The Journal of Contemporary Dental Practice

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2020 | August | Volume 21 | Issue 8

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Sachin C Sarode

Perspective on Forensic Odontology and COVID-19

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:3] [Pages No:819 - 821]

   DOI: 10.5005/jp-journals-10024-2871  |  Open Access |  How to cite  | 


Novel coronavirus infection (COVID-19) is the most deadly pandemic disease of the century and is now known for its high infectivity, morbidity, and mortality. It is conceivable to expect the ramifications of this pandemic in the form of depression and frustration. An increase in crime rate and violence is expected in the near future. Forensic experts along with forensic odontologists will be receiving many cases shortly and they should be ready to face the challenges. In the present paper, a critical perspective is presented on COVID-19 and its socioeconomic impact. Recommendations are provided for effectively carrying out the investigative procedures related to forensic odontology. Clinical relevance: Novel coronavirus infection (COVID-19) is the most deadly pandemic disease of the century and is now known for its high infectivity, morbidity, and mortality. Hence, it is recommended to treat every forensic sample as potential COVID-19 infected. In this regard, the present paper gives some important recommendations for handling the samples that are related to forensic odontology. These will prevent the infection spread in the forensic experts, which are considered as the backbone of this critical COVID-19 situation.



Xin Xiong, Yanmei Huang, Wei Liu, Yange Wu, Yating Yi, Jun Wang

Distribution of Various Maxilla-Mandibular Positions and Cephalometric Comparison in Chinese Skeletal Class II Malocclusions

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:7] [Pages No:822 - 828]

   DOI: 10.5005/jp-journals-10024-2897  |  Open Access |  How to cite  | 


Aim: To obtain the distribution of different maxilla-mandibular characteristics in Chinese skeletal class II mixed dentition patients and to compare the differences of cephalometric variables among different maxilla-mandibular types. Materials and methods: A cross-sectional study was conducted among 310 skeletal class II patients in mixed dentition. The patients were divided into 6 groups according to SNA and SNB angle of the cephalogram. A total of 38 cephalometric measurements were measured on their cephalograms. Differences among groups were tested by one-way analysis of variance. Results: There were 34 (10.97%) patients in group I, 10 (3.23%) in group II, 4(1.29%) in group III, 69 (22.26%) in group IV, 133 (42.90%) in group V, and 60 (19.35%) in group VI. In all, 14.19% of the patients exhibited maxillary protrusion (MxP), and 62.26% exhibited mandibular retrusion (MnR) with either normal or retruded maxilla. Groups II and III were excluded for statistical comparison due to a limited sample size. Statistical differences were found in 25 cephalometric measurements among the other 4 groups. Patients with MnR (groups V and VI) exhibited bigger sella angle, gonial angle, Frankfort mandibular plane angle, and smaller mandibular body length and ramus height than patients without MnR (p value < 0.05). Conclusion: The most common etiology forming skeletal class II malocclusion in Chinese children was MnR, which was mainly caused by the small size and hyperdivergent growth direction of mandible. Clinical significance: The study presents various cephalometric characteristics of Chinese skeletal class II malocclusions. The results indicated that for the early orthodontic treatment of Chinese class II children with mixed dentition, orthodontists might emphasize more importance to mandibular length augmentation and growth direction change in mandible.



Pedro Luis Tinedo-López, Violeta Malpartida-Carrillo, Fernando Ortiz-Culca, Maria E Guerrero, Silvia P Amaya-Pajares

Vertical Marginal Discrepancy of Retrievable Cement/Screw-retained Design and Cement-retained Implant-supported Single Metal Copings

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:829 - 834]

   DOI: 10.5005/jp-journals-10024-2905  |  Open Access |  How to cite  | 


Aim: To compare the vertical marginal discrepancy of retrievable cement/screw-retained design (RCSRD) and cement-retained (CR) implant-supported single metal copings cemented on implant abutments. Materials and methods: Single metal copings were fabricated for 20 4.5 × 10 mm titanium dental implants. Two groups of 10 implants each were randomly allocated. One group received RCSRD metal copings and the other group received CR metal copings. Both types of restorations were fabricated on solid abutments with 5.5 mm of diameter. The copings were cemented with resin cement. After the cementation procedure, cement excess was carefully removed in both groups. Inspections of coping-abutment vertical marginal discrepancy were measured using scanning electronic microscopy (SEM) under 800× magnification. The independent sample Student's t test was used to detect differences between groups (p < 0.05). Results: The RCSRD implant-supported metal coping group (57.80 ± 2.34 μm) showed statistically better vertical marginal discrepancy than the CR implant-supported metal coping group (64.40 ± 2.23 μm) (p = 0.001). Conclusion: The RCSRD implant-supported metal copings offer less vertical marginal discrepancy than the CR copings group. This new technique would decrease the marginal discrepancy with less bacterial filtration and biomechanical problems. Clinical significance: Retrievable cement/screw-retained design is another alternative technique for dental implant rehabilitation that combines the advantages of CR and SR prostheses. The hybrid design offers less vertical marginal discrepancy for better control of bacterial filtration and biomechanical problems.



Ritwik Tyagi, Rajnish Aggarwal, Sunita Choudhary, Akhilesh Malethia, Nikki Saini

A 3-D Finite Element Analysis of Stress Distribution on Implant-supported Fixed Prosthesis with Four Different Commercially Available Implant Systems

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:835 - 840]

   DOI: 10.5005/jp-journals-10024-2906  |  Open Access |  How to cite  | 


Aim: To investigate by the finite element analysis comparison of stress distribution on the cortical and cancellous bone in an implant-supported yttrium tetragonal zirconia polycrystals (Y-TZP FPD) in four different widely used implant systems under different loading conditions. Materials and methods: Four 3-D finite element analysis (FEA) models of mandible having different implant systems with dimensions 8.0 mm × 5 mm in the second premolar and molar region were developed. In these models, abutment was tightened and 3-unit implant-supported Y-TZP FPD were cemented. A lateral force component of 100 N at 30° to the occlusal plane and a vertical intrusive force component of 250 N were applied to the central fossa of the FDP and the stress on bone around the implant was analyzed by FEA. Results: In the four implant systems, the maximum stress values on the crestal bone differ for the different implant systems for the two loading conditions applied. In both cases, the maximum stress values on the cortical bone were in ADIN Touareg Closefit WP implants and the maximum stress on the cancellous bone was observed in the Nobel Speedy Groovy implants. Conclusion: The ADIN Touareg Closefit WP implant system induced maximum stress on the crestal bone in both axial and buccolingual loading. Nobel Speedy Groovy implant system favored more equitable load distribution to the peri-implant crestal bone when compared to the other three implant systems. Clinical significance: From this study, it was found that out of all the implants used for the study, the Nobel Speedy Groovy implant system favored more equitable load distribution due to the platform switch design contrary to the other systems and at the cancellous bone the least load was transferred by the Nobel Active implants due to the reverse buttress thread design and larger thread pitch.



Sai S Ramachandran, Chinnu R Koshy, Shankar Narayanan, Balakrishnan Venkatesh, Rajasekaran M Sundaran, Chellaswamy S Karumaran

Evaluation of Cleaning Efficacy of S-One and WaveOne File Systems Using Scanning Electron Microscopy Analysis: An In Vitro Study

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:5] [Pages No:841 - 845]

   DOI: 10.5005/jp-journals-10024-2898  |  Open Access |  How to cite  | 


Aim: The aim of this study is to compare the canal cleaning ability of S-One file (AF BLUE) system with WaveOne Gold single file system, using scanning electron microscopy (SEM). Materials and methods: In the present study, 40 freshly extracted permanent mandibular premolars with a single-root canal and straight roots were selected. The teeth were randomly divided into three groups. The canals were prepared by crown-down technique. Buccolingual sectioning of the samples were done followed by SEM evaluation. Data were statistically analyzed using Kruskal–Wallis test. The statistical significance level was set at p value <0.05. Results: The analysis of the results demonstrated that WaveOne presented higher cleaning capacity of root canals with a statistically significant difference, when compared to S-One file system (p value < 0.05). Both the file systems showed significant cleaning efficacy in the coronal and middle-thirds of the root canals when compared to the apical thirds. Also, the WaveOne showed better results than S-One (AF BLUE), and the results were statistically significant. Conclusion: With the limitation of the study, the cleaning ability of rotary file system is high in coronal and middle-third followed by apical third. In this study, the WaveOne showed better results than S-One (AF BLUE), and the results were statistically significant. Clinical significance: The aggressive cutting of dentin during canal preparation is less in WaveOne file than S-One file system. The cleaning efficiency is good in reciprocating file system (WaveOne) than continuous rotary file system (S-One).



Mohammed Ghazi Sghaireen

Effect of Verbal and Visual Information on the Level of Anxiety among Dental Implant Patients

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:846 - 851]

   DOI: 10.5005/jp-journals-10024-2842  |  Open Access |  How to cite  | 


Aim: To compare the effect of visual information and verbal communication on the level of anxiety among patients undergoing dental implant (DI) therapy. Materials and methods: A total of 270 patients who were undergoing DI treatment were recruited for the study. An equal number of patients (n = 90) were randomly allocated into three study groups which were formed on the basis of the mode of delivery. Subjects in group I received verbal information, whereas patients in group II were shown a video of surgery on manikins. Group III subjects were made to watch a video of surgery on a real patient. Before the surgery, anxiety levels were measured for all patients using the modified Corah dental anxiety scale (MDAS). Results: Questionnaires were filled by all patients and were later analyzed. The values of Cronbach's α and the behavioral involvement subscale were 0.89 and 0.91, indicating hemogeneous sample. Patients of group I showed significantly reduced anxiety levels (p < 0.01) followed by groups II and III. Conclusion: Verbal information generated less anxiety than visual information on patients undergoing DI therapy. Clinical significance: To assess the best method of information delivery to dental implant patients in which their anxiety will be minimal.



Nikki Saini, Rajnish Aggarwal, Sunita Choudhary, Ritwik Tyagi, Akhilesh Malethia

Comparative Analysis of Marginal Accuracy of Complete Crowns Fabricated by Using Ringless and Metal Ring Investment Systems: An In Vitro Study

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:5] [Pages No:852 - 856]

   DOI: 10.5005/jp-journals-10024-2902  |  Open Access |  How to cite  | 


Aim: To compare the vertical margin accuracy of lost wax castings produced by the conventional casting technique with all metal (WIRONIUM®) and PFM alloy (WIRON®99) using a metal ring and ringless system. Materials and methods: A brass die assembly was used to fabricate standardized wax pattern crowns. A total of 100 wax patterns were made with both ringless and metal ring investment systems. Wax patterns were readapted and refined on the master die and divided into two groups, namely, group I and group II with 50 wax patterns in each group. Group I (ringless system) and group II (metal ring system) were further divided into subgroups having a sample size of 25 in each group. Each coping was invested and cast individually. The marginal discrepancy between the metal die and the castings were measured by a stereomicroscope and AutoCAD software 2013. Measurement was made on the facial area of the metal die. Results: The resultant casts obtained from different casting systems show statistically significant difference found between the marginal discrepancies using metal ring and ringless castings system, and statistically nonsignificant difference was found between the marginal discrepancies using all metal alloy (WIRONIUM®) and PFM alloy (WIRON®99) within the same group. Conclusion: The marginal discrepancy for castings made with ringless casting system was less when compared to metal ring casting system, and there was no difference in marginal discrepancy when compared to all metal alloy (WIRONIUM®) and PFM alloy (WIRON®99) within the same group. Clinical significance: Marginal fit is influenced by several factors including type of crown, tooth preparation geometry, dimensional accuracy of impression materials, factors related to dental casting, type of cement, luting pressure, duration of cementation, and use of occlusal vents or die spacers.



Nazanin Kiomarsi, Paniz Zamani, Abbas Bahador, Sedighe S Hashemikamangar, Maryam Pourhajibagher, Mohammad J Kharazifard

Effect of Addition of Nano-TiO2, Nano-SiO2, and a Combination of Both, on Antimicrobial Activity of an Orthodontic Composite

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:857 - 862]

   DOI: 10.5005/jp-journals-10024-2929  |  Open Access |  How to cite  | 


Aim: This study aimed to assess the effect of addition of nano-titanium oxide (nano-TiO2), nano-silicon dioxide (nano-SiO2), and a combination of both, on antimicrobial activity of an orthodontic composite. Materials and methods: Molds measuring 0.64 × 0.5 mm were used for the fabrication of composite disks. For this purpose, 0.5% and 1% nano-TiO2, nano-SiO2, and a combination of both (0.5% nano-TiO2 and 0.5% nano-SiO2), were mixed with Transbond XT composite (3M Unitek). A total of 180 composite disks were fabricated for eluted component, disk agar diffusion (DAD), and biofilm inhibition tests. The colony counts of Streptococcus mutans (S. mutans), Streptococcus sanguinis (S. sanguinis), and Lactobacillus acidophilus (L. acidophilus) and the diameters of growth inhibition zones were measured at 3, 15, and 30 days after exposure to the materials. Data were analyzed using one-way ANOVA and a post hoc test. Results: None of the nano-TiO2 and nano-SiO2 concentrations had any significant effect on the growth inhibition zone. All tested concentrations of nano-TiO2 and nano-SiO2 decreased the colony count of all bacteria. The composite sample containing both nano-TiO2 and nano-SiO2 had the greatest efficacy for reduction of S. mutans and S. sanguinis colony counts at all three time points. Also, 1% nano-TiO2 and 1% nano-SiO2 had similar effects on L. acidophilus in eluted component test. Conclusion: Addition of TiO2 and SiO2 nanoparticles conferred antimicrobial property to the tested orthodontic composite. Clinical significance: Using orthodontic composite containing nonoparticles with antibacterial activity may prevent dental caries.



Dinsha AR Naseema, Mohammad A Alshahrani, Vinutha Kumari, Jenny Atom

Impact of Different Root Conditioning Agents on Periodontally Affected Root Surface: A Scanning Electron Microscope Study

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:5] [Pages No:863 - 867]

   DOI: 10.5005/jp-journals-10024-2928  |  Open Access |  How to cite  | 


Aim: The present study aimed to evaluate the effect of various root-conditioning agents on root surfaces that are periodontally affected. Materials and methods: A total of 90 human teeth having single root that were extracted because of chronic periodontitis were chosen. The extracted teeth were cleaned of saliva and blood using a soft-bristled brush and distilled water. The investigational groups were categorized into group I—doxycycline HCl, group II—ethylenediaminetetraacetic acid, and group III—tetracycline HCl. Samples were readied for histological study by scanning electron microscope (SEM). The SEM was used to assess the effectiveness of smear layer removal, amount of patent dentinal tubules out of the totality of dentinal tubules present, and the appreciation of collagen fiber-like structures inside the intertubular area. Results: The highest efficacy for smear layer removal was seen for group III—tetracycline HCl samples (1.80 ± 0.148) followed next by group II— EDTA (1.36 ± 0.230), and group I—doxycycline HCl (1.30 ± 0.283). The highest number of patent dentinal tubules were seen in group III—tetracycline HCl (44.50 ± 0.18) followed immediately by group II—EDTA (38.10 ± 0.42), and group I—doxycycline HCl (34.90 ± 0.23). The highest number of appreciation of collagen-like structures was recorded in group III—tetracycline HCl (2.64 ± 0.04) followed next by group I—doxycycline HCl (1.88 ± 0.10) and group II—EDTA (1.76 ± 0.28). Conclusion: The present in vitro study concludes tetracycline HCl root-conditioning agent to be significantly more efficient in smear layer removal, exposing collagen fibers and amount of patent dentinal tubules than doxycycline HCl and EDTA. Clinical significance: The modification of the root surface of human teeth with the use of root conditioning agents leads to enhanced attachment by connective tissue resulting in improved reconstructive periodontal treatment goals.



Violeta Malpartida-Carrillo, Pedro Luis Tinedo-López, Fernando Ortiz-Culca, Maria E Guerrero, Silvia P Amaya-Pajares

Fracture Resistance of Cement-retained, Screw-retained, and Combined Cement- and Screw-retained Metal-ceramic Implant-supported Molar Restorations

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:868 - 873]

   DOI: 10.5005/jp-journals-10024-2884  |  Open Access |  How to cite  | 


Aim: To compare fracture resistance between the cement-retained (CR), screw-retained (SR), and combined cement- and screw-retained (CCSR) metal-ceramic (MC) implant-supported molar restorations and the fracture mode after vertical loading simulation. Materials and methods: Thirty MC molar restorations were fabricated on thirty tilted dental implants that were repositioned using prefabricated or universal castable long abutments (UCLA) with 15° of angulation divided into three groups of ten specimens each. Group C: CR, group S: SR, and group CS: cement- and screw-retained. The crowns in group CS were adhesively bonded extraorally, and composite resin was used to fill the screw access holes (SAHs) in groups S and CS. Subsequently, all the specimens were tested for fracture resistance. A scanning electron microscope (SEM) evaluation of the fracture mode was also performed. Mean values of fracture loads were calculated and compared in Newtons (N) using one-way ANOVA and Tukey post hoc test (p < 0.05) for each group. Results: Mean fracture load values were 2718.00 ± 266.25 N for group C, 2125.10 ± 293.82 N for group S, and 2508.00 ± 153.59 N for group CS. Significant differences were found between group S and the other groups on fracture load values. However, no significant differences were found between groups C and CS (p = 0.154). The failures were at MC framework interfaces on mesiolingual cusps. Conclusions: Cement and CCSR MC molar restorations showed comparable fracture resistance using abutments with 15° of angulation. However, SR design showed significantly the lowest values of resistance. Screw access hole did not significantly affect the fracture resistance of cemented MC molar restorations. All the specimens exhibited mixed adhesive fractures at the mesiolingual cusps. Clinical significance: Combined cement- and screw-retained restorations (CCSRRs) incorporate the simplicity of the cement method and the retrievability of the screw method, offering good resistance, allowing the removal of the excess of cement before clinical placement of the restoration, and providing another alternative for dental implant rehabilitation.



Hooman Zarif Najafi, Niloofar Azadeh, Mohammad Motamedifar

Evaluation of the Preventive Effect of Composites Containing Silver and TiO2 Nanoparticles on Demineralization around Orthodontic Brackets

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:874 - 879]

   DOI: 10.5005/jp-journals-10024-2903  |  Open Access |  How to cite  | 


Aim: The aim of this study was to investigate the antidemineralization effect of composites containing silver and titanium dioxide (TiO2) nanoparticles used for bonding brackets to tooth specimens. Materials and methods: A total of 75 freshly extracted teeth were etched and primed and then randomly assigned to three adhesive groups: (1) conventional orthodontic adhesive, (2) conventional adhesive mixed with TiO2 nanoparticles, and (3) conventional adhesive mixed with silver nanoparticles. In each group, brackets were bonded with the pertinent adhesive. Teeth were painted with varnish on all surfaces except a 2-mm rim around brackets. Specimens were subjected to a cariogenic process in a circulating microbial model inoculated with Streptococcus mutans and Lactobacillus casei for 12 days and subsequently sectioned for cross-sectional microhardness testing. In each specimen, enamel microhardness was determined in three locations: 25–30 μm and 1.5 mm away from the bracket and under the varnish-protected enamel. Hardness of enamel in the first two locations was reported as a percentage of the protected enamel hardness. Results: Enamel hardness was higher at 25–30 μm away from brackets in both the experimental groups (p value < 0.05), and the nanoparticles acted similarly in this location (p value = 0.992). At 1.5 mm away from the brackets, there was no difference between experimental and control groups (p value > 0.05); the effect of TiO2 attenuated in this location while silver remained as potent. Conclusion: Both nanoparticles resulted in decreased demineralization at 25–30 μm from the bracket but farther away the effect of TiO2 was diminished. Clinical significance: According to the results of this study, composites containing silver and TiO2 nanoparticles can be suggested as anti-demineralization adhesives in case their biocompatibility is proved.



Kyatsandra N Jagadeesh, Amit Kumar Verma, Anuj Singh Parihar, Abhaya C Das, Mohammed A Razi

Assessment of the Survival Rate of Short Dental Implants in Medically Compromised Patients

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:4] [Pages No:880 - 883]

   DOI: 10.5005/jp-journals-10024-2854  |  Open Access |  How to cite  | 


Aim: To assess the survival rate of short dental implants in medically compromised patients. Materials and method: This follow-up study was conducted on 342 medically compromised patients of both genders (580 dental implants). The failure rate of dental implants was assessed. Results: There were 142 diabetes mellitus patients with 254 dental implants, 108 patients with hypertension with 190 dental implants, 26 patients with mental disabilities with 40 dental implants, 20 oral cancer patients with 36 dental implants, and 46 osteomyelitis subjects with 60 dental implants. There were 60 (10.5%) short dental implant (SDI) failures of which a maximum of 25 (22.7%) were seen with 4 mm diameter. Maximum failure was seen with osteomyelitis patients 8 (13.3%) followed by diabetes mellitus 32 (12.5%). Out of 270 dental implants in 130 control patients, implant failure was seen in 11 (4.07%). There was a significant (p < 0.05) bone loss on follow-up at 6 months, 1 year, and 2 years. Conclusion: Medically compromised patients are more prone to dental implant failure as compared to healthy subjects. Clinical significance: Since medically compromised patients are prone for implant failure, careful selection of cases is necessary.



Chandrasekar Lakshmi Krithika, SP Nehru Anand, Gayathri Ponnusami Subramani

Topical Curcumin and Triamcinolone Acetonide in Recurrent Minor Aphthous Ulcers: A Pilot Trial

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:7] [Pages No:884 - 890]

   DOI: 10.5005/jp-journals-10024-2901  |  Open Access |  How to cite  | 


Aim: To evaluate the efficacy of topical curcumin and topical triamcinolone acetonide in a professional population with minor aphthous ulcers by assessing six clinical variables: site, size, pain, healing period, frequency of recurrence and number of ulcers. Materials and methods: This randomized, parallel designed pilot trial was performed on 60 symptomatic individuals with minor aphthous ulcer. Willing participants were allocated randomly into group I and group II. Participants in group I were treated with topical curcumin and group II were treated with topical triamcinolone acetonide for a period of 6 months. All participants were blinded to the drug they received. Participants were assessed on day 1, day 3, day 5, day 7, and after healing for symptomatic reduction in pain, size, healing period, frequency of recurrence, and in the number of ulcers. Statistically, independent sample t test, Chi-square test, and Log rank Kaplan–Meier survival analysis were performed. Results: Lower labial mucosa was found to be the predominant site of minor aphthous ulcer in both the groups. A gradual reduction in pain and size was noted in both the groups with statistical significance of p value <0.001. All the ulcers in both the groups healed completely without scarring within 2 weeks with statistical significance. In both the treatment groups, new ulcers occurred throughout the follow-up period of 6 months. The mean number of the ulcers are statistically not significant with p value >0.05. Conclusion: Our study showed clinically beneficial effects with topical curcumin with regard to ulcer size, pain, healing, and recurrence rate. Also topical curcumin gel was well tolerated and performed ot par with topical triamcinolone acetonide oral paste with a borderline favorable result with triamcinolone. Clinical relevance: Curcumin can be safely recommended on a long-term basis as a more appealing therapeutic agent and is a better alternative choice for aphthous ulcers in children, pregnant woman, lactating mother, and in immunocompromised individuals.



Gulshan K Tomar, Mirna Garhnayak, Abhijita Mahapatra, Sitansu S Das, Abhilash Mohapatra, Gopal K Choudhury

Comparative Evaluation of Stress Distribution around Various Threaded Implants with and without Platform Switch: A 3-D Finite Element Analysis

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:891 - 896]

   DOI: 10.5005/jp-journals-10024-2895  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to compare the stress distribution around various thread design implants with or without platform switching in the maxillary posterior region. Materials and methods: Stress-based performances of four different thread design implants (single, double, triple, and asymmetric thread design each with or without platform switching) were analyzed by the three-dimensional finite element method under a static load of 100 N at 15° oblique direction buccolingually at the central portion of the abutment. A geometric model of the posterior maxillary segment (first molar region) with an implant and abutment was modeled using the CATIA V5R19 software. Type IV bone quality was approximated and complete osseous integration was assumed. Results: The von Mises stresses recorded around the neck of the fourthread design implants without platform switching were greater than the platform switching variety. The single-threaded implant with platform switching showed the lowest amount of von Mises stress. Additionally, total displacement or micromovement of single, triple, and asymmetric thread implants with platform switching was found to be greater than the without platform switching variety. Further, the total displacement of the single-threaded implant without platform switching was lowest. Conclusion: Implant surface design, platform switching, and site of placement affect load transmission mechanisms. Due to low crestal resorption, single thread design with platform switching is preferred. The success of an implant in the maxillary molar region is more challenging in terms of the density of bone and the worst load transfer mechanism. With the right kind of implant surface design selection, this can be reduced to a great extent by the preservation of crest of the ridge. Clinical significance: Crestal bone resorption following implant placement is an important issue. An optimum implant design with a single thread having a platform switch could compensate for this issue to a great extent.



Suresh R Rao

Salivary, Plasma, and Gingival Levels of Melatonin and TNF-α in Nonsmokers and Current Smokers with and without Periodontal Disease

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:8] [Pages No:897 - 904]

   DOI: 10.5005/jp-journals-10024-2858  |  Open Access |  How to cite  | 


Aim: The aim of this study was to quantify the levels of gingival, salivary, and plasma melatonin and tumor necrosis factor-α (TNF-α) in healthy individuals and chronic generalized periodontitis patients with and without cigarette smoking habit and to investigate whether a relationship exists between melatonin and TNF-α levels in the samples. Materials and methods: Blood of 5 mL, 5 mL of saliva, and gingival tissue samples were obtained from 30 periodontally healthy individuals without smoking habit (HP), 30 nonsmoking patients with chronic generalized periodontitis (CP), 30 periodontally healthy individuals with current smoking habit (SHP), and 30 current smoker patients with chronic generalized periodontitis (SCP). The levels of melatonin and TNF-α in the samples were measured using commercially available enzyme-linked immunosorbent assay (ELISA) kit. The results obtained were statistically analyzed using SPSS statistical software (23.0 version). Results: This study demonstrated the presence of melatonin and TNF-α in all the saliva, plasma, and gingival tissue samples. Gingival tissue melatonin levels were highest in the HP group and least in the SCP groups, while TNF-α levels were least in the HP group and highest in the SCP groups. No significant difference was observed between the groups with regard to salivary and plasma melatonin. An overall significant difference was also observed between the groups with regard to salivary TNF-α but not with regard to plasma TNF-α. Binary logistic regression analysis was carried out after dividing the study groups into current smokers and nonsmokers. Results revealed that a reduction in gingival melatonin and an increase in gingival TNF-α were associated with a transition from periodontal health to chronic generalized periodontitis in current smokers but not in nonsmokers. Conclusion: This study sheds light on the anti-inflammatory actions of melatonin in the gingival tissues in states of periodontal health and disease in current smokers. Clinical significance: Melatonin could be used as a supplement to boost anti-inflammatory mechanisms in periodontal therapy especially in cigarette smokers.



Dinesh Sridhar, Arasappan Rajkumar, Karthikeyan Selvaraj, Sathish Sankar

Comparative Evaluation of Antifungal Activity of Octenidine: An In Vitro Confocal Laser Study

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:5] [Pages No:905 - 909]

   DOI: 10.5005/jp-journals-10024-2860  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate the antifungal efficacy of a novel endodontic irrigant octenidine against conventional irrigants sodium hypochlorite and EDTA on Candida albicans growth in the young and old population by calculating the number of colonies formed and by qualitative identification of dead/viable fungi by Confocal laser scanning microscopy (CLSM) method. Materials and methods: The total number of samples used in the study was eighty samples after decoronation of the crown portion the middle third of root canal. Each group was subdivided into four subgroups with various irrigation protocols: (A) 17% EDTA + 5.25% NaOCl, (B) 100% Octenisept, (C) 17% EDTA + 5.25% NaOCl + 1% clotrimazole, and (D) phosphate buffer saline. After completion of irrigation ATCC samples (90028) of C. albicans were inoculated with 5 mL of peptone water each and incubated at 37°C for 72 hours to attain the turbidity corresponding to 0.5 McFarland standards CFU. Eight samples were analyzed for the formation of candidal colonies, and two samples for the assessment of viability of Candida by confocal laser scanning microscope in each subgroup. Results: Comparison of antifungal efficacy of endodontic irrigants employed in the young and old populations revealed a significant reduction in the mean values of CFU and the mean values of percentage of non-viable microorganism by CLSM method. A positive relationship was revealed in the younger population which had a better antifungal efficacy than the older population in all the irrigant subgroups evaluated in the study. Conclusion: All the endodontic irrigants employed in our study had a good antifungal efficacy against Candida albicans. Octenisept had a maximum antifungal efficacy, while phosphate saline showed the least efficacy in both age groups, which was quantitatively evaluated by CFU method, and the same was confirmed through qualitative evaluation by CLSM method. Clinical significance: Candida albicans plays a major role in the establishment and pathogenesis of failed root canal treatment. Age-related changes alter the adhesion potential of dentin, in turn influence the outcome of endodontic therapy. Octenidine, a novel antifungal agent, can be substituted over the conventionally used EDTA and NaOCl with less adverse effects.



Elyssia Inaty, Carla Jabre, Gaby Haddad, Walid Nehme, Issam Khalil, Alfred Naaman, Carla Zogheib

Anatomical Investigation of Middle Mesial Canals of Mandibular Molars in a Middle Eastern Population: A Cross-sectional Cone-beam Computed Tomography Study

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:910 - 915]

   DOI: 10.5005/jp-journals-10024-2920  |  Open Access |  How to cite  | 


Aim: To identify the prevalence of middle mesial canals (MMC) in mandibular molars in a Lebanese population to determine the relationship between MMC and different factors (age, sex, and tooth type) and to examine the canal's morphological aspects (category, length, orifice position, and dentin width toward furcation). Materials and methods: The presence of MMC in the mesial roots of 505 mandibular molars of 200 patients was analyzed using cone-beam computed tomography (CBCT). Then, the position of the MMC orifices with respect to the pulpal floor and the main canals orifices, and the width of dentin along the canal toward the furcation were determined using 3D Slicer 4.10.1. Results: In all, 14.65% of the first and second mandibular molars presented an MMC. A higher frequency of confluent canals was noted mostly joining the mesiobuccal canal (MBC). Gender appears to be a factor influencing the prevalence of MMCs, contrary to age-groups and tooth type. In mandibular first molars, the orifice is located at a mean distance of 1.22 ± 0.44 mm from the pulpal floor, 1.42 ± 0.53 mm from the MBC orifice, and 1.57 ± 0.60 mm from the mesiolingual canal (MLC) orifice. The width of dentin toward the furcation varies between 0.95 and 2.29 mm. In mandibular second molars, the orifice is located at a mean distance of 1.00 ± 0.51 mm from the pulpal floor, 1.39 ± 0.60 mm from the MBC orifice, and 1.37 ± 0.50 mm from MLC orifice. The width of dentin toward the furcation varies between 0.71 mm and 2.22 mm. Conclusion: Middle mesial canal is present in 14.65% of mandibular molars in the Lebanese population, with its orifice located under the pulpal floor. The majority of MMCs join the MBC. Clinical significance: Middle mesial canal is not a rare finding in the Lebanese population (14.65%). Clinicians should take time to search for this canal in the isthmus between the main mesial canals.



Deepa Venkatesh, Parveen Rajora, Shweta V Sagare, Simerpreet K Bagga, Prabhleen Kaur, Vaishali Gandhi

Plasma Osteocalcin Levels, Status of Oral Disease and Alteration in Mandibular Bone Density in Postmenopausal Women

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:6] [Pages No:916 - 921]

   DOI: 10.5005/jp-journals-10024-2919  |  Open Access |  How to cite  | 


Aim: The present study was undertaken for assessing plasma osteocalcin levels, status of oral disease, and alteration in mandibular bone density in postmenopausal women (PMW). Materials and methods: In all, 80 premenopausal women and 80 PMW were enrolled. For analyzing the oral dryness, clinical score of oral dryness (CSOD) on a scale of up to 10 was used. Complete dental profiling of all the patients was done. Digital panoramic radiographs were taken for all the patients. Bone mineral density (BMD) was evaluated by measuring the following parameters: mandibular cortical index (MCI), panoramic mandibular index (PMI), mandibular cortical width (MCW), and fractal dimension (FD). Osteocalcin levels were evaluated with enzyme-linked immunosorbent assay technique. All the results were recorded and analyzed. Results: Mean osteocalcin levels of PMW (453.12 ng/mL) were significantly higher in comparison to the premenopausal women (249.28 ng/mL). Postmenopausal women had significantly higher CSOD and number of peri-apical radiolucencies in comparison to premenopausal women. Bone mineral density as assessed by MCI was found to be negatively and significantly correlated with oral disease status and osteocalcin levels. Significant difference was obtained while comparing the MCI inbetween the two study groups. Conclusion: There is significantly higher prevalence of oral lesions along with oral dryness in postmenopausal women. Also, thinning of mandibular cortex is significantly higher in postmenopausal women. Higher plasma osteocalcin levels help in predicting osteopenia/osteoporosis at an early stage in such patients. Clinical significance: In PMW, special considerations should be made while planning for dental implant therapy.



Mohammed S Al-ak hali, Esam S Halboub, Yahya M Asiri, Alhussain Y Asiri, Abdulrahman A Maqbul, Mazen A Khawaji

WhatsApp-assisted Oral Health Education and Motivation: A Preliminary Randomized Clinical Trial

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:4] [Pages No:922 - 925]

   DOI: 10.5005/jp-journals-10024-2935  |  Open Access |  How to cite  | 


Aim: The study aimed to assess the efficacy of using WhatsApp instant messages in enhancing the oral hygiene in patients with gingivitis. Materials and methods: Forty-three systemically healthy male dental patients with gingivitis were recruited consecutively and randomly divided into two groups: WhatsApp group (n = 24) and a control group (n = 19). At baseline visit, the participants were educated and motivated about oral health and given a folio on instructions about the oral hygiene preventive measures. The participants in the study group further received WhatsApp messages about the dental care at weekly intervals throughout the study (3 months). Plaque index (PI) and gingival index (GI) were measured at baseline and after 1 and 3 months. Results: The averages of PI and GI were not significantly different between both groups at any time point of measurement (baseline, after one, and three months; p value >0.05). Intragroup comparisons revealed that the reductions in PI were highly significant after 1 and 3 months (−0.26 ± 0.26 and −0.57 ± 0.35, respectively, for WhatsApp group, and −0.24 ± 0.27 and −0.64 ± 0.4. respectively, for the control group; p value range: 0.001 to <0.001). Similar were the reductions in GI in each individual group (−0.17 ± 0.46 and −0.67 ± 0.05, respectively, for WhatsApp group, and −0.28 ± 0.29 and −0.69 ± 0.41, respectively, for the control group: p value < 0.001). Conclusion: Implementing WhatsApp instant messages does not appear to add extrabenefit to the traditional motivation and education on oral hygiene practices in terms of changes in PI and GI over time in patients with gingivitis. Clinical significance: Although the results were not motivating, this does not preclude the dental professionals from using WhatsApp and the similar technology to deliver oral healthcare advices.



Nezar Mohammed Boreak

Effectiveness of Artificial Intelligence Applications Designed for Endodontic Diagnosis, Decision-making, and Prediction of Prognosis: A Systematic Review

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:9] [Pages No:926 - 934]

   DOI: 10.5005/jp-journals-10024-2894  |  Open Access |  How to cite  | 


Aim: With advancements in science and technology, there has been phenomenal developments in the application of neural networks in dentistry. This systematic review aimed to report on the effectiveness of artificial intelligence (AI) applications designed for endodontic diagnosis, decision-making, and prediction of prognosis. Materials and methods: Studies reporting on AI applications in endodontics were identified from the electronic databases such as PubMed, Medline, Embase, Cochrane, Google Scholar, Scopus, and Web of Science, for original research articles published from January 1, 2000, to June 1, 2020. A total of 10 studies that met our eligibility criteria were further analyzed for qualitative data. QUADAS-2 was applied for synthesis of the quality of the studies included. Results: A wide range of AI applications have been implemented in endodontics. The neural networks employed were mostly based on convolutional neural networks (CNNs) and artificial neural networks (ANNs) in their neural architectures. These AI models have been used for locating apical foramen, retreatment predictions, prediction of periapical pathologies, detection and diagnosis of vertical root fractures, and assessment of root morphologies. Conclusion: These studies suggest that the neural networks performed similar to the experienced professionals in terms of accuracy and precision. In some studies, these models have even outperformed the specialists. Clinical significance: These models can be of greater assistance as an expert opinion for less experienced and nonspecialists.



Suresh Nayar, Balagopal Varma, Venkitachalam Ramanarayanan, Anil Mathew, Rakesh Suresh, Raghunath Puttaiah

Dental Care Implications in Coronavirus Disease-19 Scenario: Perspectives

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:7] [Pages No:935 - 941]

   DOI: 10.5005/jp-journals-10024-2896  |  Open Access |  How to cite  | 


Aim: The aim of this review is to discuss the implications of COVID-19 on various aspects of dental care. Background: The COVID-19 pandemic had suspended dental practice globally for over 3 months. While dental practice is being resumed cautiously, standard infection control protocols that were traditionally overlooked are now being strictly implemented. Post-COVID-19, dental care is expected to see a drastic change in the way it is practiced. Review results: With a view on the natural history and disease dynamics of COVID-19, this review reports various aspects of dental care, viz., patient triaging, engineering and work practice controls, and administrative, financial, and ethical aspects of dental care during and after COVID-19 pandemic. Current evidence-based recommendations with regard to infection-control practices are discussed. A call for universal oral health care with suggestions regarding integration of medical and health care is also proposed. Conclusion: COVID-19 is expected to be a watershed moment in the field of dentistry. While we expect to see positive changes in safe delivery of dental care, an increase in cost of availing care is imminent. Clinical significance: The practice of dentistry and dental infection control has undergone dimensional changes due to bloodborne infectious diseases such as hepatitis B virus infections and human immunodeficiency virus epidemic. Due to these pandemics, many regulatory organizations have provided safety recommendations and guidelines that impact the dental practice. Currently, we are faced with a highly infective disease with a high mortality rate among people with comorbidities and of predominantly droplet transmission and no concrete safety recommendations and guidelines. This manuscript addresses multiple issues, gaps, and pragmatic solutions in controlling transmission of SARS-CoV-2 in dental settings, during and after the pandemic.



Philip Mathew, Vivekanand S Kattimani, Rahul VC Tiwari, Mohammad S Iqbal, Aisha Tabassum, Khalid G Syed

New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal

[Year:2020] [Month:August] [Volume:21] [Number:8] [Pages:7] [Pages No:942 - 948]

   DOI: 10.5005/jp-journals-10024-2849  |  Open Access |  How to cite  | 


Aim: The present study proposed a new classification system based on computed tomography (CT) scan appraisal; this enables the surgeon to identify the extent of the defect and helps to execute the proper treatment plan. Background: Various terminologies and classifications were proposed to understand developmental defects. But none of the existing classifications/nomenclatures used the preoperative radiographic evaluation (i.e., computed tomography scan—CT scan) in the management and prognosis. Various treatments were advocated and practiced successfully for the surgical correction of lip and palate. Materials and methods: The available CT scans from archives of the Department of Radiology and Oral and Dental Surgery were evaluated (retrospectively) for cleft alveolus and its morphology as per the proposal. The English language literature was searched in the MEDLINE database without date restriction to revise existing literature on numerous classification systems/nomenclatures using MeSH keywords related to cleft lip, palate, alveolus, developmental disturbance, facial clefts, and classification. Existing classification systems were revisited with a note on the drawbacks. After careful examination of morphological patterns of all clefts, the new CT scan-based alveolar cleft classification is proposed depending on the extent of cleft. Results: The literature revealed a total of twenty-nine classifications of cleft lip and palate starting from the year 1922 to the year 2015, but none exclusively classified the cleft alveolus based on CT scan observations. The observation of three thousand CT scans showed five types of cleft alveolus, depending on the extent of involvement. Conclusion: The CT scan-based classification is essential to the surgeon for successful surgical planning of cleft alveolus. The proposed classification is clinically relevant in this digital era for relating surgical outcomes. The three-dimensional viewing of a defect is essential for the surgeon for virtual planning. This paper provides a CT scan-based classification for universal acceptance in this era of digital technology, and CT scan aids in achieving these goals. Clinical significance: The new proposal is based on preoperative evaluation of cleft using a CT scan. CT scan imaging provides a clear picture of the cleft in three dimensions for the operating surgeon. Advanced technology-enhanced surgical management modalities like CAD/CAM guided templates to support graft for successful management. The classification system will help the medical and surgical fraternity in various aspects. The three-dimensional modeling of defect and printing of a defect model using additive manufacturing technology helps the surgeon for presurgical visualization and virtual planning in a better way. This strategy of defect classification using a CT scan will help obtain better clinical outcomes and patient satisfaction.


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