The Journal of Contemporary Dental Practice

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2021 | October | Volume 22 | Issue 10


Anitha K Pandarathodiyil, Srinivas P Vijayan, Anand Ramanathan, Roopa S Rao

Autophagy: The “Pac-Man” within Us—Ally or Adversary?

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:3] [Pages No:1079 - 1081]

   DOI: 10.5005/jp-journals-10024-3213  |  Open Access |  How to cite  | 


Chiang X Mae, Naresh Y Shetty

Radiographic Evaluation of Crestal Bone Level Changes for Allografts or Xenografts Placed during Implant Placement: A Retrospective Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:5] [Pages No:1082 - 1086]

Keywords: Bone augmentation, Bone level changes, Dental implant success, Implant osteotomy

   DOI: 10.5005/jp-journals-10024-3195  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate initial peri-implant crestal bone level changes when the allografts and xenografts were placed simultaneously during the implant placement. Materials and methods: This retrospective study was planned with the convenient sampling total of 77 implant sites that were bone grafted either with allografts (group I) or xenografts (group II). Using the periapical radiographs obtained after placement of bone grafts as baseline, the changes in the alveolar crestal bone around the implants were evaluated by comparing periapical radiographs taken at 3 months and 6 or 8 months after the surgery. Results: The alveolar bone loss at crestal region at the time of placement of bone grafts were −1.85 ± 1.26 mm at the xenograft sites and −1.75 ± 1.51 mm at allograft sites, respectively (p = 0.791). At the time of reentry, 3 months after tooth extraction and ridge preservation, the bone dimensions were 1.17 ± 0.83 mm for xenograft and 1.00 ± 1.14 mm for allograft (p = 0.523). At the final reentry, bone-grafted sites were divided into after 6 months and after 8 months postoperatively. After 3 months, the allografts showed lesser bone resorption (0.9 ± 0.52 mm) as compared with the xenografts (1.25 ± 1.00 mm). The bone loss after 8 months for the allografts was spiked to 1.83 ± 0.42 mm as compared with the xenografts 1.37 ± 1.12 mm with no statistically significant difference (p >0.05). Conclusion: Both allografts and xenografts present comparable crestal bone level changes around dental implants when simultaneously placed during implant placement surgery. Clinical significance: Both allografts and xenografts are suitable for the preservation of the alveolar ridge regarding crestal bone level changes. Selection of allografts and xenografts may not be carried out based upon the crestal bone level changes.


Aya AEM Nemt-Allah, Shereen H Ibrahim, Amira F El-Zoghby

Marginal Integrity of Composite Restoration with and without Surface Pretreatment by Gold and Silver Nanoparticles vs Chlorhexidine: A Randomized Controlled Trial

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:11] [Pages No:1087 - 1097]

Keywords: Chlorhexidine, Marginal adaptation, Marginal staining, NanoCare Gold, Postoperative sensitivity

   DOI: 10.5005/jp-journals-10024-3200  |  Open Access |  How to cite  | 


Aim: This study was conducted to evaluate the marginal adaptation, marginal staining, and postoperative sensitivity of resin composite restorations after disinfection of class II cavities with NanoCare Gold and chlorhexidine in class II cavities immediately, after 6 months, 1, and 2 years using World Dental Federation (FDI) criteria for assessment of dental restorations. Materials and methods: In this study, 19 participants were recruited, 3 carious lesions in each one. After preparation of these lesions, they were randomly allocated into three parallel groups according to the disinfection protocol. The first group was for NanoCare Gold, the second was for chlorhexidine, and the third was for the control. The three groups were evaluated clinically and radiographically using (FDI) criteria at different intervals till 2 years of clinical service. Results: There was no statistically significant difference in age, gender, arch, and tooth type distribution among study groups. Regarding marginal adaptation, there was no statistically significant difference among the different groups but the difference was only statistically significant within each group after 2 years. Regarding the marginal staining, the difference was only significant between the NanoCare and the other groups after 2 years. In case of postoperative sensitivity, there was no statistically significant difference among the different groups and within each one at different intervals. Conclusion: NanoCare Gold could be promising in durability preservation of direct tooth-colored restorations. Marginal staining and postoperative sensitivity are regulated by other factors than surface pretreatment. Clinical significance: As long as restorations are inserted under rubber dam isolation, proper application steps, proper filling, and adequate finishing and polishing, the performance of the restorations would be satisfactory up to 1 year without any surface disinfection. However, after a longer follow-up, some changes may be noticed. NanoCare Gold and chlorhexidine are accepted as a cavity disinfectant without any negative effect on marginal adaptation of resin composite restorations.


Varsha Maria Sebastian, Farhat Nasreen, Pramod Junjanna, Azeem Hassan, Reshma Rajasekhar, Venkidesh Hari Maratt

Comparative Evaluation of Root Reinforcement Using MTA-based, Epoxy Resin-based, and Silicone-based Endodontic Sealers in Canals Instrumented with Single-file Rotary System: An In Vitro Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:7] [Pages No:1098 - 1104]

Keywords: AH plus, Dia-ProSeal, Fracture resistance, GuttaFlow 2, MTA Fillapex, Single-cone obturation, Universal testing machine

   DOI: 10.5005/jp-journals-10024-3194  |  Open Access |  How to cite  | 


Aim: To evaluate root reinforcement by four different sealers, namely, AH Plus, MTA Fillapex, Dia-ProSeal, and GuttaFlow 2, on endodontically treated teeth. Materials and methods: Sixty human mandibular premolars were randomly divided into four groups of 15 teeth each, according to the type of sealer used: Group I AH Plus, Group II MTA Fillapex, Group III Dia-ProSeal, and Group IV GuttaFlow 2. All samples were decoronated to a length of 13 mm from the apex. Root canals were prepared by OneShape, 25/0.06 taper file and obturated with a matching single cone gutta percha (25/0.06) using the above-mentioned sealers. All samples were subjected to load by universal testing machine until a point at which root fractured, which was recorded. Results: Teeth obturated with GuttaFlow 2 showed the maximum fracture resistance followed by AH Plus, Dia-ProSeal, and MTA Fillapex. There was no significant difference in fracture resistance between AH Plus and Dia-ProSeal. Conclusion: Teeth obturated with GuttaFlow 2 sealer, which has powdered gutta percha particles, showed the highest fracture resistance. Clinical significance: According to the results obtained from this study, obturation of roots with GuttaFlow 2 increased the resistance of root canal-filled teeth to vertical root fracture.


Neha Bhutani, Ghousia Fatima, Neha Rampure, Roopali Tapashetti, Sandeep S Prabhu, Fatru Rahman

Esthetic Evaluation of Maxillary Anterior Immediate Implant with Provisionalization with or without Bone Grafting

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:8] [Pages No:1105 - 1112]

Keywords: Esthetic zone, Immediate implant, Provisionalization

   DOI: 10.5005/jp-journals-10024-3158  |  Open Access |  How to cite  | 


Aim: Immediate implant in the esthetic zone is a treatment of choice. However, much research regarding immediate implant provisionalization lacked in the literature. Hence, our study was conducted with an aim to assess the changes in the soft tissue, hard tissue, and esthetic outcomes following immediate implants with provisionalization with or without bone grafting. Materials and methods: Twenty patients with a mean age between 18 and 55 years referred to the department of periodontology, for immediate implant placement in maxillary anterior region were included in the study. Patients were enrolled into two groups. Group I (test group) included patients with immediate implant placement with provisionalization with bone grafting. Group II (control group) included patients with immediate implant placement with provisionalization without bone grafting. Cement-retained provisional restoration was fitted over temporary abutment for 6 months of healing period. After 6 months of implant placement, definite crown was delivered. Results: The results of our study showed the least resorption of buccal cortical plate and good amount of bone gain in both the groups in terms of horizontal alveolar dimensional changes. The mean amount of horizontal alveolar gain in group I was 1.12 mm at 2 mm, 1.08 mm at 4 mm, and 0.85 mm at 6 mm; in group II, it was 0.97 mm at 2 mm, 1.4 mm at 4 mm, and 0.93 mm at 6 mm. Conclusion: This study showed a significantly better outcome in both the groups in terms of all the parameters when compared from baseline but the mean differences between the two groups were not very significant. The study concluded that immediate implant with provisionalization with or without bone grafting has maintained stability of soft tissues as well as hard tissues and has also given better esthetic outcomes. Clinical significance: The findings of this study proved that immediate implant placement with provisionalization with bone grafting is a predictable treatment modality that maintains the three-dimensional stability of alveolar bone and integrity of soft tissue and gives acceptable esthetics. Hence, this technique promises to fulfill both functional and esthetic concerns of the patient.


Sonali Gupta, Jayasree Komala, Pradeep N Tavane, G Vamshi Krishna, Bhargavi Chandula, Srinivas Satyanarayana Katta, Nandalur Kulashekar Reddy

Oral Health-related Quality of Life among Psychiatric In- and Outpatients Diagnosed with Different Disorders in Indore, Central India

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:5] [Pages No:1113 - 1117]

Keywords: Disability, Oral hygiene, Pain, Psychological, Quality of life

   DOI: 10.5005/jp-journals-10024-3162  |  Open Access |  How to cite  | 


Aim: To assess oral health-related quality of life among psychiatric patients. Materials and methods: A total of 400 inpatients and outpatients reporting to the Department of Psychiatry was taken as the final sample. Subjects diagnosed with mental illness and on medication for at least 1 year, who were able to respond to the pro forma and oral health impact profile (OHIP) questionnaire, were included. A guided, self-administered structured questionnaire was designed to include sociodemographic characteristics and short form of the OHIP-14 consisting of 14 items covering 7 domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. It was used to assess the impact of oral conditions on well-being and quality of life. The data collected were subjected to statistical analysis using SPSS IBM version 20.0. Results: The highest mean OHIP score for the disorders was seen among the patients diagnosed with schizophrenia for functional limitation (2.73 ± 1.194), 2.91 ± 1.111 for psychological discomfort, 2.67 ± 1.203 was recorded for physical disability, 2.79 ± 1.156 was the mean score for psychological disability followed by a score of 2.87 ± 1.172 for social disability. The highest mean score for the handicap domain was recorded for schizophrenia patients (2.73 ± 1.241) whereas for physical pain, a mean score of 3.01 ± 1.261 was recorded for patients diagnosed with bipolar disorder. Conclusion: Based on the findings of the study, it can be stated that the psychiatrists should pay attention to the dental anxiety concerns of the patients and encourage them to visit oral health professionals. Clinical significance: The study highlights the importance of incorporating dental health education to psychiatric rehabilitation programs.


Manea Musa Al-Ahmari

Effect of Antibiotics and Carbohydrate Diet Control Instructions in Improving Glycated Hemoglobin among Type II Diabetic Patients with Periodontitis

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:5] [Pages No:1118 - 1122]

Keywords: Antibiotics, Diabetes, Glycated hemoglobin, Periodontitis

   DOI: 10.5005/jp-journals-10024-3185  |  Open Access |  How to cite  | 


Aim: This study was aimed to assess the effect of the scaling and root planing (SRP) with or without doxycycline and received carbohydrate diet control instructions in improving glycated hemoglobin (HbA1c) among type II diabetes mellitus (DM) patients diagnosed with periodontitis. Materials and methods: Nonrandomized clinical study design was conducted among 150 patients who were referred to the specialist dental centers in Abha city, between April 2019 and March 2021. The patients were allocated into two groups. Those receiving SRP with doxycycline were classified as group A, whereas patients who received SRP alone were classified as group B. The HbA1c levels were assessed at the baseline, and 3, 6, 12, and 24 months. Statistical package for the social sciences SPSS version 26 was used. p <0.05 was considered statistically significant. Results: There is a statistically significant difference in HbA1c level between the two groups during follow-up after 3, 6, 12, and 24 months (p <0.001, p <0.001, p <0.001, and p <0.001, respectively). Moreover, the improvement in HbA1c level was significantly observed after 24 months of follow-up in group A compared to group B (p <0.001) and most of this improvement was after the first 3 months of the follow-up. Conclusion: The SRP associated with doxycycline is more effective in improving HbA1c level among type II DM patients diagnosed with periodontitis than SRP alone. Most of the improvement is seen after 3 months of the follow-up. Clinical significance: Valuable information is provided for dental professionals about the importance of prescription of antibiotics with the periodontal treatment in improving the HbA1c level in type II DM patients.

Original Article

Radwa Osama Ibrahim, Rania Ahmed Salama, Abdelhady Mohamed Amin

Can Ethanolic Leaf Extract of Olive or Black Mulberry Substitute Sodium Hypochlorite as a Root Canal Irrigant? An In Vitro Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:7] [Pages No:1123 - 1129]

Keywords: Endodontic irrigant, Enterococcus faecalis, Herbal extracts, Microbiology, Microhardness

   DOI: 10.5005/jp-journals-10024-3205  |  Open Access |  How to cite  | 


Aim: This study aimed to evaluate Olea europaea (olive) leaves and Morus nigra (black mulberry) leaves as potential natural alternatives to sodium hypochlorite (NaOCl) endodontic irrigant. Their antimicrobial activity against Enterococcus faecalis (E. faecalis) and their effects on both root dentin microhardness and push-out bond strength of resin sealer/root dentin were assessed. Methodology: Fifty-four extracted teeth were selected. Samples were grouped according to the irrigant used: group I (control): 2.5% NaOCl, group II: 8% ethanolic extract of Olea europaea, and group III: 2% ethanolic extract of Morus nigra. Antibacterial activity (n = 6) was evaluated after each canal was autoclaved, inoculated with E. faecalis, and incubated. Canals were sampled before and after chemicomechanical canal preparation with 2 mL of irrigant. The colony-forming units (CFUs) were counted at 1/10 and 1/100 broth concentrations. Vickers hardness number (VHN) of root dentin (n = 6) was measured before and after root canal preparation and irrigation. Push-out bond strength testing (n = 9) was carried out following preparation, irrigation, obturation, and thermocycling. Results were considered statistically significant at p ≤0.05. Results: Following irrigation, the CFUs of E. faecalis were significantly reduced with no significant difference in the CFU count between all groups at both broth concentrations. A significant reduction in root dentin microhardness resulted in all groups following irrigation, with Morus nigra resulting in the lowest percentage reduction (26.42 ± 1.12). The lowest significant mean push-out bond strength was revealed in the Olea europaea group (3.372 ± 1.513 MPa). Conclusion: The use of 2% mulberry (Morus nigra) leaf extract and 8% olive (Olea europaea) leaf extract as alternatives to NaOCl provides promising antimicrobial action against E. faecalis. Clinical significance: 2% Morus nigra extract may represent a promising natural endodontic irrigant.


Rashtra Bhushan, Shruti Shivakumar, PS Prasanth, T Faraz Afzal, Abdul Saheer, Thara Chandran

Assessment of the Effectiveness of Different Fluoride-releasing Bonding Agents on Prevention of Enamel Demineralization around Orthodontic Bracket: An In Vitro Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:5] [Pages No:1130 - 1134]

Keywords: Bonding agents, Enamel demineralization, Fluoride release, Premolar brackets

   DOI: 10.5005/jp-journals-10024-3161  |  Open Access |  How to cite  | 


Aim: The aim of the current research was to evaluate the efficacy of different fluoride-releasing bonding products in preventing enamel demineralization around orthodontic brackets by using a scanning electron microscope (SEM). Materials and methods: This research was performed using 80 healthy human premolar teeth that were extracted in course of orthodontic therapy. Until use, the sample premolars were subjected to storage in 0.1% thymol. Each premolar was thereafter cleansed with pumice for 10 seconds. Stainless steel brackets for premolars were employed. The 80 samples were allocated at random to one of the four groups (20 in each) as follows: Group I, control; group II, Transbond Plus color change adhesive; group III, GC Fuji Ortho LC; and group IV, Vitremer. An hour following bonding, all samples were subjected to pH cycling at a temperature of 37°C for a 14-day period. The premolar teeth were assessed below SEM. Analysis was performed with the one-way analysis of variance. Statistical significance was set at a p-value less than 0.05. Results: The extreme area of demineralization was abridged by the use of Transbond™ Plus color change adhesive (108.19 ± 0.68), trailed by GC Fuji Ortho LC (119.24 ± 0.37) use, Vitremer (121.56 ± 0.92) as well as the control group (141.88 ± 1.09) in that order. And there was a statistically significant difference found between the groups (p <0.001). Tukey\'s honestly significant difference (HSD) was employed in an overall comparison of mean areas of enamel demineralization, which depicted that differences were significant statistically with the exception of group III and group IV. Conclusion: The current research came to a conclusion that the Transbond Plus color change adhesive group was more potent in significant inhibition of demineralization areas in comparison to GC Fuji Ortho LC group and Vitremer group. Clinical significance: In course of fixed orthodontic therapy, demineralization of enamel is an inherent occurrence. Multiple approaches are being continually developed to avoid the formation of white spot lesions (WSLs) that compromise esthetics and cause deprived remineralization that enhances the menace of dental caries. Bonding agents that can release fluorides are thus considered highly efficacious.


Amir Shaikh, Asna Fatima Jamdar, Shakeel Ahmed Galgali, Smita Patil, Inayat Patel

Efficacy of Infrazygomatic Crest Implants for Full-arch Distalization of Maxilla and Reduction of Gummy Smile in Class II Malocclusion

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:9] [Pages No:1135 - 1143]

Keywords: Gummy smile, Infrazygomatic crest implants, Intrusion, Maxillary arch distalization, Skeletal anchorage, Skeletal class II discrepancy

   DOI: 10.5005/jp-journals-10024-3179  |  Open Access |  How to cite  | 


Aim: The purpose of the study was to evaluate the efficacy of infrazygomatic (IZ) implants along with mini-implants for full-arch distalization of maxilla and reduction of gummy smile in patients with class II division I malocclusion. Materials and methods: Ten orthodontic patients were taken from the department of orthodontics and dentofacial orthopedics. Each patient required distalization and intrusion of the complete maxillary arch as a part of the treatment plan. Patients were of class II malocclusion with gummy smile. Initial leveling and alignment were done by using 0.22″ slot Mclaughlin Bennett Trevisi (MBT) prescription. Fav Anchor infrazygomatic crest (IZC) implants of 2 mm of head diameter and 14 mm length were inserted between first and second molar and 2 mm above the mucogingival junction in the alveolar mucosa and in the anterior region, two titanium mini-implants of 1.4 mm head diameter and 6 mm length. The screws were loaded immediately with e-chain with a minimal force from mini-implants in the anterior region to crimpable hook placed between lateral and canine and continuing the same till the IZ implants. To measure the amount of distalization and reduction of gummy smile, pre- and postlateral cephalograms were taken and assessed. Pre- and postdistalization and intrusion readings of all patients were obtained and calculated statistically for quantifying the amount of distalization of maxillary arch and intrusion for reduction of gummy smile. Results: The distalization of the maxillary arch achieved was 4.6 mm which is clinically and statistically significant. The anterior teeth in the study were intruded with a minimum of 3.8 mm which is clinically and statistically significant; the gingival smile line was reduced with a mean of 3.4 mm which is clinically and statistically significant. Overbite correction of 4 mm was done with the mean difference of 4 mm which is also statistically significant. Conclusion: The IZ bone screws can be effectively used as an absolute anchorage to correct class II skeletal discrepancy with gummy smile devoid of premolar extraction with noninvasive procedure. Clinical significance: The use of IZC implants along with anterior implants, a biomechanical approach is effective in achieving full-arch distalization of maxilla and intrusion as the force vectors allow that the line of action passes through the center of resistance (Cr) of the entire maxillary arch, facilitates the distalization and intrusion of the maxillary arch, establishes ideal occlusion, and improves the smile esthetics.


Ayman M Sulimany, Saad S BinSaleh, Eram AlYahya, Rawan Bataweel, Imtinan Alhussain, Ahmed Almahdy

Effect of Aging on the Microhardness of Different Resin-based Fluoride-releasing Fissure Sealants: An In Vitro Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:6] [Pages No:1144 - 1149]

Keywords: Aging, Fissure sealant, Microhardness, Resin-based fluoride-releasing sealants

   DOI: 10.5005/jp-journals-10024-3153  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to evaluate the effect of aging on the microhardness score [Vickers hardness number (VHN)] of different resin-based fluoride-releasing sealants compared to non-fluoride resin-based sealants. Materials and methods: A total of 48 extracted sound molars that were sectioned mesiodistally were used. In the current study, four types of sealants were compared: Group A, a resin-based non-fluoride-releasing pit and fissure sealant (Eco-S sealant) served as a control. Groups B, C, and D received resin-based fluoride-releasing pit and fissure sealants Helioseal F, Fissurit F, and Embrace™ WetBond, respectively. Subsequently, each group was further divided into immediate and aged subgroups. The samples had been evaluated regarding their microhardness using a pyramidal diamond indenter of a Vickers hardness test at two-time intervals: Immediately and after the aging process through thermocycling. Results: There were no statistically significant differences between mean VHN and material types (p = 0.72). Aging appeared to significantly increase the mean VHN (p = 0.001). The interaction model between material type and time factor showed that the effect of aging differs by the material type, where the VHN of the Embrace™ group increased significantly after aging from 24.33 ± 5.60 to 31.70 ± 3.59 (p = 0.001). Conclusion: While there were no significant differences in the microhardness of commonly used fluoride-releasing fissure sealants, time appears to significantly increase the mean microhardness score (VHN), especially in the Embrace™ group. Clinical significance: Embrace™ WetBond fissure sealant showed a significant improvement in the mean microhardness score (VHN) with time. However, clinical studies with long-term follow-up are needed to confirm our results.


Anadha N Gujar, Prashantha G Shivamurthy, Sharanya Sabrish

Effect of 125–150 Hz Vibrational Frequency Electric Toothbrush on Teeth and Supporting Structures: A Finite Element Method Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:10] [Pages No:1150 - 1159]

Keywords: Electric toothbrush, Finite element analysis, Finite element model, Mechanical vibration, Safe range, Vibrational frequency

   DOI: 10.5005/jp-journals-10024-3202  |  Open Access |  How to cite  | 


Aim and objective: The aim of this finite element method (FEM) study was to assess the safety of 125–150 Hz vibrational frequency electric toothbrush on teeth and associated structures. Materials and methods: A three-dimensional (3D) geometric model of entire skull having maxilla, mandible, and their dentitions was created using a computed tomography (CT) image of a healthy male patient. Linear static analysis was carried out by applying 15 g of force on anterior part of maxilla and mandible from labial and lingual sides each to calculate the primary displacement (sagittal, vertical, and transversal) and principal stress levels generated on the maxillary and mandibular dentition, on the maxilla and mandible and on the whole skull. Results: A force of 15 g applied to maxillary anterior teeth from labial side caused a mean deflection of 0.003 mm and stress of 0.004 MPa on the teeth and supporting structures. A force of 15 g applied to maxillary anterior teeth from palatal side caused a mean deflection of 0.017 mm and stress of 0.017 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from labial side caused a mean deflection of 0.078 mm and stress of 0.051 MPa on the teeth and supporting structures. A force of 15 g applied to mandibular anterior teeth from lingual side caused a mean deflection of 0.077 mm and stress of 0.051 MPa on the teeth and supporting structures. Conclusion: For the applied loads and boundary conditions, very small or negligible amount of stresses were observed in maxilla, mandible, and their dentitions. The vibrational frequency of 150 Hz producing 15 g of force did not produce any harmful effects on maxilla, mandible, and their dentitions. Hence, 125–150 Hz of vibrational frequency can be considered optimum. Clinical significance: An electric toothbrush using the vibration of 125–150 Hz produces negligible stress on teeth and associated structures.

Original Article

Naohiko Kawamura, Takashi Murakami, Kazuki Sobue, Shigemasa Kobayashi, Atsue Yamazaki, Yuya Nakao, Masahiro Iijima

Esthetics of Orthodontic Appliances: Objective Evaluation by Spectrophotometry vs Subjective Evaluation Using the Visual Analog Scale Method

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:7] [Pages No:1160 - 1166]

Keywords: Esthetics, Orthodontic appliances, Orthodontic archwire, Orthodontic bracket, Spectrophotometry

   DOI: 10.5005/jp-journals-10024-3210  |  Open Access |  How to cite  | 


Aim and objective: In this study, we quantified the color of brackets and archwire appliances for an objective evaluation and investigated its relationship with subjective esthetic evaluation. Materials and methods: Five types of commercially available brackets (ceramic brackets C1, C2, and C3; plastic brackets P1 and P2) and three types of archwires (coated nickel-titanium archwires W1, W2, and W3) were used. The reflectance (%) and color (lightness: L*, hue: a*, b*) of each sample were quantified using a spectrophotometer (n = 5). Fifteen combinations of brackets and archwires were used. The esthetic evaluation was performed using the visual analog scale (VAS) method, and responses were obtained from 30 laypersons and 15 orthodontists. The mean VAS score was calculated, and the relationship between the reflectance and color of the bracket and archwire was discussed. Results: The reflectance and L* of the brackets showed significantly higher values for C3 and C1 than for the others and lower values for P1 and P2. The reflectance and L* of the archwire showed significant differences among all samples. There was a high positive correlation between the reflectance and L*. There were statistically significant positive correlations between the layperson and orthodontist groups, between the VAS score and reflectivity, and between VAS score and L*. Conclusion: Our results showed that as the lightness and reflectance of the brackets and archwires increased, the subjective evaluation concerning their esthetic value was higher. Clinical significance: It is extremely difficult to evaluate esthetics despite the fact that patients’ demands for esthetics have been increasing in recent years. If a method for evaluating esthetics is established, it should help in the development and selection of esthetic devices. The results of this study will facilitate the development of future study designs.


Anwar Alhazmi, Mesfer Alshehri, Abdullah Alrefai, Omar Alattas, Fatimah Arif, Salwa Hakami, Rawan Dowiry

Assessment of Severity of Malocclusion and Orthodontic Treatment Need Using the Dental Esthetic Index and Angle's Classification: A Retrospective Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:4] [Pages No:1167 - 1170]

Keywords: Angle\'s classification, Dental esthetic index, Malocclusion, Orthodontics

   DOI: 10.5005/jp-journals-10024-3193  |  Open Access |  How to cite  | 


Introduction: Angle\'s classification is the most widely used instrument for evaluation of malocclusion. The dental esthetic index (DAI) is a reliable, valid, and universally accepted cross-cultural index adopted by the World Health Organization (WHO) that links objective, clinical, and subjective esthetic factors to produce a single score that reflects the severity and the treatment needs of the malocclusion. The present study aims to evaluate Angle\'s classification and DAI to assess the severity of malocclusion and treatment needs. Materials and methods: This retrospective cross-sectional study was done on pretreatment orthodontics records of 145 male patients and 153 female patients in the age-group 9–42 years with malocclusion who had received or were undergoing orthodontic treatment in the orthodontic department clinics of the College of Dentistry, Jazan University. Preorthodontic study casts, orthopantomography, and lateral cephalometric X-rays were analyzed. DAI scores were calculated, and treatment needs were assessed. Angle\'s classification of malocclusion was also noted. Results: Among patients with normal or minor malocclusion (DAI score ≤25), a significantly higher percentage of patients were class I (58%) than any other class of malocclusion. Among patients determined to have handicapping malocclusion (DAI score ≥36), significantly higher percentage of patients were class II/1 (44%) than any other class of malocclusion. Class II/1 showed the highest percentage of definite (24%) (DAI score 26–30), severe (19%) (DAI score 31–35), and handicapping malocclusions (44%) (DAI score ≥36). A total of 26% of patients had skeletal class I. A total of 38% of patients had skeletal class II. A total of 36% of patients had skeletal class III. Approximately 13% of patients had maxillary canine impactions and 3% of patients had mandibular canine impactions. Conclusion: The study reported 35% of patients were having handicapping malocclusion (DAI ≥36) and 14% having severe malocclusion (DAI score 31–35). The malocclusion was characterized by a high frequency of anterior crowding. Thus, the complementary use of DAI and Angle\'s classification, with improvements, helps establish an all-inclusive criterion for screening and prioritizing of patients eligible for receiving subsidized, publicly funded orthodontic care and thus allows better use of limited available resources.


Prashanth Bytarahosalli Rajachar, Mythreyee S Vidhya, Rupali Karale, Vinay Kumar Govindaraju, Nithin K Shetty

Evaluation of Free Available Chlorine of Sodium Hypochlorite When Admixed with 0.2% Chitosan: A Preliminary Study

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:4] [Pages No:1171 - 1174]

Keywords: Chlorhexidine, Chitosan, Ethylenediaminetetraacetic acid, Free available chlorine, Iodometric titration, Sodium hypochlorite

   DOI: 10.5005/jp-journals-10024-3207  |  Open Access |  How to cite  | 


Aim and objective: The aim of the study was to evaluate the changes in free available chlorine (FAC) when 6% sodium hypochlorite (NaOCl) is admixed with irrigants 17% ethylenediaminetetraacetic acid (EDTA), 2% chlorhexidine (CHX), and 0.2% chitosan in varying proportions of 90:10, 80:20, and 50:50. Materials and methods: The 25 mL aliquots of 6% NaOCl were admixed in varying proportions of 90:10, 80:20, and 50:50 with secondary irrigation solutions: (a) 17% EDTA, (b) 2% CHX, (c) 0.2% chitosan. Iodometric titration was done to evaluate the change in FAC. Statistical analysis used: Kruskal–Wallis and Mann–Whitney tests. Results: On titration, the mean FAC value of NaOCl at baseline was 1.99 g%. On mixing NaOCl with EDTA, the FAC decreased in all the three proportions and the values were 0.17 g%, 0.17 g%, and 0.06 g% at 90:10, 80:20, and 50:50 ratios, respectively. pH obtained was 9.55 at 50:50 ratio. On mixing NaOCl with CHX, FAC reduced and the values were 1.84 g%, 1.72 g%, and 0.27 g% at 90:10, 80:20, and 50:50 ratios, respectively. pH obtained was 10.87 at 50:50 ratio. On mixing NaOCl and chitosan, the FAC remained unaltered in all the three proportions and the values were 1.64 g%, 1.51 g%, and 1.63 g% at 90:10, 80:20, and 50:50 ratios, respectively. pH obtained was 11 at 50:50 ratio. Conclusion: Combination of NaOCl and chitosan did not lead to a reduction in FAC and the pH of the solution remained unaltered, suggesting that tissue-dissolving property of NaOCl might be preserved. Clinical significance: The combination of chitosan with NaOCl is advantageous in two ways. Firstly, FAC remained unaltered and the pH of the solution was also maintained at 11.05 indicating that the tissue-dissolving property of NaOCl prevailed. Secondly, chitosan is known for its chelating property and is effective in smear layer removal. With further in vivo and in vitro studies, a combination of chitosan and NaOCl can be proposed as a novel irrigant.


Dina G Mufti, Saad A Al-Nazhan

Retreatability of Bioceramic Sealer Using One Curve Rotary File Assessed by Microcomputed Tomography

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:9] [Pages No:1175 - 1183]

Keywords: AH Plus sealer, Bioceramic sealer, Mandibular molar, Microcomputed tomography, Root canal retreatment

   DOI: 10.5005/jp-journals-10024-3214  |  Open Access |  How to cite  | 


Aim and objective: This article aims to evaluate the residual filling materials after retreatment of bioceramic sealer used in the obturation technique of mandibular molars with different root curvatures using microcomputed tomography (micro-CT). Materials and methods: A total of 106 canals of mandibular molar teeth with closed apex, no fracture, calcification, or previously root canals treated were selected. Each tooth was mounted in acrylic resin blocks, and canals were instrumented with 06 One Curve rotary file and filled with gutta-percha and EndoSequence bioceramic (group A) or AH Plus sealer (group B) then subdivided into three groups (each) based on the degree of root curvature; mild (≤15°), moderate (16–30°), or severe (≥31°). Retreatment was done with the same rotary file. Samples were scanned before and after retreatment, and the volume of the residual materials was calculated. Data were statistically analyzed. Results: The micro-CT scans show remaining filling in all canal levels of the two groups after retreatment. The mean values of all canals in bioceramic as well as AH Plus samples were significantly higher at coronal level (p < 0.001). In addition, the mean differences of distolingual canal after retreatment were not significantly different between the three levels in bioceramic group (p = 0.051). In regard to the AH Plus group, the mean values of mesiolingual canal after retreatment were statistically significant higher at coronal level (p < 0.001). Conclusion: Micro-CT tool provides a clear 3D visualization. Remnants of Bioceramic and AH Plus sealers were detected in different canal curvatures. The use of One Curve rotary file did not improve the removal of the filling materials. Clinical significance: It is difficult to achieved complete removal of bioceramic filling material from the root canal system using rotary file.


Shinya Horiuchi, Hiroko Sato, Akihiko Iwasa, Aki Ichihara, Hirofumi Tenshin, Keiichiro Watanabe, Masahiro Hiasa, Ichiro Hashimoto, Eiji Tanaka

Long-term Management of a Patient with Apert Syndrome

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:7] [Pages No:1184 - 1190]

Keywords: Apert syndrome, Craniosynostosis, Distraction osteogenesis, Le Fort III osteotomy, Maxillary growth deficiency

   DOI: 10.5005/jp-journals-10024-3201  |  Open Access |  How to cite  | 


Aim and objective: To present an Apert syndrome patient with midfacial growth deficiency treated with Le Fort III distraction osteogenesis and subsequent two-jaw surgery. Background: Apert syndrome is expressed as a severe and irregular craniosynostosis, midfacial hypoplasia, and symmetric syndactyly in the fingers and toes. For craniosynostosis syndromes, treatment planning is complex due to the disharmony between facial profile and occlusion. Case description: A 4-year-and-5-month-old boy, diagnosed with Apert syndrome, showed a concave profile accompanied with midfacial hypoplasia, moderate exorbitism, a reversed occlusion of −10.0 mm, an anterior open bite of −5.0 mm, and skeletal class III jaw-base relationship. The patient, aged 15 years and 4 months, underwent a Le Fort III osteotomy, and subsequent osteodistraction was performed via a rigid external distraction (RED) device. His midfacial bone was advanced by approximately 7.0 mm. One year after the distraction, preoperative treatment with 0.018-in preadjusted edgewise appliances was initiated. Two-jaw surgery with a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy was performed after 42 months of preoperative orthodontic treatment. At the age of 20 years and 9 months, his facial profile dramatically changed to a straight profile, and an acceptable occlusion with an adequate interincisal relationship was obtained. A functional occlusion with an excellent facial profile was maintained throughout the 2-year retention period, although the upper dental arch width was slightly decreased, resulting in the recurrence of the left posterior crossbite. Conclusion: Our report indicates the necessity of long-term follow-up in patients with craniosynostosis because of syndrome-specific growth and methodologically induced relapse. Clinical significance: The two-stage operation combining early distraction osteogenesis and postgrowth orthognathic surgery proves to be an effective therapy for correcting midfacial hypoplasia and skeletal mandibular protrusion caused by Apert syndrome.


Hafiz A Adawi

Use of a Rotational Flap with Soft Tissue Graft and Tunneling Technique for Ovate Pontic Site Development for a Highly Esthetic Outcome: A Case Report

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:6] [Pages No:1191 - 1196]

Keywords: Esthetic zone, Ovate pontic, Rotational flap, Tissue graft, Tunnel technique

   DOI: 10.5005/jp-journals-10024-3203  |  Open Access |  How to cite  | 


Aim and objective: The objective of therapy was to replace the missing teeth with a restoration that closely adhered to the natural teeth and soft tissue contour to provide an esthetic outcome. Case description: A 19-year-old male reported a failed fixed partial denture (FPD) in the maxillary left central incisor. The abutment extended to the maxillary right central incisor and the maxillary left lateral incisor. Radiographic examination revealed that the neighboring maxillary right central incisor abutment was nonrestorable. The treatment plan was the extraction of the maxillary right central incisor with socket preservation, modification of the pontic sites for placement of an ovate pontic for the replacement of the missing maxillary upper central incisors with an FPD with the maxillary lateral incisors serving as the abutment teeth. The pontic sites were corrected with a U-shaped flap extended 5 mm palatal from the mid-crestal line. The incision was avoided at the interdental papilla area. The facial flap was elevated. The facial soft tissue was vertically tunneled. The flap was flipped into the facial tunnel and stabilized with horizontal nylon matrix sutures. The surgical site was stabilized with a provisional FPD with an ovate pontic. The final restoration was a full zirconia facial veneered FPD. Results: Surgical site showed significant healing with a natural emergence profile, and interdental papillae filling the gingival embrasure, showing no evidence of recession. At the 1-year follow-up, the gingival thickness improved and the pontic emergence profile was natural. A very stable result for soft tissue volume and interdental papillae were seen. Conclusion: According to the result obtained with rotational flap, it can be used for small anterior defects with promising results, without the need for bone graft procedures or additional tissue graft. Clinical significance: With proper case selection, the use of a rotational flap with a tunnel technique and an ovate pontic in the anterior esthetic region is an alternative treatment option that can successfully restore masticatory and esthetic function.


Bruna R Neves, Rafaella S Leão, Andressa S Carneiro da Silva, Joel F Santiago Junior, Belmiro C do Egito Vasconcelos, Eduardo P Pellizzer, Sandra L Dantas Moraes

Influence of Complete Denture Use on Respiratory Capacity: A Systematic Review

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:9] [Pages No:1197 - 1205]

Keywords: Airways, Denture, Respiratory function tests, Spirometry

   DOI: 10.5005/jp-journals-10024-3206  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to determine whether the use of complete dentures has an influence on the respiratory capacity, assessed by the spirometry examination. Materials and methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis and registered in the International Prospective Register of Systematic Reviews (CRD42021255224). The PICO question (population/exposure/comparison/outcome) was “Does the use of complete dentures influence the respiratory capacity of a toothless subject?” A search strategy was adapted for the PubMed/MEDLINE, The Cochrane Library, OpenGrey, Lilacs, Scopus, and Embase databases. Inclusion criteria were prospective and retrospective studies. The new castle ottawa (NOS) scale and the Methodological Index for Non-randomized studies were selected to assess the quality of the included studies. Results: Four studies were selected, totalizing the evaluation of 242 participants, aged ranging from 40 to 73 years old. Two studies concluded that the use of complete dentures can negatively affect the respiratory capacity. One study stated that it did not interfere regardless of its use during spirometric measurements, and the other reported that dental prosthesis was required in cases of evaluation of the extrathoracic airways. Conclusion: The use of complete dentures did not represent relevant changes from the reference values for pulmonary function in the spirometry test. Considering the results of this review, it is not yet possible to establish a clinical protocol for the use of complete dentures during the test. Clinical significance: Oral rehabilitation with conventional complete dentures is widely used for the treatment of edentulism, especially in elderly patients. In addition, with aging, many complex changes in immunity and respiratory function contribute to the increase in the development of lung diseases. Therefore, it is important to establish a guidance regarding the use or not of the removable dental prostheses in the respiratory capacity test through spirometry examination.


Sri P Narayanan, Hemamalini Rath, Abhijit Panda, Shilpa Mahapatra, Rubian H Kader

Prevalence, Trends, and Associated Risk Factors of Traumatic Dental Injury among Children and Adolescents in India: A Systematic Review and Meta-analysis

[Year:2021] [Month:October] [Volume:22] [Number:10] [Pages:19] [Pages No:1206 - 1224]

Keywords: Adolescent, Children, Dental trauma, Inadequate lip coverage, Overjet, Permanent teeth, Systematic review

   DOI: 10.5005/jp-journals-10024-3212  |  Open Access |  How to cite  | 


Aim and objective: Traumatic dental injury (TDI) is a significant public health concern. This study aimed to perform a systematic review on the prevalence, trends, and possible risk factors of dental trauma in permanent teeth among children and adolescents in India. Materials and methods: Literature search was carried out, in PubMed, EMBASE, Web of Science, Cochrane, Google scholar, and Gray literature (MDS dissertation, manuscripts) database up to October 5, 2020, reporting on dental trauma prevalence in India. Meta-analyses were done using random effects model. Pooled estimates were calculated with a confidence interval of 95% (95% CI) both for prevalence and odds ratios (OR). Trend analysis was performed for the included studies. Quality assessment of the included studies was done using the Hoy checklist for prevalence studies. Qualitative synthesis was done for predictors in which meta-analysis could not be performed. Results: This online searching strategy collected and listed 2,491 articles on this topic. After evaluating their titles and abstracts, only 59 were finally selected for complete review and data collection. All studies had been performed in children and adolescents. The pooled prevalence of dental trauma in permanent teeth was 11%. Positive summary association of dental trauma with male gender (pooled OR = 1.52; 95% CI: 1.37–1.70), inadequate lip coverage (pooled OR = 4.76; 95% CI: 3.18–7.11), and increased overjet of >3.5mm (pooled OR = 4.84; 95% CI: 2.86–8.19) and >5.5 mm (pooled OR = 4.93; 95% CI: 4.32–5.63) was observed. Prevalence of dental trauma showed an increasing trend with time. All of the studies were having moderate–high risk of bias. Conclusion: Approximately 9–13% of the children and adolescents in India presented some type of TDI in permanent teeth, with an increasing trend. Boys, children, and adolescents presenting inadequate lip coverage, or an increased overjet greater than 3.5 and 5.5 mm are more likely to have traumatic dental injuries. Clinical significance: Future population-based analytical studies on TDI in India are recommended.

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