against Streptococcus mutans, which were calculated earlier. And it is divided into three groups, i.e., group I: aqueous liquorice extract 1.75 g/10 mL saline, group II: ethanolic liquorice extract 350 mg/10 mL, and group III: hexidine (0.2% chlorhexidine, CHX). For statistical analysis, Tukey's post hoc with one-way analysis of variance (ANOVA) and t test were applied. Results: It was found that hexigel has a potential antibacterial activity against S. mutans, with minimum inhibitory concentration (MIC) of 3.14 ± 2.02. Ethanolic liquorice shows MIC of 2.15 ± 0.91 and aqueous liquorice shows MIC of 1.30 ± 1.08. Tukey's post hoc test showed statistically nonsignificant difference between hexigel and ethanolic liquorice against S. mutans. Conclusion: On conclusion, the present study found that hexigel was better than both the ethanolic and aqueous solutions of liquorice. And ethanolic liquorice was found to be better than aqueous solution, but it was not statistically significant, which could be due to the small sample size. Clinical significance: Dental caries is one of the most common infectious microbial diseases. Various steps have been taken to prevent dental caries, fluoride being the most common among them. Nowadays, G. glabra, commonly known as liquorice (mulethi), is one such medicinal plant used by various cultures for thousands of years to relieve coughs, sore throats, and gastric inflammation. This drug in our study demonstrated inhibitory effect on the growth of S. mutans.



Oral Disease Risk Assessment in Conjunction with Comprehensive Periodontal Care: A Case Report

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:5] [Pages No:580 - 584]

Keywords: Caries risk, Cariogram, Case report, Periodontal risk assessment

   DOI: 10.5005/jp-journals-10024-2843  |  Open Access |  How to cite  | 


Aim: To illustrate the treatment of a complex periodontal disease patient utilizing oral disease risk assessment. Background: Periodontal disease is multifactorial in nature and requires addressing multiple factors in order to manage it successfully. Maintenance care is crucial for a favorable outcome, and risk assessment may help formulate the most suitable treatment plan and maintenance program. Case description: A 37-year-old man presented at the clinic for comprehensive periodontal treatment prior to replacing his missing teeth. He was healthy but smoked 5–10 cigarettes per day. Based on the clinical and radiographic examinations, the patient had generalized advanced periodontitis with multiple caries lesions, defective fillings, and missing teeth. A comprehensive treatment plan was put for the patient and a detailed assessment of his periodontal disease and caries risk was performed. The patient was assigned as being of high risk for periodontal disease progression and of low-medium caries risk. Three months following execution of the proposed nonsurgical and surgical treatment procedures, the patient demonstrated notable improvement compared to the baseline and was put under a strict maintenance program every 3 months. Conclusion: The presented case illustrates how oral disease risk assessment measures may be incorporated within comprehensive management of a periodontitis patient. Recommending this approach remains a personal preference and is yet to be substantiated by evidence. Clinical significance: Incorporating risk assessment measures in daily clinical practice may prevent the onset and/or progression of future disease, reducing unnecessary effort and expenses, and should be evaluated by concerned policymakers.



Shrikanth Muralidharan, Sangeeta Mahendrakar, Abhinav Talekar, Aditi A Kanitkar, Aneesh Kanitkar

Oral Health-related Quality of Life in HIV: A Systematic Review

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:8] [Pages No:585 - 592]

Keywords: HIV, Oral health, Quality of life

   DOI: 10.5005/jp-journals-10024-2833  |  Open Access |  How to cite  | 


Aim: To systematically evaluate the literature evidence related to oral health and quality of life (QoL) among HIV-positive adults. Background: The oral health-related quality of life (OHRQoL) is an essential entity to be measured for understanding the domains affected due to oral health problems. HIV comes with an array of complexities in the oral cavity and is also reflection of the systemic illness of the oral cavity. Hence, it is essential to know the area affected and also the lesions that contribute the most to decrease the QoL in this aspect. A systematic review was carried out in relation to studies across PubMed and Google Scholar regarding HIV and OHRQoL from January 1970 to May 2019. Of the 1,374 articles screened, 11 studies were filtered for the final review. Review results: The physical domain followed by the psychological domain is the most affected in the HIV-positive patients. The maximum effect is due to dental caries and periodontitis. No studies report about oral substance abuse and its effect. Conclusion: Studies are further needed on a larger sample size and on similar scales and parameters to ensure greater evidence for intervention related to areas that should be focused upon for improving the QoL of HIV-positive patients. Clinical significance: There is a greater need to include quality-based assessment while treating HIV-positive people. Also not just physical indicators like pain or dental caries, even social indicators like mental and social dimensions of a patient's life should be included while deciding the treatment approach.



Ahmad Y Imam, Raghad A Al-Dabbagh

Angled Abutment Transfer Jig: A Technical Report

[Year:2020] [Month:May] [Volume:21] [Number:5] [Pages:4] [Pages No:593 - 596]

Keywords: Angled abutment, Implant, Technical report, Transfer jig

   DOI: 10.5005/jp-journals-10024-2821  |  Open Access |  How to cite  | 


Aim: To introduce an angled abutment transfer jig that splints abutments securely together to facilitate easy and quick orientation. Background: Transferring angled abutments from cast to patients’ mouth could be tasking and time-consuming. Transfer jigs are often used to facilitate orientation of abutments into implant fixtures. However, with the available jigs, abutments could move out of place and thus pose a hassle in repositioning. Technique: This technical report introduces an angled abutment transfer jig that consists of two impression copings screwed onto angled abutments which are splinted together with red acrylic resin. Access to abutment screws is feasible through slots created in the impression copings. Conclusion: The introduced jig is rigid and thus ensures very accurate and easy transfer of abutments into implants followed by accurate prosthesis seating. Clinical significance: This transfer jig design allows clinicians to transfer the orientation of angled abutments from cast to patients’ mouth with optimal speed and precision.


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