The Journal of Contemporary Dental Practice

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2021 | November | Volume 22 | Issue 11


Maurilio D\'Angelo, Federico Valenti Obino, Shilpa Bhandi, Gabriele Miccoli, Andrea Cicconetti

Mechanical Characteristics, Testing, and Future Perspective of Nickel–Titanium Rotary Instruments

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:2] [Pages No:1225 - 1226]

   DOI: 10.5005/jp-journals-10024-3230  |  Open Access |  How to cite  | 


Kevin Huamaní, Luzmila Vilchez, Franco Mauricio, Hilda Jáuregui, Arnaldo Munive-Degregori, Frank Mayta-Tovalino

Comparison of the Antifungal Efficacy of Four Concentrations of Minthostachys mollis (Muña) Essential Oil against Candida albicans: An In Vitro Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1227 - 1231]

Keywords: Antifungal efficacy, Candida albicans, Minthostachys mollis

   DOI: 10.5005/jp-journals-10024-3225  |  Open Access |  How to cite  | 


Aim and objective: This paper aims to compare the antifungal efficacy of four concentrations of Minthostachys mollis essential oil (MEO) against Candida albicans ATCC 10231. Materials and methods: This study was conducted in vitro. Ten kilograms of M. mollis (Muña) were collected in the city of Tarma, Peru. The plant was then dried in the shade at room temperature (21°C), and the essential oil was obtained through distillation. C. albicans ATCC 10231 was cultured at a MacFarland scale of 0.5, which corresponds to a concentration of 3 × 108 CFU/mL. Each plate was filled with one of the four MEO concentrations (25, 50, 75, or 100%), dimethyl sulfoxide (negative control), or fluconazole (positive control), a known antifungal agent. After incubation, each plate was examined using the Kirby-Bauer method. Results: Compared to MEO 25%, MEO 50%, and MEO 75%, MEO 100% had the highest antifungal efficacy at 24, 48, and 72 hours of evaluation, with an average of 18.9 ± 0.7, 18.2 ± 0.7, and 17.0 ± 0.4 mm, respectively. However, fluconazole had higher efficacy (27.9 ± 0.5, 27.5 ± 0.5, and 23.7 ± 0.7 mm, respectively). Post hoc analysis showed that there were significant differences between all concentrations of the MEO groups and their respective positive and negative control groups (p <0.001). Conclusion: Among the MEO groups, the pure concentration (MEO 100%) had the highest antifungal efficacy. However, fluconazole presented greater efficacy, and the differences were statistically significant. Clinical significance: This research allowed to know the efficacy of this natural resource against one of the most prevalent fungi in the oral cavity. Therefore, a line of research could be opened to deepen its potential benefits for oral health.


Mônica M Bezerra, Victor P Feitosa, Flavia D Vivacqua, Bruno C de Vasconcelos, Nilton Vivacqua-Gomes

Evaluation of Foraminal Enlargement with Thermally Treated Nickel–Titanium Systems

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1232 - 1236]

Keywords: Apical foramen, Apical foramen enlargement, Endodontics, Root canal therapy, Tooth apices

   DOI: 10.5005/jp-journals-10024-3234  |  Open Access |  How to cite  | 


Aim and objective: To evaluate morphologic changes in the main foramen after enlargement with four different systems. Materials and methods: One hundred and twenty canals (buccal of maxillary molars and mesial of mandibular molars) with patency and apical foramen ≤200 µm were included. These apical foramina were photographed and then randomly divided into four experimental groups, according to the ProDesign Logic (PDL), ProDesign R (PDR), twisted file adaptive (TFA), and WaveOne Gold (WOG) systems, all of which were composed of three sequential instruments (Glidepath, #25 and #35). Root canals were prepared 1 mm beyond the main foramen (n = 30). The specimens were photographed again to capture intermediate (#25) and final enlargement (#35) images. These were analyzed using an image software that allowed comparison of the enlarged area and shape of the main foramen. Results: In the Intragroup comparison, the Friedman\'s test showed a statistical difference between each phase of foramen enlargement (p <0.05). In the intergroup comparison, the percentage of foramen enlargement showed statistically significant difference between Groups PDR and TFA only in the analysis from #25 to #35, with 42.88 and 67.34% of foramen area widening, respectively. Relative to the final foramen shape, 81.7% were observed to be circular, 17.5% oval, and 0.8% flattened. Conclusion: Our results showed that foramen enlargement allowed an increase in area, maintained the circular shape of the foramen in the majority of cases, irrespective of the system used, and was a feasible option for use during preparation of the root canal system.


Jumanah Babiker, Nur Hafizah Kamar Affendi, Mohd Yusmiaidil Putera Mohd Yusof, Stephen J Chu

Qualitative and Quantitative Assessments of Alveolar Bone Dimension and Its Correlation with Tooth Angulation in the Anterior Maxilla for Immediate Implant Placement

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1237 - 1242]

Keywords: Alveolar bone, Cone-beam computed tomography, Facial bone, Immediate implant placement, Palatal bone thickness

   DOI: 10.5005/jp-journals-10024-3211  |  Open Access |  How to cite  | 


Aim and objective: The aim of this paper is to ascertain the quantitative measurements of alveolar bone thickness at all maxillary anterior teeth and qualitatively demonstrate the relationship between tooth angulation (TA) and alveolar bone thickness. Materials and methods: Cone-beam computed tomography (CBCT) images of 189 maxillary anterior teeth were collected. Sagittal view was selected to perform the measurement on alveolar bone wall at crestal, midlevel, and palatal. TA was measured along to the tooth long axis (TLA) related to the alveolar bone housing. Spearman\'s correlation coefficients were conducted to test the correlation between the variables. Results: The facial alveolar bone (FAB) is predominantly thin (<1 mm) at the crestal and midroot region. A significant difference was recorded in the median thickness of FAB at the midroot and apical area (p = 0.001, p = 0.021). The FAB thickness was not gradual with midroot being thinner than crestal. For the palatal alveolar bone (PAB), the thickness was increased continuously toward the apex. At all apical levels of inspected teeth, a significant negative correlation existed between TA and FAB. A positive correlation of TA was only significant at the facial crest of lateral incisor (r = 0.308). However, the canines did not correlate with the FAB, but correlated with the PAB at the apical level (r = 0.478). Conclusion: The FAB wall crest of maxillary anterior teeth was generally thin and not gradual with the lateral incisor being the thinnest. A significant correlation of TA existed based on different types of maxillary anterior teeth and alveolar bone level. The maxillary anterior teeth with increased buccolingual angulation were correlated with thicker bone at the apical level. Clinical significance: The quantitative assessment of FAB and TA in degree may serve as an anatomical index for ideal implant position.


Bharath Naga Reddy, Sabari Murugesan, Syed Nahid Basheer, Rajeswary Kumar, Vinoth Kumar, Saravanan Selvaraj

Comparison of Cyclic Fatigue Resistance of Novel TruNatomy Files with Conventional Endodontic Files: An In Vitro SEM Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:7] [Pages No:1243 - 1249]

Keywords: Canal curvature, Cyclic fatigue, Dynamic, Heat treatment, HyFlex EDM, ProTaper gold, Reciproc blue, TruNatomy

   DOI: 10.5005/jp-journals-10024-3177  |  Open Access |  How to cite  | 


Aim and objective: To compare and analyze the cyclic fatigue resistance of novel TruNatomy files against the conventionally used rotary files and reciprocating files in a simulated canal system with curvatures in the middle, apical portions root, and S-shaped canal employing scanning electron microscopy. Materials and methods: Endodontic files tested in the study include ProTaper, HyFlex EDM, Reciproc blue, and TruNatomy files operated in a simulated root canal system. A total of 96 files were employed in this study. They were categorized into four groups. Group 1 employed 24 TruNatomy files, group 2 employed 24 ProTaper gold files, group 3 employed 24 HyFlex EDM files, and group 4 employed 24 Reciproc blue files. All the groups employed eight files each under three subgroups namely A, B, and C representing middle, apical, and double curvatures, respectively. Artificial grooves were incorporated in the stainless steel blocks having three different curvatures. All the file systems were operated with a torque-controlled electric motor. The files were engaged in the artificial canal until the occurrence of fracture. The time required for the fracture was noted. Length of fractured tip was measured using the digital Vernier caliper. The number of cycles of failure (NCF) was calculated. The fractured parts were subjected to scanning electron microscope to analyze the mode of fracture. Results: TruNatomy files had the highest mean NCF values of 588.01 in middle curvature, 1,321 in apical curvature, and 642.5 in S-shaped curvature HyFlex EDM and Reciproc blue file system exhibited comparable cyclic fatigue resistance among them. ProTaper gold file system exhibited least mean NCF values of 158.13 in the middle, 196.5 in the apical curvature, and 116.88 in the S-shaped canal system. Middle portion fractured first than the apical curvature. The mean length of fractured segments was found to be insignificant among the experimental study groups tested. Conclusion: All the file systems employed in the study had good cyclic fatigue resistance while TruNatomy files had the highest cyclic fatigue resistance while HyFlex EDM and Reciproc blue had comparable fatigue resistance. ProTaper gold file system had the least fatigue resistance at different radius of curvature in the simulated canal system in the apical and middle portions and S-shaped root canal. Clinical significance: The selection of file systems in cleaning and shaping protocols is an enigma to the endodontics. This in vitro study explored the selection protocols for the execution of root canal preparation. Heat treatment of nickel–titanium (NiTi) endodontic files had improved the cyclic fatigue résistance significantly enhancing the clinical life of file systems.


Omnia M Refai, Noha H Nawar, Ingy T Lebshtien

Assessment of Retention of CAD-CAM Milled PEKK vs PEEK Double Crown-retained Removable Partial Dentures: A Randomized Clinical Trial

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:7] [Pages No:1250 - 1256]

Keywords: Computer-Aided Design-Computer-Aided Manufacturing, Denture retention, Polyetheretherketone, Randomized clinical trial, Telescopic attachments

   DOI: 10.5005/jp-journals-10024-3233  |  Open Access |  How to cite  | 


Aim and objective: To assess and compare the dislodging force of double crown-retained removable partial dentures (RPDs) made from polyetherketoneketone (PEKK) and polyetheretherketone (PEEK) at insertion (baseline) and one year after clinical functional use. Materials and methods: A total of 18 patients with maxillary symmetrical Kennedy class I with the second premolars being the last standing abutment were selected. The patients were randomly assigned into two groups according to the materials used for the construction of the double crown-retained RPD. Group I: Double crown-retained RPDs were made from PEKK. Group II: Double crown-retained RPDs were made from PEEK. For both groups, the primary copings were made from zirconia (ZrO2). The dislodging force was measured using a digital force gauge at baseline and one year after clinical functional use. An independent t-test was used for intergroup comparisons and a paired t-test for intragroup comparisons. Results: when comparing both groups at baseline, there was no significant difference between the two groups, but after one year, Group I had a significantly higher dislodging force value than Group II. Individually, there was an increase in dislodging force in both groups one year after clinical functional use, which was statistically significant for Group I. Conclusion: After clinical functional use, double crown-retained RPDs made from PEEK in combination with ZrO2 primary copings demonstrate a minimal increase in dislodging force, while those made of PEKK demonstrate a significant increase in dislodging force. Clinical significance: All patients were satisfied with the retention and esthetics of their dentures. Polyetherketoneketone double crown-retained RPDs demonstrate better retention one year after clinical functional use.


Mahmoud Darwish, Mohammad Z Nassani, Khaled R Al-Hallak, Omar Kujan

Effect of Denture Adhesives on Adhesion of Candida albicans to Denture Base Materials: An In Vitro Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1257 - 1261]

Keywords: Candida adhesion, Dentures adhesives, Denture bases

   DOI: 10.5005/jp-journals-10024-3209  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to investigate the adhesion of Candida albicans (CA) to the surface of the denture base using two different types of resins after exposure to denture adhesives (DAs). Materials and methods: Twenty-five samples of polymethyl methacrylate (PMMA) and 25 samples of urethane dimethacrylate (UDMA) (10 mm × 10 mm × 2 mm) were prepared and allocated to 10 groups (five samples in each group). For each type of denture base materials, four test groups were immersed for 30 days in four commercially available DAs in addition to water as control group. Specimens were then in vitro evaluated for CA adhesion using light microscopy under × 1,000 magnification. Results: The results showed that the mean number of CA per specimen in the adhesive-exposed groups was higher than that in the control group for both UDMA and PMMA resins. However, this difference was not statistically significant. No association between the type of denture base material and Candida count was identified following immersion in different types of DA and distilled water (p >0.05). Candida count was not associated with the type of DA when UDMA specimens were compared (p >0.05). PMMA resin specimens that were immersed in Corega cream showed significantly higher counts of Candida compared to control specimens that were immersed in distilled water (p <0.05). Conclusion: The study found no association between the type of denture base materials and CA adhesion. No clear impact was identified for the type of DA on CA adhesion to acrylic denture bases. Clinical significance: Using DAs would likely not increase the incidence of denture stomatitis in completely edentulous patients.


Pankaj P Kadam, Rupali Patil, Arti Gachake, Vijaysinh More, Harshwardhan Sawant, Bhagyashree Kalsekar

Comparison of Marginal Fit of Metal Copings in Two Different States with and without Using Ring Liners: An In Vitro Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1262 - 1267]

Keywords: Casting, Cellulose liners, Marginal fit, Ni–Cr cast copings

   DOI: 10.5005/jp-journals-10024-3180  |  Open Access |  How to cite  | 


Aim and objective: To compare the marginal fit of Ni–Cr copings made by casting in two different states (dry and wet) with either cellulose ring liners or no ring liners. Materials and methods: An in vitro study was conducted on 40 patterns which were invested, and a burnout casting procedure was used, using a Ni–Cr alloy to obtain the cast copings. The cast copings were divested, cleaned, and run through a finishing procedure. The copings were seated on the stainless steel die and microscopically evaluated for marginal discrepancies at two predetermined reference points using an optical microscope (Rieichert, Austria). Statistical analysis was done using Pearson\'s correlation coefficient and Chi-square test, keeping 95% confidence intervals and having a p value of less than 0.05 statistically significant. Results: Our results identified marginal discrepancies in all the Ni–Cr cast copings, which significantly differed from each other. The copings obtained from casting with a cellulose ring liner in a wet state showed a significantly higher value followed by casting using a cellulose ring liner in a dry state. The mean marginal discrepancy values were within the clinically acceptable range for all the Ni–Cr cast copings included in two groups. Conclusion: Our study concludes that the copings cast with a cellulose ring liner in dry states had the least amount of vertical marginal discrepancies as compared to those that were cast with a ring liner in two different forms or those cast without a ring liner, suggesting that the use of cellulose ring liner in a dry state is favorable for all casting procedures. Clinical significance: Measuring gaps or discrepancies at margins is the commonly used method to determine the fit of Ni–Cr copings. In order to minimize marginal inaccuracies, various authors have suggested different methods to improve the marginal adaptation of cast restorations. There are compensation methods like setting expansion, hygroscopic expansion, and thermal expansion of the investment, which are used to assess metal shrinkage during cooling.


Soumya Anugraha Rajan, Biniraj Kannanganatt Ramabhadran, Rishi Emmatty, Tony P Paul, Priya Jose, Divyasree Kochilat Ameyaroy, Preena Thalakottukara Variath, Mary Joseph

Comparative Evaluation of Different Soft Tissue Coverage Techniques at Immediate Implant Sites: A Cohort Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:7] [Pages No:1268 - 1274]

Keywords: Bone grafting, Buccally advanced flap, Connective tissue graft, Mucosal phenotype, Platelet-rich fibrin

   DOI: 10.5005/jp-journals-10024-3208  |  Open Access |  How to cite  | 


Aim and objective: To compare the mucosal thickness, width of attached gingiva, and extent of coverage achieved with the usage of connective tissue graft, platelet-rich fibrin (PRF) membrane and buccally advanced flap along with bone grafts in the closure of immediate implant site. Materials and methods: Twenty-one sites requiring immediate implants were randomly divided into three groups of seven samples each. The techniques comprised bone grafting in jumping space along with either buccally advanced flap (group A), PRF membrane (group B), or connective tissue graft (group C) to cover the socket. In each group, the extent of socket coverage, mucosal phenotype, and width of attached mucosa achieved were assessed after 3 months and intercompared with initial measurements to identify the best technique in achieving primary tissue closure of immediate implant sites. Results: Comparative assessment of gain in attached mucosal width had a remarkable difference in all the groups but exhibited no statistical significance among the groups compared. Also, comparative assessment of mucosal thickness and the extent of socket coverage equally indicated a clinical significance among all groups, but failed to achieve any statistical significance. Conclusion: All the three techniques were found to be equally effective in achieving additional width of attached mucosa around implants, coverage of mucosa at osteotomy sites, and a thicker mucosal phenotype at implant sites. In comparison with one another, no single technique was found to be advantageous over the other. Clinical significance: The commonly used three techniques for socket coverage following the immediate implant placement has been proven to be equally effective. Thus, the selection of the technique to meet the objective of complete closure of an extraction socket along with implant platform is left open to operator skill and operation site, which should consider least traumatic and most feasible technique.


Tan-Tai Tran, Quynh-Trang Thi Ngo, Dang Huu Tran, Thuy-Duong Thi Nguyen

Effect of Two Nonsurgical Periodontal Treatment Modalities in Type 2 Diabetes Mellitus Patients with Chronic Periodontitis: A Randomized Clinical Trial

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1275 - 1280]

Keywords: Chronic periodontitis, Glycemic control, Nonsurgical periodontal therapy, Type 2 diabetes mellitus

   DOI: 10.5005/jp-journals-10024-3232  |  Open Access |  How to cite  | 


Aim and objective: The current study aimed to investigate the effect of two nonsurgical periodontal treatment modalities on clinical periodontal parameters and glycemic control. Materials and methods: A randomized clinical trial was conducted with a sample of 64 type 2 diabetes mellitus (T2DM) patients with chronic periodontitis. Subjects were randomly assigned into two groups. Group I received oral hygiene instructions (OHI) at baseline and each recall visit. Group II received one-stage full-mouth scaling and root planning (SRP) combining OHI. At baseline, third month, and sixth month the plaque index (PlI), gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL), and glycated hemoglobin (HbA1c) were recorded and analyzed. Results: After treatment, two groups showed significant differences for all parameters at both assessed times (p <0.05). The OHI alone only demonstrated a slight reduction in GI in third month, with no significant changes for PlI and PPD indexes. However, Group I recorded the increased HbA1c and CAL values at 6-month follow-up (p <0.05). The combination of OHI and SRP exhibited a significant improvement in all periodontal values (p <0.05). Also, the HbA1C levels of Group II showed a significant reduction after treatment and were lower than those of Group I. Conclusions: Oral hygiene instructions only resulted in a better gingival condition of diabetic patients in the initial time. The nonsurgical periodontal therapy by combining SRP and OHI significantly improved both periodontal health and glycemic control. Clinical significance: Diabetic patients should be supplied with an effective OHI modality and a professional dental debridement.


Ranganthan Ajay, Ramajayam Sasikala, Chandrasekaran Divagar, Boaz Ebenezer Solomon, Velayudhan Anand, Ghiaz Khalid

Histocompatibility of Thermopolymerized Denture Base Copolymer Processed with a Novel Ring-opening Oxaspiro Comonomer: A Histomorphometric Investigation in Rats

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1281 - 1286]

Keywords: Comonomer, Denture, Histocompatibility, Initiation, Ring-opening

   DOI: 10.5005/jp-journals-10024-3182  |  Open Access |  How to cite  | 


Aim and objective: The aim of the research was to evaluate the histocompatibility of thermopolymerized (TP) novel denture copolymer containing 3,9-dimethylene-1,5,7,11-tetraoxaspiro[5,5]undecane (DMTOSU) comonomer in rats’ palatine tissue. Materials and methods: The rats were randomly categorized into four groups (n = 6 per group). GCW: Denture base appliance (DBA) fabricated by short polymerization cycle in a water bath without DMTOSU; GTW: DBA with 20 wt.% DMTOSU polymerized at 70°C for 2 hours followed by short polymerization cycle in a water bath; GTA: DBA with 20 wt.% DMTOSU polymerized at 60°C for 45 minutes followed by 130°C for 20 minutes in an autoclave; and Group NC (negative control): rats with no DBA. The rats were euthanized after 2 weeks and the palatal tissues were subjected to histological examination. Epithelial thickness (ET), connective tissue thickness (CT), and keratin layer thickness (KT) were measured. Results: GCW exhibited greater ET, CT, and KT than the other groups. The ET and KT of GTA were significantly lesser than GTW. Multiple comparisons exhibited significant differences between the groups, except for GTW and GTA concerning the CT. Conclusion: The novel denture copolymer containing 20 wt.% of DMTOSU comonomer is histocompatible with rats’ palatine tissue. Clinical significance: As DMTOSU is a double-ring-opening antishrinking oxaspiro monomer, its incorporation in TP-DBR would result in dimensionally accurate and stable dentures without endangering the biocompatibility in the prospective years.


Yasser M Al-Qahtani, Mohammed I Al-Shehri

Evaluation of Photosensitizers on Root Canal Disinfection and Bonding Interface of Fiber Post Cementation System: An In Vitro Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1287 - 1291]

Keywords: Curcumin, Riboflavin, Rose Bengal, Photodynamic therapy, Pushout bond strength

   DOI: 10.5005/jp-journals-10024-3227  |  Open Access |  How to cite  | 


Aim and objective: The current study aimed to assess and compare the effectiveness of photosensitizers rose Bengal (RB), riboflavin, and curcumin (CP) to the conventional canal disinfection regime sodium hypochlorite (NaOCl) on the bonding interface of a fiber post cementation system. Materials and methods: Sixty nontraumatic, extracted, and closed apex human mandibular second premolars were gathered and disinfected. All specimens were decoronated and embedded perpendicularly in heat cure acrylic resin. Shaping and cleaning of the canal were done and obturated with gutta-percha and sealer. Using peeso-reamer canal space was prepared. To assess the effectiveness of various disinfectants, post space was cleansed with four different types of disinfectants (n = 15) in each group. Group I riboflavin + 17% mixture of tetracycline, acid, and detergent (MTAD); group II CP + 17% MTAD; group III RB + 17% MTAD; and group IV 2.5% NaOCl + 17% MTAD. Fiber post was luted within radicular dentin of each sample with dual-cure self-etch resin cement. The specimen\'s radicular portions were vertically segregated into apical, middle, and coronal dentinal post portions and positioned over the universal testing machine. Modes of failure were assessed. Analysis of variance (ANOVA) was applied for the means of independent unrelated groups. Mean differences were calculated using Tukey multiple comparison tests (p = 0.05). Results: Group II canal disinfected with CP + 17% MTAD at all three levels of root demonstrated the highest PBS score. Group IV (control) in which samples were disinfected by the conventional method (2.5% NaOCl + 17% MTAD) showed the lowest PBS at all root portions. Intergroup comparison unveiled PBS at all three root levels for group II (CP + 17% MTAD) and group I (riboflavin + 17% MTAD) than group III (RB + 17% MTAD) (p >0.05). The intragroup assessment demonstrated a significant inclination in values of PBS from coronal to apical direction in all examined groups. Conclusion: The use of photosensitizers curcumin, rose Bengal, and riboflavin as canal disinfectant demonstrated better PBS compared to the conventional method of canal disinfectant NaOCl at all three root levels coronal, middle, and apical. Clinical significance: In a nonvital tooth, radicular disinfection is necessary. Loss of structure in endodontically treated teeth requires post which improves strength and prognosis of treatment. The bonding of glass fiber post to radicular dentin necessitates good clinical outcomes.


Kiran M Dhananjaya, Mrinmoy Chakraborty, Suneel V Vadavadagi, Garima Sinha, Tanya Verma, Saikat Deb

A Scanning Electron Microscope Evaluation of the Efficacy of Different Fluoride-releasing Dental Restorative Materials to Prevent Enamel Demineralization: An In Vitro Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1292 - 1296]

Keywords: Demineralization, Fluoride, Remineralization, Restorative materials

   DOI: 10.5005/jp-journals-10024-3188  |  Open Access |  How to cite  | 


Aim: Aim of the present research was to investigate the effectiveness of various fluoride-releasing dental restorative agents in preventing demineralization of enamel. Materials and methods: Eighty human mandibular permanent molar teeth constituted the study group. All samples were subjected to storage in thymol, after which they were taken out to prepare alike proximal box in each. Inductions of artificial enamel surface lesions were done by placing the teeth in demineralizing solution for 96 hours. Subsequently, all 80 molars were randomly assigned to any of the four groups (i.e., 20 in every individual group) according to the restoration as group A: giomer (composite resin containing surface pre-reacted glass-ionomer fillers), group B: compomer (polyacid-modified composite resin), group C: resin-modified glass-ionomer cement (RMGIC), group D: fluoride-releasing composite. After this, the pH cycling was performed, and the samples were subjected to examination beneath scanning electron microscope (SEM). Results: Higher mean areas of remineralization were noted when RMGIC (96.34 ± 0.06) was used followed by the compomer (109.52 ± 0.17), giomer (118.39 ± 0.82), and the fluoride-releasing composite group (129.27 ± 0.31) in that order. A statistically significant difference was seen amid the investigational groups that utilized different restorative agents (p <0.001). A pairwise evaluation that was performed revealed that except for the giomer group and the compomer group, a statistically significant difference (p <0.001) was found among the experimental groups. Conclusion: This research infers that the RMGIC-treated samples exhibited significantly superior performance in preventing enamel demineralization in comparison to compomer, giomer as well as fluoride-releasing composites. Clinical significance: One among the highly frequently employed anticariogenic materials is fluorides. Owing to this characteristic, they are integrated into numerous restorative substances. Nevertheless, the quantity and speed of fluoride release differ in different agents, which translates to the efficacy of the restorative agent in avoiding demineralization about the restoration.


Athma Shetty, Manali Oswal, Manoj Shetty, Nivya John, Naresh Shetty

A Study to Determine the Correlation between the Intercondylar and Interdental Widths in South Indian Population: A Cross-sectional Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:5] [Pages No:1297 - 1301]

Keywords: Denture teeth positioning, intercanine width, intercondylar width, intermolar width

   DOI: 10.5005/jp-journals-10024-3199  |  Open Access |  How to cite  | 


Aim: Anatomical landmarks that remain fairly constant throughout an individual\'s life help determine the position of the artificial teeth closer to that of their predecessors. The aim of the present study was to evaluate whether there is a relationship between the intercondylar widths (ICWs) and the interdental widths (IDWs) in the maxillary and mandibular arches in dentate subjects. Materials and methods: The study was conducted in two parts, with 80 dentate subjects in total. Initially, in the first 40 subjects, a mathematical index was obtained by dividing the mean ICWs by the mean IDWs. In the second part, the ICW was measured and was used along with the index obtained in the first part, to estimate the IDW. These estimated values were then verified with the real IDWs by direct intraoral measurements. An arbitrary earpiece facebow (ARTEX® Gesichtsbogen Facebow) was used to measure the ICW. Statistics was done using SPSS software version 18 using Karl Pearson\'s correlation test and paired t-test. Results: The IDW was correlated to the ICW; the maximal correlation was found between ICW and lower 6–6 width (L6-6W) (p value 0.033) and the lowest correlation was found between ICW and upper 6–6 width (U6-6W) (p value 0.046). Conclusion: ICW can be used as an additional guide to position denture teeth. This method suggested would result in a better buccolingual positioning of the posterior teeth, which would help avoid encroaching on the tongue space, thereby improving phonetics and speech with dentures. Clinical significance: ICW bears a relationship with the IDWs in the maxillary and mandibular arches. ICW being a fairly constant anatomical landmark can be used as an additional guide aid in positioning the artificial teeth.


SV Sowmya, Roopa S Rao, E Vinesh, Chandini Rajkumar, Prasanna Nichat, B Prem Karthick, Thilla S Vinothkumar, Girish Chandra, Snehashish Ghosh

Histopathological Changes in Oral Tissues Induced by Pesticide Poisoning: A Pilot Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1302 - 1307]

Keywords: Autopsy, Degeneration, Histopathology, Oral mucosa, Pesticide, Poisoning

   DOI: 10.5005/jp-journals-10024-3218  |  Open Access |  How to cite  | 


Objective: The present study evaluated the histopathological changes in oral tissues induced by pesticide poisoning. Patients and methods: This was a cross-sectional pilot study. The sample consisted of oral tissues obtained from deceased patients during autopsy. The study samples were obtained from 10 cases of ingested pesticide poisoning, and the control samples were obtained from road traffic accident cases. All the obtained samples were subjected to histopathological examinations. The changes observed in poisoning cases were compared to those in the road traffic accident cases. Results: Significant degenerative changes were observed in the epithelial cells and connective tissue components, such as collagen, muscles, nerves, vasculature, adipose tissue, and salivary acini and ducts, in the poisoning cases. The oral tissues of the road traffic accident cases did not show any significant degenerative changes. Conclusion: The degenerative changes in the study samples can be attributed to the direct contact of the pesticide with the autopsied oral tissues when the poison was consumed. There are instances in which the entire body may not be recovered or may not be in an examinable state. In such cases, an oral autopsy could provide additional evidence for determining the cause of death in suspected poison cases.


Sameer Punathil, Mohamad R Alqhtani, Preethi Sathydevi, Moaz M Almoteb, S Preethi Archana, Niranjana Arumugasamy

In Vitro Evaluation of the Efficacy of Three Different Remineralizing Agents on Artificial Enamel Lesions in Primary Teeth: A Comparative Study

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:6] [Pages No:1308 - 1313]

Keywords: Artificial enamel lesion, Demineralization, Primary teeth, Remineralization

   DOI: 10.5005/jp-journals-10024-3215  |  Open Access |  How to cite  | 


Aim: The aim of the present study was to assess the effectiveness of three various remineralizing agents on artificial enamel lesions in deciduous teeth. Materials and methods: Eighty primary teeth that were implicated for extraction were taken from patients of 4 to 14 years of age. Every specimen was subjected to air drying followed by the creation of 3 × 3 mm window positioned on the central surface of the coronal portion of the tooth to restrict the area of investigation. A digital pH meter was utilized to formulate a demineralizing solution by checking the pH before and following formulation of the solution. A total of 80 specimens (20 in every group) were allocated to three of the following experimental groups and one control group: group I: control, group II: tricalcium phosphate, group III: casein phosphopeptide-amorphous calcium phosphate-fluoride (CPP-ACPF), and group IV: calcium sucrose phosphate (CaSP). Specimens in every group were subjected to treatment with the assigned remineralizing substance once in 24 hours for 14 days. Confocal laser scanning microscopic (CLSM) evaluation of the samples was performed to assess the baseline and posttreatment remineralization as well as demineralization. Results: CPP-ACPF group (110.73 ± 0.11) displayed the greatest mean remineralization depth, in pursuit by the calcium orthophosphate complex (CaSP) group (122.19 ± 0.28), tricalcium phosphate group (126.87 ± 0.15) as well as the control group (158.46 ± 0.07). These differences amid the investigational groups for remineralization were significant. The greatest depth (μ) area of remineralization was seen in the CPP-ACPF group (50.29 ± 0.06) in pursuit by the CaSP group (36.70 ± 0.17) as well as the tricalcium phosphate group (33.29 ± 0.06). This difference amid the remineralizing agents was statistically significant. Conclusion: Amid the confines of the limitations of the current research, it may be concluded that the three remineralizing agents studied, exhibited a remineralization capability on the artificially induced lesions in enamel. CPP-ACPF exhibited the greatest remineralization capability in comparison with the CaSP and tricalcium phosphate groups. Clinical significance: Dental caries is an unalterable course that leads to everlasting loss of dental hard tissues with eventual formation of a cavity. Off late, numerous techniques have centered on applying remineralizing substances to early lesions due to dental caries, aiming at arresting demineralization while encouraging remineralization. Such remineralizing substances form an atmosphere that is superconcentrated with calcium and phosphate, thereby forcing these ions to diffuse into the unoccupied areas, thereby avoiding further loss of minerals.


Fuad A Al-Sanabani, Nazim H Abidi, Manea M Al-Ahmari, Nasser S Alhashim, Abdlelah A Daghriri, Bandar A Al-Makramani, Mohammed M Al Moaleem

Socket-shield Technique: A Systematic (Scoping) Review of Case Series and Case Reports

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:13] [Pages No:1314 - 1326]

Keywords: Esthetic, Bone preservation, Bone regeneration, Dental implants, Immediate implant, Socket-shield technique

   DOI: 10.5005/jp-journals-10024-3196  |  Open Access |  How to cite  | 


Aim: The present study is aimed to evaluate the effectiveness of the socket-shield technique (SST) and immediate implant placement (IIP) as the treatment of choice for the stabilization of soft and hard tissues at the extraction site and correlate with patient-related and implant-related factors. Methodology: An electronic search was performed on Cochrane, EBSCO host, Medline/PubMed, Scopus, Wiley Library, Google website search, and Web of Science databases from January 2010 to September 2021. The search terms used were “socket-shield technique,” “modified SST,” “root membrane technique,” “pontic shield technique,” and “immediate implant.” Case report and case series, both retrospective and prospective in nature, where SST procedures were done with IIP after tooth extraction were considered for the study. However, clinical trials on animals and studies with less than 3-month follow-up after implant placement were not considered for the study. The studies were collected, analyzed, and tabulated for further analysis to evaluate the aim and objectives of the study. Results: Preliminary search identified through databases resulted in 350 articles, which on further screening led to exclusion of 299 articles based on the selection criteria. Therefore, 51 articles were considered for the final analysis which comprised 11 case studies and 40 case reports. With a wide age-group, the maxillary anterior region was the site of choice for the SST with IIP when compared to the posterior region. Better adaptability, maintenance of ridge contour, and good success rate followed by limited complications were observed among case series and reports. Conclusion: SST was successful in providing stability, esthetics, with lesser marginal bone loss and higher pink esthetic scores. However, well-designed prospective case series are few in number; thereby insufficient data on its reliability and longtime stability limit its application. Clinical significance: SST provides a promising result and better esthetic outcome with minimal requirement of soft tissue grafts, thereby increasing its popularity and its application. However, further studies with a larger sample size and effective clinical research designs with a follow-up period are a requirement to establish the procedure and its reliability.


LuisGabriel Ladino, Martin Eduardo Sanjuan, Darell Josué Valdéz, Rosa Angélica Eslava

Clinical and Biomechanical Performance of Occlusal Veneers: A Scoping Review

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:11] [Pages No:1327 - 1337]

Keywords: CAD/CAM, Dental ceramics, Fracture resistance, Occlusal veneer, Tooth wear

   DOI: 10.5005/jp-journals-10024-3226  |  Open Access |  How to cite  | 


Aim: This manuscript aims to evaluate, through a scoping review, current knowledge of the biomechanical behavior, materials, preparations, and limitations of occlusal veneers. Background: Occlusal veneers are a minimally invasive alternative for the additive restoration of posterior teeth with significant loss of the occlusal structure. This type of restoration has been emerged in recent years as an alternative to invasive treatment, which in the same way seeks to restore the structure of the posterior teeth. All this is because in recent years restorative dentistry has focused a large part of its objectives on conservative therapies. Review results: Five electronic databases—PubMed, Cochrane, LILACS, EMBASE, and Google Scholar—were searched. Title and abstracts were independently screened by three reviewers, followed by a full-text review. A total of 42 articles met our inclusion criteria; most of these studies were in vitro (n = 35) and other studies were clinical studies (n = 7). These in vitro studies included 21 studies that analyzed the type of preparation and 6 studies that evaluated the limitations of occlusal veneers. Conclusion: Thicknesses between 0.7 and 1.0 mm are recommended for ceramic materials; in addition, thicknesses less than 0.7 mm are recommended to use polymeric materials. The materials used for this type of restoration are plastic- and ceramic-based materials, whose load resistance values were found to exceed 2000 N in most studies. It is recommended to carry out a minimally invasive preparation or not to carry out a dental preparation, as long as there is a peripheral enamel to make an external bevel that redirects the eccentric forces to the axis of the tooth. Clinical significance: Restorative dentistry has moved toward conservative treatments with the least amount of dental tissue being removed. Occlusal veneers appear to be a conservative option in the reconstruction of tooth tissues lost due to tooth wear and in cases where it is necessary to restore or increase the vertical dimension.


Shilpi Tiwari, Parimala Kulkarni, Nikita Agrawal, Shikha Mali, Saurabh Kale, Nandani Jaiswal

Dental Anxiety Scales Used in Pediatric Dentistry: A Systematic Review and Meta-analysis

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:8] [Pages No:1338 - 1345]

Keywords: Children, Dental anxiety, Dental anxiety scales, Reliability

   DOI: 10.5005/jp-journals-10024-3229  |  Open Access |  How to cite  | 


Aim: To assess various dental anxiety scales used in children and to know the effectiveness of different projective dental anxiety scales used in pediatric dentistry. Background: Dental anxiety poses a significant problem in child patient management and is considered to be the main barrier for successful completion of the dental treatment. Review results: This systematic review and meta-analysis has been registered at the International prospective register of systematic reviews—PROSPERO—CRD42021247586. The systematic review was conducted in accordance with the Preferred Reporting Items in Systematic Review and Meta-Analysis (PRISMA) guidelines. Electronic databases [PubMed (MEDLINE), COCHRANE Library, EMBASE, EBSCO host, and Google Scholar database] were searched for corresponding references up to 2021. Observational cross-sectional studies comparing two different dental anxiety scales were selected for this systematic review. Search strategy generated 500 articles out of which 13 studies included in qualitative synthesis and only 7 studies were taken for quantitative synthesis. Among these seven studies, five studies compared FIS and VPT scales, two studies compared RMS, FIS, and VPT scales. Results of meta-analysis showed that an overall mean difference of dental anxiety between VPT and FIS scales was 0.11 (95% CI: 0.26–0.48), RMS and FIS scales was 0.05 (95% CI: 0.40–0.50), RMS and VPT was 0.27 (95% CI: 0.80–0.27) in the investigated population. Conclusion: No statistically significant difference was noted in all comparisons suggesting that all these scales are at par in assessing anxiety levels in pediatric population. Clinical significance: The projective scales Raghavendra, madhuriu, sujata pictorial scale (RMS), Facial image scale (FIS), and Venham\'s picture test (VPT) can be a pragmatic tool in assessing children\'s dental anxiety.


Pravinkumar G Patil, Liang Lin Seow, Ting Jing Kweh, Smita Nimbalkar

Unsplinted Attachment Systems and Peri-implant Outcomes in Two-implant-retained Mandibular Overdentures: A Systematic Review of Randomized Controlled Trials

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:9] [Pages No:1346 - 1354]

Keywords: Edentulism, Geriatric dentistry, Implant dentistry, Mandibular overdenture

   DOI: 10.5005/jp-journals-10024-3228  |  Open Access |  How to cite  | 


Aim: The purpose of this review is to compare randomized clinical trials evaluating the peri-implant tissue outcomes using different unsplinted attachment systems in two implant-retained mandibular overdentures. Background: Literature lacks information on various unsplinted attachment systems and their effect on peri-implant tissue health. A focus question (as per PICOS) was set as follows: Does one particular unsplinted attachment system (I) compared with another (C) results in better peri-implant outcomes (O) in two implant-retained mandibular overdentures (P) using randomized controlled trials (RCTs) (S)? The literature search was conducted in the PubMed, MEDLINE and Cochrane Central Register of Controlled Trials (CENTRAL) databases between January 2011 and December 2021. The keywords used were “denture, overlay,” “denture,” “overlay” AND “dental prosthesis, implant supported,” “dental implants,” “dental implant abutment design” AND “jaw, edentulous,” “mouth, edentulous” AND “mandible.” Only RCTs on two implant-retained mandibular overdentures using unsplinted attachment systems measuring peri-implant tissue outcomes with minimum 1-year follow-up were selected. In total, 224 studies were identified in initial search, and 25 were shortlisted for full-text evaluation. Four studies were included for systematic review upon considering inclusion and exclusion criteria. The risk of bias was evaluated using Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Review results: A total of 41 patients received ball attachments (in 3 studies), 36 patients received low-profile attachments (in 3 studies), 16 patients received magnet attachments (in 1 study), and 13 patients received telescopic attachments (in 1 study). All four studies used standard sized implants, however, differed in implant manufacturers. Two studies which compared ball attachments low-profile attachments revealed-similar peri-implant tissue health parameters but differed in crestal bone-level changes. One study compared ball with telescopic attachments and revealed similar results in crestal bone-level changes and all four peri-implant tissue health parameters. Single study compared magnets with low-profile attachments and shown lesser bone loss with magnet attachments. Single study was judged to have low risk of bias, single with some concerns, and remaining two to have high risk of bias. Conclusion: Gingival index and bleeding index of the patients were not influenced by any of the unsplinted overdenture attachment (stud, magnet, telescopic) system. Inconclusive results found among the studies evaluated comparing crestal bone loss and plaque index. Clinical significance: This review manuscript has simplified comparative analysis of different unsplinted attachment systems used in two implant mandibular overdentures to help clinicians choose correct system in such situation.


Thilla S Vinothkumar

Application of Near-infrared Light Transillumination in Restorative Dentistry: A Review

[Year:2021] [Month:November] [Volume:22] [Number:11] [Pages:7] [Pages No:1355 - 1361]

Keywords: Dental caries, Early diagnosis, Ionizing radiation, Minimally invasive, Near-infrared, Occlusal caries, Transillumination

   DOI: 10.5005/jp-journals-10024-3204  |  Open Access |  How to cite  | 


This paper presents the various applications of near-infrared light transillumination (NILT) in dentistry. Untreated dental caries is considered the most prevalent health condition affecting both children and adults worldwide. Increased awareness and a paradigm shift toward utilization of minimally invasive treatment procedures and nonionizing radiation led to the discovery of newer techniques for screening and early diagnosis of demineralized lesions. Demineralized lesions detected early can be treated with minimally invasive treatment procedures such as the usage of fluoridated dentifrice to encourage remineralization and resin infiltration to arrest caries progression. NILT procedure involves noninvasive, nonionizing radiation and helps in the identification of early demineralized lesions using light transillumination. At near-infrared wavelengths, the enamel appears translucent and helps in visualizing and detecting demineralized lesions when long-wave light transilluminated against the tooth surface. The wavelength in the range of 1310 nm is considered best for the transillumination of lesions. This technique has been proven to be successful in the detection of carious and demineralized lesions. NILT can be used as a screening tool for the early detection of demineralized lesions and can be considered as an adjunct to bitewing radiographs. It can be advantageous in screening pregnant, growing adolescent patients and in cases where multiple follow-ups are needed and ionizing radiation must be avoided.

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