The Journal of Contemporary Dental Practice

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2020 | September | Volume 21 | Issue 9

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Dinesh Rajput, Ayushi Kaushik

Novel Viewpoints on Tobacco Smoking and COVID-19

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:2] [Pages No:949 - 950]

   DOI: 10.5005/jp-journals-10024-2910  |  Open Access |  How to cite  | 



Priyanka Debta, Saswati Siddhartha, Fakir M Debta, Santosh K Swain, Mahesh C Sahu, Sangram Patro

GLUT-1 Expression: An Aid in Complementing the WHO Oral Epithelial Dysplasia Grading System

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:951 - 955]

   DOI: 10.5005/jp-journals-10024-2870  |  Open Access |  How to cite  | 


Aim and objectives: The clinicopathologic parameters alone are not sufficient to precisely predict if oral potentially malignant disorders (OPMDs) remain unchanged, i.e., without any malignant changes, regress, or advance to oral squamous cell carcinomas (OSCC). Few of the OPMDs, with or without epithelial dysplasia, may transform to frank OSCC. Discovering various molecular markers that can predict OSCC transformation is essential to develop effective therapeutic strategies. GLUT-1 is one of the hypoxia as well as metabolic indicator markers that have been used to study the metabolic activity of the cells. Hence, given by the World Health Organization (WHO), GLUT-1 expression was studied in various grades of dysplasia to see whether it complements the WHO grading system (mild, moderate, and severe). Materials and methods: The study was carried out on paraffin-embedded tissues of 10 normal oral mucosa and 30 OPMD cases. OPMD cases were classified into hyperkeratosis, mild dysplasia, moderate dysplasia, and severe dysplasia groups. Immunohistochemistry was carried out to evaluate the expression of GLUT-1 antigen. Results: According to the WHO grading system of dysplasia, 11 (36.66%) cases were classified as hyperkeratosis, 9 (30%) cases were classified as mild dysplasia, 6 (20%) cases as moderate dysplasia, and 4 (13.33%) cases as severe dysplasia. There was a significant increase in GLUT-1 expression from normal to mild, moderate, and severe dysplasia (p value = 0.00). Conclusion: The expression of GLUT-1 marker complements the WHO grading system of oral epithelial dysplasia. Clinical significance: GLUT-1 expression can be used to complement the WHO grading system to grade epithelial dysplasia.



Mohammed N Alhajj, Mohammed Mashyakhy, Zaihan Ariffin, Zuryati Ab-Ghani, Yanti Johari, Nurul S Salim

Quality and Readability of Web-based Arabic Health Information on Denture Hygiene: An Infodemiology Study

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:956 - 960]

   DOI: 10.5005/jp-journals-10024-2918  |  Open Access |  How to cite  | 


Aim: This study aimed to assess the quality and readability of the available health information on the net regarding denture hygiene. Materials and methods: Three search engines (Google, Yahoo!, and Bing) were searched. The first 20 consecutive websites from each engine were obtained and checked for eligibility. For the quality of the websites, the Health on the Net Foundation Code of Conduct (HONcode), the DISCERN tool, the Journal of the American Medical Association (JAMA) Benchmarks, and Google PageRank were used for the assessment of the included websites. For readability, an online web tool was used, including well-known analyzing indices [Flesch Kincaid grade level (FKGL), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE)]. The acceptable readability level was set to be ≥80.0 for the FRE and <7 for the FKGL and SMOG. The data were presented in frequencies and percentages. Results: Out of the 60 screened websites, 14 websites were eligible for analysis. There was only one (7.1%) website that had the HONcode seal. The mean score of all websites based on the DISCERN tool was 29.6 ± 12.1, with no website achieved the high score (≥65). Only one (7.1%) website scored >5 based on Google PageRank. Regarding JAMA benchmarks, all websites achieved a mean score of 2.57 ± 1.1. The mean grade level based on the FKGL was 8.4 ± 6.3. All websites had a score of <7 according to the SMOG index. The mean score of the readability ease index was 90.5 ± 16.4. Conclusion: Most of the dental health information on denture hygiene available on the Arabic websites did not have the required level of quality, regardless of being readable and comprehensible by most of the general people. Clinical significance: Directing the patients to the appropriate websites related to their cases is the responsibility of the dentists.



Sonali Sharma, Sanjay M Londhe, Mithra N Hegde, Vandana Sadananda

Are Bioceramics the Dernier Cri in the Management of Stage 4 Developed Root? A Finite Element Analysis

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:9] [Pages No:961 - 969]

   DOI: 10.5005/jp-journals-10024-2916  |  Open Access |  How to cite  | 


Aim: To compare the stress distribution of four modalities of reinforcing the radicular space of a pulpless central incisor exhibiting stage 4 root development. Materials and methods: The model of a pulpless immature central incisor with a stage 4 of root development supporting periodontium was generated based on the properties. The longitudinal growth of the root was completed. Four such models were developed. Then, the radicular space was rehabilitated as follows: Model 1: Ceramicrete; Model 2: Biomimetic Mineralization; Model 3: Biodentine; Model 4: Bioaggregate. They were subjected to three different loading conditions. One was to mimic the mastication by applying a load of 70 N applied at 45° angle. Second loading condition was a vertical load of 100 N to mimic bruxism. The third loading condition was to mirror the impact of a frontal trauma. A load of 100 N was applied labially. Results: It was observed that during mastication, Model 2 has exhibited the lowest concentration of von Mises stresses, followed by Model 3 and then Model 4 followed by Model 1; this could be because the modulus of elasticity of Model 2 is comparable to that of Dentin. During bruxism and horizontal impact, the maximal stress concentration was found in Model 4, Model 3, Model 2, followed by Model 1. Conclusion: The closer the elasticity of modulus of the primary endodontic replacement monoblock was to that of dentin, the lower were the stresses generated. However, as the increase in stress values was minimal between groups, these obturating materials can be viable reinforcement materials for the rehabilitation of cases of stage 4 developing root. Biomimetic mineralization strategies can be a viable treatment option for managing cases of the open apex. Clinical relevance: Biomimetic mineralization strategies and bioceramics can be used for obturation of root canals with open apex, instead of utilizing these bioceramics as apical plugs.



Giacomo Tarquini

Treatment of Intrabony Defects Using Equine-derived Bone Granules and Collagen Membranes: A Retrospective Study with a 13-year Follow-up

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:7] [Pages No:970 - 976]

   DOI: 10.5005/jp-journals-10024-2924  |  Open Access |  How to cite  | 


Aim: The aim of this study is to investigate the effectiveness of a combination of an equine-derived, enzyme-treated bone graft and an equine collagen membrane to treat intrabony defects caused by periodontitis. Materials and methods: About 22 patients with a single 1-, 2-, or 3-wall intrabony defect and a probing pocket depth (PPD) of ≥5 mm, who were treated using an enzyme-deantigenated equine bone graft in addition to a collagen membrane and were followed up for at least 10 years, were retrospectively assessed. The plaque index (PI), the sulcus bleeding index (SBI), PPD, and the clinical attachment level (CAL) at each follow-up visit were compared to baseline. Results: The mean PI, SBI, PPD, and CAL were 0.22 ± 0.41, 1.86 ± 0.78, 7.86 ± 1.39 mm, and 8.84 ± 1.86 mm, respectively, at baseline, and 0.25 ± 0.44, 0.12 ± 0.32, 2.59 ± 0.50, and 4.04 ± 0.77 mm, respectively, at the last follow-up. The difference was significant for all parameters (p < 0.001) except PI (p = 0.83). The final CAL gain was 4.8 mm (49.8%). The SBI, PPD, and CAL still significantly improved at the 12-month follow-up visit but not at the 24-month follow-up visit. There were no correlations between either the number of defect walls or smoking and outcomes. In one case, a surgical re-entry at 5 years allowed a clinical evaluation, showing that intrabony defect was repaired with the newly formed bone of the patient. Conclusion: Equine bone granules in addition to an equine collagen membrane effectively and safely treated intrabony defects caused by periodontitis providing long-term results. Clinical significance: Equine-derived bone grafts have been in the market for more than 20 years. However, to the author's knowledge, no studies have reported long-term results for the use of this type of bone graft in periodontal surgery. The equine-derived bone granules used in the present study appears a promising option for treating intrabony defects due to moderate to severe periodontitis.



Murilo Fernando Neuppmann Feres, Osama Eissa, Marina Guimarães Roscoe

Comparison of the Condyle Sagittal Position of Class I and Class II Division 2 in Orthodontic Patients

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:977 - 981]

   DOI: 10.5005/jp-journals-10024-2867  |  Open Access |  How to cite  | 


Aim: To compare the condyle sagittal position of class I and class II division 2 in orthodontic patients. Materials and methods: Fifty orthodontic cases (30 females and 20 males; 12–31 years) from the records of an Orthodontic Graduate Program were collected. Such cases presented cone-beam computed tomography (CBCT) as part of their initial diagnostic examinations. The study sample constituted two groups, i.e. class I and class II division 2 groups. A previously calibrated examiner performed the measurements of the images, representing the distance between the condyle and the articular surface of the glenoid fossa, both anteriorly (anterior disk space—ADS) and posteriorly (posterior disk space—PDS). Descriptive statistics were performed. Data were normally distributed, and parametric tests were used. Paired sample test was used to identify differences between the right and the left joints. Differences between class I and class II/2 groups were tested using independent t test. All statistical tests were interpreted at 5% significance level. Results: When the study groups were compared in relation to the dimensions observed for the right and the left ADS and PDS, no significant differences were detected. This study also calculated the differences between right and left disk spaces within the groups, and the differences were not significant for both class I and class II/2 groups. Conclusion: The results demonstrated, after the performance of a CBCT comparative analysis, that there is no significant difference between class II/2 and class I orthodontic patients in relation to the condyle sagittal position. Clinical significance: The results collected here refute the expectation of spontaneous mandibular anterior repositioning after correcting the overbite in class II/2 patients.



Shubha Choudhury, Sunita Shivanand, Anand C Patil, Sneha A Patil, Preeti K Doddwad, Chetan Patil

Evaluation of Push-out Bond Strength of a Resin Sealer to Dentin after a Final Flush of Three Irrigants

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:4] [Pages No:982 - 985]

   DOI: 10.5005/jp-journals-10024-2869  |  Open Access |  How to cite  | 


Aim: To evaluate the push-out bond strength of resin-based sealer to root dentin after a final flush of three different irrigants. Materials and methods: Thirty extracted human mandibular premolars were sectioned 4 mm below the cement–enamel junction and 60 horizontal disks of 2 mm from middle one-third of the root were prepared. The disks were immersed in 3% sodium hypochlorite for 1 minute, and after drying the disks, they were finally flushed with the following irrigants: group I—Chitosan solution, group II—Morinda citrifolia juice (MCJ), and group III—ethylenediaminetetraacetic acid (EDTA). The disks were filled with AH Plus sealer, and after 7 days, the disks were subjected to push-out bond strength using a universal testing machine. Results: EDTA had the highest push-out bond strength followed by MCJ and then chitosan. Conclusion: Chitosan and MCJ can be used as alternative irrigants as a final flush during the cleaning and shaping of the root canals. Clinical significance: EDTA, chitosan solution, and MCJ are efficient in smear layer removal which thereby increases better sealer penetration and prevents the dislocation of obturating materials.



Gaurav Singh, Amit Gaur, Shailesh Kumar, Mohammad Numan, George Jacob, Kamini Kiran

Role of Platelet-rich Plasma in the Healing of Impacted Third Molar Socket: A Comparative Study on Central India Population

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:6] [Pages No:986 - 991]

   DOI: 10.5005/jp-journals-10024-2930  |  Open Access |  How to cite  | 


Aim: The aim of the study was to compare the healing and osseous regeneration of mandibular third molar extraction sockets with and without platelet-rich plasma (PRP) with the evaluation of clinical objectives such as pain, swelling, trismus, soft tissue healing, pocket depth distal to second molar and radiological evaluation of the bony density in the postextracted third molar socket. Materials and methods: In this prospective study, 100 patients were selected by the random sampling method from the outpatient department of oral and maxillofacial surgery in the year 2016–2017. Patients were equally allocated into intervention (transalveolar extraction followed by PRP placement) and nonintervention (transalveolar extraction without PRP placement) group as group I and group II, respectively, and evaluation parameters were considered accordingly. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 (IBM, USA) statistical analysis software. Results: The pain score of patients of group I (non-PRP) was found to be higher as compared to group II (with PRP). Mean trismus of patients of group II was found to be higher than that of group I at postoperative day 7, but this difference was not found to be statistically significant. Swelling at T-Sn (Tragus-Subnasale) and T-Pog (Tragus-Pogonion) was higher among patients of group I as compared to group II. Healing in group II was two to three times faster than group I. Healing among patients of group I and group II was found to be statistically significant. The mean pocket depth of patients of group I was found to be significantly higher than that of group II at follow-up of 1 and 2 months. The bone density of patients of group II was found to be significantly higher than that of group I at 3 months and 6 months follow-up. Conclusion: The procedure of PRP preparation is simple and cost-effective, and can be prepared at the point of care. It had a significant impact on the postoperative healing of the third molar socket. Clinical significance: The use of PRP application increases the bone density, healing process, and improvement in the pain and swelling, and there was a definite reduction in trismus and periodontal probing depth after the impacted mandibular wisdom teeth extraction.



Shoroog Hassan Agou, Abeer Adel Basri, Shaymaa M Mudhaffer, Ahmed T Altarazi, Mustafa A Elhussein, Ahmad Yahya Imam

Dimensions of Maxillary Lateral Incisor on the Esthetic Perception of Smile: A Comparative Study of Dental Professionals and the General Population

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:992 - 996]

   DOI: 10.5005/jp-journals-10024-2931  |  Open Access |  How to cite  | 


Aim: To evaluate the effect of the differences in the dimensions of maxillary lateral incisor on the esthetic perception of smile among dental professionals and the general population. Materials and methods: Two sets of photographs where the maxillary incisor dimensions were modified using computer software (Adobe Photoshop) were created. In the first set, six images were included where the maxillary lateral incisor width was modified. The second set included five images where only the maxillary lateral incisor length was modified keeping the gingival margins same. Three groups of participants formed the sample. Hypodontia patients formed the first group, non-hypodontia patients formed the control group, while the dentists constituted to the third group. A total of 156 participants were recruited, 36 patients with radiographically confirmed hypodontia out of which 22 were female and 14 were male, 54 non-hypodontia “control” patients out of which 29 were female and 24 were male, and 66 dentists out of which 39 were female and 27 were male. Every participant had 15 seconds to view each photograph along with 30 seconds at the end for confirmation. Results: The “most attractive smile” was the ones with 77% lateral incisor to central incisor width proportion according to 25.0% of the hypodontia group and 40.8% of the dentist's group, while only 4.2% of the control group agreed that it was the most attractive. However, the “least popular” was the 52% lateral incisor to central incisor width proportion according to 40.0% of patients who are hypodontic, 20.8% of participants from control group, and 49.0% of dentists. Conclusion: The golden proportion was not considered as the most attractive among all groups. The esthetic perceptions of the patients might not be same as that of the dentists. In general, reductions in the maxillary lateral incisor width were not all acceptable. Clinical significance: This study will help us understand the different perceptions of the patients and the dentists on esthetics, which would further help us in planning the treatment accordingly.



Mohammed A Razi, Ankit Mahajan, Salil Mehra, Tulika Rani Roy, Puja Kumari

A Comparative Study of Platelet-rich Fibrin (PRF) and Titanium-prepared Platelet-rich Fibrin (T-PRF) in Management of Endo-perio Lesions

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:997 - 1001]

Keywords: Endo-perio lesions, Platelet-rich fibrin, Titanium-prepared platelet-rich fibrin

   DOI: 10.5005/jp-journals-10024-2865  |  Open Access |  How to cite  | 


Aim: The aim of the study was to compare the platelet-rich fibrin (PRF) and titanium-prepared platelet-rich fibrin (T-PRF) in the management of endo-perio lesions. Materials and methods: This study was conducted with 140 patients who are affected by endo-perio lesions, and the patients were divided into two groups. In group I, patients were treated with PRF, and in group II, patients were treated with T-PRF. Endodontic treatment was done in all cases, following a standardized aseptic method. Probing pocket and relative attachment level were recorded after 3 months and 6 months in both groups. Results: After 3 months, the mean change of probing pocket depth (PPD) was 68% in group I and 33.41% in group II. The intergroup distinction was not significant (p > 0.05), whereas the intragroup evaluation was significant (p < 0.05). The mean change after 6 months was 42.59% in group I and 43.90% in group II. The difference was not significant (p > 0.05). After 3 months, the mean% change of relative attachment level (RAL) was 31.20% in group I and 31.60% in group II. The intergroup distinction was not significant (p > 0.05), whereas the intragroup evaluation established a considerable discrepancy (p < 0.05). The mean change after 6 months was 40.82% in group I and 42.12% in group II. Conclusion: Both PRF and T-PRF were effective in inducing a reduction in pocket depth and useful in gaining attachment level. Clinical significance: With the use of PRF and T-PRF, the complex case of endo-perio lesions can be efficiently managed.



Jesús Limas

Effect of Post-bleaching Surface Microroughness with Whiteness HP Blue vs Whiteness HP Maxx on Different Locations of Bovine Enamel

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:6] [Pages No:1002 - 1007]

Keywords: Hydrogen peroxide, In vitro study, Roughness, Teeth whitening

   DOI: 10.5005/jp-journals-10024-2889  |  Open Access |  How to cite  | 


Aim: To compare the effect after bleaching with 35% hydrogen peroxide with and without calcium gluconate on surface microroughness in an in vitro study on the bovine enamel. Materials and methods: The study had an in vitro experimental design. The following groups were formed: group I: MV (mesiovestibular) enamel, group II: V (vestibular) enamel, and group III: DV (dystovestibular) enamel, undergoing treatment with Whiteness HP Blue (H2O2 at 35% with calcium gluconate), Whiteness HP Maxx: H2O2 at 35% (without calcium gluconate), and physiological serum. A Surftest SJ-210 digital roughness meter (Mitutoyo) was used to evaluate microroughness. Results: The highest mean microroughness was found in group II (V) with 0.23 ± 0.13 μm and 0.17 ± 0.02 μm for Whiteness HP Blue and Whiteness HP Maxx, respectively. The post hoc analysis of surface microroughness subjected to H2O2 with and without calcium gluconate showed that there were only statistically significant differences between Whiteness HP Blue and the control (p = 0.032). Conclusion: There were no significant differences in surface microroughness on comparing the Whiteness HP Maxx group with the control group and the Whiteness HP Blue group. Clinical significance: The clinical importance of this study was that it allowed us to know the direct impact that bleaching agents with and without calcium have on dental structures.



Guneet Guram, Junaid A Shaik, Raghu Devanna, Swati Vishwakarma

Assessment of Correlation between Craniofacial Proportions and Genetic Indicators

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:4] [Pages No:1008 - 1011]

Keywords: Craniofacial dimensions, Genes, Markers, Estrogen receptors

   DOI: 10.5005/jp-journals-10024-2888  |  Open Access |  How to cite  | 


Aim and objective: To assess correlation among craniofacial proportions and genetic indicators using estrogen receptors (ESR1 and ESR2). Materials and methods: A total of 128 patients undergoing orthodontic treatment with age range 12–18 years of both genders were included. Lateral cephalogram of all subjects were taken. Vertical and sagittal parameters were studied on these cephalogram. Saliva was used for DNA extraction. Real-time polymerase chain reaction was performed for assessment of genetic indicators in ESR1 (rs9340799 and rs2234693) and in ESR2 (rs4986938 and rs1256049). Results: The mean SN cranial base was 68.4 mm, ANB (sagittal jaw relationship) was 2.8°, Ptm-A maxillary length was 46.2 mm, Go-Pg (mandibular body length) was 68.2 mm, Co-Gn (total mandibular length) was 112.8 mm, lower anterior facial height (ANS-Me) was 58.4 mm, N-Me (total anterior facial height) was 108.4 mm, lower posterior facial height (Co-Go) was 58.7 mm, and S-Go (total posterior facial height) was 72.4 mm. It was found that rs4986938 in ESR2 was linked with S-N dimension, with patients having CC genotype possessing negative correlation values (p value 0.05). Similarly, CC genotype possessed minimum mandibular body dimension, and it was found that rs4986938 in ESR2 was also linked with Go-Pg dimension (p value = 0.02). We found reduction in the ANS-Me values in patients with CC genotype in ESR1 rs2234693 (p value = 0.02), whereas there was no correlation of rest genotype with other craniofacial measurements (p value > 0.05). Conclusion: Evaluation of ESR1 and ESR2 may show role of genetic markers in disparity of craniofacial dimensions in individuals. Clinical significance: This study provides an outlay and supports the concept of possible correlation between genetic markers and craniofacial measurements.



Mona Nahas, Elia Sfeir

Salivary Immunoglobulin A and Streptococcus mutans Levels among Lebanese Preschool Children with Early Childhood Caries

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:6] [Pages No:1012 - 1017]

Keywords: Early childhood caries, Immunoglobulin A, Prevention, Streptococcus mutans

   DOI: 10.5005/jp-journals-10024-2907  |  Open Access |  How to cite  | 


Aim and objective: We checked in this study the correlation between total immunoglobulin A (IgA) and Streptococcus mutans (SM) levels in saliva derived from Lebanese children with inappropriate eating habits and showing early childhood caries (ECC). Materials and methods: Sixty Lebanese preschool children with similar alimentation were included in this study and divided into two groups. Group I included children having 0 cavities where group II contained children having ECC. We measured the SM and IgA levels collected from saliva and dental plaque. Results: We observed a significant difference in SM levels between the two groups (p < 0.001). There was a marginal correlation between salivary total IgA and SM collected from dental plaque (r = 0.33, p = 0.077). However, no significant correlation was detected between total salivary IgA and salivary SM (p = 0.35). Conclusion: This study suggests the absence of significant relationship between salivary markers of immune system and the development of ECC. Clinical significance: Early childhood caries is a public dental health problem that has been affecting preschool children all over the world. Its prevention must be a priority for all professionals in the medical and dental community. This study highlights the absence of correlation between total IgA and SM collected from the saliva. This does not completely exclude the preventive role of salivary immune components, but further studies are required to better understand this relationship.



Jibin Skaria, Nanditha Hegde, Pradeep P George, Tony Michael, Joseph Sebastian

Botulinum Toxin Type-A for the Treatment of Excessive Gingival Display on Smiling

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:4] [Pages No:1018 - 1021]

Keywords: Botulinum toxin type-A, Experimental study, Gingival display, Gummy smile

   DOI: 10.5005/jp-journals-10024-2926  |  Open Access |  How to cite  | 


Aim and objective: To determine the effect of botulinum toxin type-A (BTX-A) in reducing gummy smile. Materials and methods: This was an interventional case series conducted at a tertiary care setting in Mangaluru, Karnataka, India. Twenty patients with the gingival display of >3 mm were selected through convenience sampling technique. 2.5 units of BTX-A were injected under sterile conditions on either side of the face. The effect of the injection on gingival display was measured at the interval of 2, 4, 12, and 24 weeks. At the end of the treatment, the patient was asked to smile and was photographed and was compared to pretreatment photo. Repeated measures analysis of variance (ANOVA) was used to detect the change at each interval and intergroup comparisons were performed using post hoc Bonferroni test. Results: The mean gingival exposure reduction from 4.93 to 3.705 mm at week 2. At the end of 24 weeks, the evaluation showed the mean gingival display of 4.755 mm on administration of 2.5 units on either side. The photographs also showed the change in smile at the end of the treatment. Conclusion: From the study, it was inferred that botulinum toxin was effective in eliminating gummy smile along with noticeable decrease in the nasolabial fold despite for the effect lasting only about 24 weeks. Clinical significance: A nonsurgical method of correction of gummy smiles when compared to surgical intervention is readily accepted by patients. Botulinum toxin type-A for gummy smiles is an effective, conservative, and satisfactory technique.



Rozita Hassan, Ab Rani Samsudin

Prevalence of Sleep-disordered Breathing and its Association with Obesity among Saudi Schoolchildren

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:1022 - 1026]

Keywords: Obesity, Pediatric sleep questionnaire, Sleep-disordered breathing

   DOI: 10.5005/jp-journals-10024-2908  |  Open Access |  How to cite  | 


Aim and objective: Epidemiological studies of sleep disturbances are essential to promote awareness among families and educational officials and deliver appropriate treatment at a very early timing. The aim of this population-based study was to determine the frequency of sleep-disordered breathing (SDB) symptoms and its association with obesity among schoolchildren in West Saudi Arabia. Materials and methods: This cross-sectional study comprised 2,000 schoolchildren aged 6–12 years. Sleep-disordered breathing symptoms were assessed with Arabic version of Pediatric Sleep Questionnaire (PSQ). Overweight/obesity was evaluated using body mass index (BMI) and their association with SDB was tested using a regression analysis model. Results: Overall, 23% of children were at high risk of SDB. Prevalence of habitual snoring was 15.9% and sleep apnea 4%. Boys were at higher risk of SDB than girls (p = 0.026), while age had no effect (p = 0.254). High-risk SDB had a strong association with sleep symptoms compared to low-risk SDB (p < 0.05). Sleep-disordered breathing increased significantly in overweight and obese children (p = 0.017 and p < 0.001, respectively). Conclusion: Around 23% Saudi schoolchildren are at risk of SDB. Related symptoms were strongly associated with high risk of SDB. Overweight and obesity had a strong and progressive association with SDB. Clinical significance: The results will help in identifying children at high risk of developing SDB and plan for early intervention to avoid the progression of SDB later in life.



Durai Pandian Chamundeeswari, Dhanapal Sakthisekaran

In Vitro Anticancer Effects of Cinnamomum verum J. Presl, Cinnamaldehyde, 4 Hydroxycinnamic Acid and Eugenol on an Oral Squamous Cell Carcinoma Cell Line

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:7] [Pages No:1027 - 1033]

Keywords: Anticancer, C. verum J. Presl, Cinnamaldehyde, Cinnamic acid, Eugenol, Oral squamous cell carcinoma

   DOI: 10.5005/jp-journals-10024-2922  |  Open Access |  How to cite  | 


Aim and objective: The present study was conducted to assess the in vitro anticancer effects of Cinnamomum verum J. Presl extract and its active constituents, such as cinnamaldehyde, 4 hydroxycinnamic acid, and eugenol on oral squamous cell carcinoma cell line. Materials and methods: Aqueous, ethanolic, and hydroalcoholic extracts of C. verum J. Presl (bark) were prepared using standardized protocols. Cinnamaldehyde, 4 hydroxycinnamic acid, and eugenol were quantified in the extracts. Total saponins, tannins, and polyphenols were quantified in the selected extracts. A commercially available SCC25 cell line was cultured according to standard protocol. The anticancer effects of the extract, active compounds, and standard cisplatin were assessed by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) cytotoxicity, acridine orange/ethidium bromide staining, DNA, fragmentation assay, cell cycle analysis by flow cytometry, and JC-1 staining (5,5′,6,6′-tetrachloro1,1′,3,3′tetraethylbenzimidazolylcarbocyanine iodide). Results: The hydroalcoholic extracts demonstrated a higher quantity of the active ingredients cinnamaldehyde, 4 hydroxycinnamic acid, and eugenol. The selected extract and active compounds demonstrated anticancer effects via apoptosis induction and S-phase arrest. Apoptosis induction was exerted by the extract via alteration in mitochondrial membrane potential. Conclusion: Cinnamomum verum J. Presl and its active compounds exhibited in vitro anticancer effects on oral squamous cell carcinoma. Further studies in animal models have to be carried out to assess toxicity and in vivo effects. Clinical significance: The anticancer properties of Cinnamomum verum J. Presl could be explored further for prevention and management of oral squamous cell carcinoma.



Saumya Khurana, Paras Mull Gehlot

Surface Nanohardness of Normal and Fluorosed Enamel Adjacent to Restorative Materials: An In Vitro Study and Polarized Light Microscopy Analysis

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:8] [Pages No:1034 - 1041]

Keywords: Cention N, Elastic modulus, Equia forte, Fluorosis, Laboratory research, Nanohardness

   DOI: 10.5005/jp-journals-10024-2917  |  Open Access |  How to cite  | 


Aim and objective: To evaluate nanohardness of normal and fluorosed enamel in teeth restored with Cention N (CN), Equia forte (EF), glass ionomer cement (GIC), and resin composite using the nanoindentation test. Materials and methods: Eighty freshly extracted human premolars were selected. Standardized cavities were prepared on the buccal surface of normal (40) and fluorosed (40) teeth. Based on the type of the restorative material, the teeth were subgrouped into (n = 10): CN, EF, Type VIII GIC, and Tetric N-Ceram (TNC). The teeth were subjected to pH cycle (progressive caries test), which consisted of alternative demineralization (18 hours) and remineralization with artificial saliva (6 hours) for 3 consecutive days. Surface nanohardness was determined using a nanoindenter at distances of 100, 200, and 300 μm from the restoration-tooth margin. A polarized light Microscope was used to correlate the effect of remineralization on the enamel. Data were analyzed by one-way ANOVA with the Scheffe's post hoc and independent t-test. Results: Nanohardness values of the fluorosed/normal enamel adjacent to various materials in descending order were as follows: EF 3.67/2.95 GPa, GIC 3.33/3.15 GPa, CN 3.13/3.23 GPa, and TNC 1.17/1.82 GPa, respectively. Statistically significant differences were found among various materials in both types of the enamel (p < 0.05). Conclusion: Based on the nanohardness test, EF can be a better choice for restoration in fluorosed teeth, followed by CN and GIC; GIC was better in normal enamel; however, this was not significant compared to CN and EF. Tetric N-Ceram composite resin had least influence on increasing the nanohardness of the adjacent enamel. Clinical significance: The surface nanohardness of normal and fluorosed enamel can be influenced by the type of restorative material used. The results of present study deserve clinician's attention while selecting restorative materials especially in dental fluorosis.



Ganapa PV Srikumar, R Shirish Kumar, Siddharth Bardia, Naiza Elsa Geojan, Geeta Nishad, Poonam Bhagat

Antifungal Effectiveness of Various Intracanal Medicaments against Candida albicans: An In Vitro Study

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:6] [Pages No:1042 - 1047]

Keywords: Candida albicans, Chitosan, Colony forming unit, Macrogol-propylene glycol, Triple antibiotic powder

   DOI: 10.5005/jp-journals-10024-2923  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the antifungal efficiency of various intracanal medicaments against Candida albicans. Materials and methods: One-hundred and forty extracted human mandibular premolar teeth were decoronated, and the biomechanical preparation was done in crown-down technique. 10 μL culture suspension of C. albicans was placed into the prepared root canal space of all the teeth. After 21 days of incubation, all the teeth were randomly divided into 7 groups with 20 teeth per each group. Group I: triple antibiotic powder (TAP) mixed with 3% chitosan solution; group II: TAP mixed with macrogol-propylene (MP) glycol; group III: chlorhexidine-guttapercha (CHX-GP); group IV: Vitapex; group V: 2% chlorhexidine gel; group VI: calcium hydroxide paste; group VII: normal saline with cotton (positive control) were used as intracanal medicaments, and the samples were incubated for 14 days. Intracanal medicaments were then completely removed using the canal brush. Dentinal chips were harvested from the walls of the root canal space in all samples using Gates-Glidden drills, were transferred into test tubes containing saline, and were serially diluted and placed in 140 Sabouraud dextrose agar plates, incubated at 37°C for 48 hours. Colony forming units (CFUs) of C. albicans were then counted using the digital colony counter. Results: One-way ANOVA test showed statistically significant difference among the seven groups, as the p value was < 0.001. Tukey's post hoc test showed intergroup comparison between group I and group V; group II and group III were statistically nonsignificant as p value was >0.05. Conclusion: 2% chlorhexidine gel and TAP mixed with 3% chitosan solution showed superior antifungal efficiency against C. albicans. Clinical significance: Chitosan solution's inherent antifungal efficiency and slow and controlled drug release make it as an effective alternate carrier in mixing it with TAP instead of mixing TAP with MP.



Ravi K Konagala, Jyothi Mandava, Anupreeta Anwarullah, Lakshman V Uppalapati, Srujana Karumuri, Priyanka L Angadala

Synergistic Effect of Arginine on Remineralization Potential of Fluoride Varnish and Nanohydroxyapatite on Artificial Caries Lesions: An In Vitro Study

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:6] [Pages No:1048 - 1053]

Keywords: Arginine, Energy-dispersive X-ray analysis, Fluoride varnish, Microhardness, Nanohydroxyapatite, Remineralization

   DOI: 10.5005/jp-journals-10024-2915  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the synergistic effect of arginine on the remineralizing potential of fluoride varnish and nanohydroxyapatite. Materials and methods: A total of 100 teeth were taken; of them, 50 teeth were allotted for microhardness test and 50 teeth for scanning-electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX) analysis. Fifty teeth used for hardness testing were sectioned to obtain 100 samples, and the baseline hardness values were measured. Samples were allotted into five groups (n = 20): group I: arginine; group II: fluoride varnish; group III: nanohydroxyapatite; group IV: arginine + fluoride varnish; group V: arginine + nanohydroxyapatite. Microhardness values were measured after 96 hours of demineralization and then again after application of remineralizing agents (pH cycling) for 10 days to check for gain in microhardness. The other 50 samples were subjected to SEM-EDX analysis for evaluating gain in the mineral content after demineralization and after application of the remineralizing agents. The collected data were subjected to statistical analysis using SPSS software version 22.0. Results: The maximum mean microhardness values were observed in group IV and group V. There was no statistical significance between them. Similarly, maximum mineral gain was seen in groups IV and V. A significant increase in fluoride gain was seen in group IV. Conclusion: Arginine has a synergistic effect on remineralization potential of fluoride varnish and nanohydroxyapatite. Clinical significance: The incorporation of arginine into fluoride varnishes and nanohydroxyapatite significantly increased their remineralization potential.



Farzan L Pouranfar, Ryan Sheridan, Cade Salmon, Kraig S Vandewalle

Effect of Toothbrushing on Surface Color of Ceramic-polymer Materials: An In Vitro Study

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:1054 - 1058]

Keywords: Ceramic polymers, Extrinsic stains, Lithium disilicate, Surface color, Toothbrushing

   DOI: 10.5005/jp-journals-10024-2933  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this study was to examine the effects of toothbrushing on the change in color of extrinsic characterization of ceramic-polymer materials. Materials and methods: Two ceramic-polymer materials (CeraSmart, GC; Enamic, VITA) and one lithium-disilicate material (IPS e.max CAD; Ivoclar Vivadent) were tested. Specimens of each material were prepared, characterized, and glazed per manufacturer's instructions. The treated surface of the blocks were then brushed in a toothpaste slurry with artificial saliva using a toothbrush machine with a soft toothbrush. Commission Internationale de L\'Eclairage (CIE) L*a*b* values were recorded with a spectrophotometer at baseline and at 3, 6, 9, and 12 simulated years of brushing (7,300 strokes/year). A mean change in color (ΔE*) and standard deviation was determined for each group and brushing interval. Data were analyzed with a two-way repeated measures ANOVA examining the effects of toothbrushing the ceramic materials on ΔE* over time (α = 0.05). Results: The difference in the ΔE* between CeraSmart and Enamic was significant at 3 years, while the differences between them were not significant at 6, 9, and 12 years of simulated brushing. The ΔE* of IPS e.max CAD was significantly lower than CeraSmart and Enamic at all time points (all p < 0.0001) except for the comparison with Enamic at 3 years. Conclusion: The extrinsic stains on the ceramic-polymer materials may be more susceptible to change from simulated toothbrushing compared to the lithium-disilicate material. Clinical significance: Toothbrushing may change the color of extrinsic characterization of ceramic-polymer materials. However, the change may remain clinically imperceptible to the naked eye (ΔE* > 1.0) for nearly 6 equivalent years of brushing.



Andrea Salmaso, Elena Canciani, Daniele Graziano, Claudia Dellavia

Ridge Preservation Using a Novel Freeze-dried Enzyme-deantigenic Bone Paste: A Histomorphometric-retrospective Pilot Case Series

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:9] [Pages No:1059 - 1067]

Keywords: Bone formation, Equine bone substitutes, Freeze-dried bone paste, Post-extractive sockets, Ridge preservation, Three-dimensional collagen matrix, Xenograft

   DOI: 10.5005/jp-journals-10024-2925  |  Open Access |  How to cite  | 


Aim and objective: The aim of this study is to provide preliminary retrospective evidence concerning the histologic and histomorphometric outcome of a novel freeze-dried equine-derived bone paste (EDEBEX) for ridge preservation of sockets following tooth extraction. Materials and methods: This pilot retrospective case series describes the histologic and histomorphometric outcome of three patients who received the equine-derived bone paste in post-extractive sockets to allow the preservation of the alveolar ridge. Patients were later rehabilitated with monolithic-zirconia, implant-supported prostheses. Results: All patients healed uneventfully. The collected biopsies showed a prevalence of bone formation at 4 months, compact lamellar bone, with well-defined lamellae surrounding Haversian and Volkmann's canals at 6 months, and an intermediate degree of maturation in active anabolic phase at 7 months after grafting. The amount of mineralized matrix was 63.3–70.7%, whereas medullar spaces were 26.0–30.7%. Conclusion: Histologic examination showed that the bone paste was fully biocompatible. Bone regeneration occurred within the first 4 months from grafting, with 63.3–70.7% mineralized bone matrix. The residual biomaterial, when present, did not exceed, on average, 2%. Clinical significance: Ridge preservation using bone substitutes as an alternative to autogenous bone is known to be effective. However, available clinical evidence still does not indicate the biomaterial, if any, that should be preferred to carry it out. The equine bone paste used in the present study appears to be a good candidate for further investigation because it is easy to handle in the clinical setting and it displays a good bone formation rate.



Shrish C Srivastava, Khyati Mahida, Chintan Agarwal, Ravindra M Chavda, Harshit A Patel

Longitudinal Stability of Rapid and Slow Maxillary Expansion: A Systematic Review

[Year:2020] [Month:September] [Volume:21] [Number:9] [Pages:5] [Pages No:1068 - 1072]

Keywords: Constricted maxilla, Crossbite, Palatal expansion, Rapid maxillary expansion

   DOI: 10.5005/jp-journals-10024-2932  |  Open Access |  How to cite  | 


Aim and objective: To review the long-term stability of slow maxillary expansion (SME) and rapid maxillary expansion (RME). Materials and methods: A systematic review of literature was carried out on the principal medical databases. Cephalometric studies, measurements on the dental casts, retrospective, cohort studies were kept as inclusion criteria. Last 20 years articles were included in the study. The studies where expansion had been performed by any one of the methods of expansion; that is, SME and RME were accepted. Studies where posttreatment follow-up had been performed were included. Selected articles were independently evaluated by three researchers. Discrepancies were resolved by discussion to reach a common consensus. Results: Total of 151 articles were first shown as relevant articles but after sorting the article according to relevancy in a stepwise manner 12 articles fulfilled the inclusion criteria and were incorporated in the study finally. In the study, nine prospective and three retrospective studies which had followed patients after maxillary expansion from 2 to 15 years were included. Conclusion: Correction with slow and rapid palatal expansion appears to be stable in the long-term when followed for extended periods after expansion treatment. Clinical significance: The article clearly describes the effectiveness of the expansion treatment and its longitudinal stability in terms of relapse by providing various evidences from the literature which were sought after systematically searching the different electronic databases.


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