The Journal of Contemporary Dental Practice

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2021 | December | Volume 22 | Issue 12

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Sujatha Govindarajan, Vishnu P Veeraraghavan, Selvaraj Jayaraman, Ullas Mony, Durairaj Sekar

Use of Toothbrush as a Cost-effective Noninvasive Source of DNA for Molecular Oral Oncology Investigations during COVID Pandemic

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:2] [Pages No:1363 - 1364]

   DOI: 10.5005/jp-journals-10024-3268  |  Open Access |  How to cite  | 



Carlos A Jurado, Clarisa Amarillas-Gastelum, Akimasa Tsujimoto, Saad Alresayes, Kennedee French, Hamid Nurrohman

Light Transmission for a Novel Chairside CAD/CAM Lithium Disilicate Ceramic

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:5] [Pages No:1365 - 1369]

Keywords: CAD/CAM, Ceramics, Light transmission, Lithium disilicate, Polishing, Thickness

   DOI: 10.5005/jp-journals-10024-3239  |  Open Access |  How to cite  | 


Aim: To evaluate light transmission in a novel chairside CAD/CAM lithium disilicate ceramic with different thicknesses and with and without polishing. Materials and methods: Sixty flat samples (10 specimens/group) were fabricated from novel chairside CAD/CAM lithium disilicate ceramic blocks (Amber Mill, Hass Bio) with different thicknesses and with and without polishing as follows: (1) 1.0 mm thickness without polishing (1.0NoP); (2) 1.0 mm thickness with polishing (1.0Po); (3) 1.5 mm thickness without polishing (1.5NoP); (4) 1.5 mm thickness with polishing (1.5Po); (5) 2.0 mm thickness without polishing (2.0NoP); and (6) 2.0 mm thickness with polishing (2.0Po). Specimens were polished with a polishing system for lithium disilicate restorations following the manufacturer's recommendations. Light transmission was evaluated with a curing radiometer. Obtained data were subjected to two-way ANOVA followed by Tukey's post hoc tests (α = 0.05). SEM observations were conducted to evaluate surface microstructure. Results: The light intensity through the lithium disilicate blocks with and without polishing was 200.9 mW/cm2 (16.1%) and 194.4 mW/cm2 (15.6%) for 1.0 mm specimens, 119.3 mW/cm2 (9.5%) and 111.9 mW/cm2 (9.0%) for 1.5 mm specimens, and 102.3 mW/cm2 (8.2%) and 96.0 mW/cm2 (7.7%) for 2.0 mm specimens. SEM images showed a smoother surface with polishing compared to nonpolished specimens. Conclusion: The thickness and polishing of the restorations were both significant influential factors in light transmission. Clinical significance: The range of light transmission percentage through the novel chairside CAD/CAM lithium disilicate blocks was 7.7–16.1%, suggesting that light attenuation through the material may influence the polymerization reaction of resin luting cement in the bonding process.



Stefano Scavia, Rachele Roncucci, Edoardo Bianco, Luca Mirabelli, Alla Bader, Marcello Maddalone

Vertical Bone Augmentation with GBR Pocket Technique: Surgical Procedure and Preliminary Results

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:7] [Pages No:1370 - 1376]

Keywords: Bone defect, Guided bone regeneration, Implantology, Occlusion, Periodontal ligament, Polytetrafluoroethylene membrane

   DOI: 10.5005/jp-journals-10024-3243  |  Open Access |  How to cite  | 


Aim: Nowadays, guided bone regeneration (GBR) is a predictable technique in both vertical and horizontal bone defects treatment. GBR Pocket Technique is an original surgical approach adopted in order to reduce the invasiveness of traditional procedures. The aim of this work is to describe the surgical procedure of GBR Pocket Technique in vertical bone augmentation and to compare the clinical outcomes of this technique with the results reported in literature of vertical bone augmentation and crestal bone remodeling achieved after 1 year after implants insertion. Materials and methods: Twenty-eight patients were recruited for this study and received 28 GBR procedures in the posterior region due to vertical and horizontal defects. A 50/50 mixture of autologous bone component and heterologous bone of equine origin was then made with the use of a bone scraper tunnel with internal reservoir. A PTFE-d membrane with titanium reinforcement was then fixed to the residual bone structure with screws in order to maintain the graft in place. Radiographic checks were made before graft procedures and implants insertion, then 6 months later and 1 year after implants placement. Results: The average bone augmentation after surgery seems to be aligned, or even better, than the average reported in literature with alternative surgical approach; in addition, the mean crestal remodeling after 1 year and the rate of complications are aligned with other previous surgical techniques with a vertical bone augmentation of 8.78 mm ± SD 2.39 and a bone remodeling after 1 year of 0.59 mm ± SD 0.29. Conclusions: The advantages of this technique are preservation of blood circulation and consequently risk of flap necrosis, dehiscence, and graft exposure. This technique also reduces mucosal healing times even if it takes longer surgical time. Clinical significance: GBR Pocket Technique is the use of a minimal-invasive surgical wound to reduce patient morbidity and compliance.



Barbara Ndagire, Louis Muwazi, Grace Ssanyu Nabaggala, Annet Kutesa, Charles Mugisha Rwenyonyi

Dental Practitioners’ Knowledge, Attitude, and Practice in Caries Risk Assessment and Management: A Cross-sectional Survey in Kampala Metropolitan, Uganda

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:9] [Pages No:1377 - 1385]

Keywords: Attitude, Caries risk assessment, Dental caries management, Dental practitioners, Knowledge, Practice, Uganda

   DOI: 10.5005/jp-journals-10024-3236  |  Open Access |  How to cite  | 


Aim: The objective of this study was to determine the knowledge, attitude, and practices regarding caries risk assessment (CRA) and management among dental practitioners in Kampala Metropolitan, Uganda. Materials and methods: This cross-sectional study was conducted among 270 dental practitioners in Kampala Metropolitan, Uganda, in May 2021. The participants were dental surgeons and public health dental officers. A self-administered structured questionnaire was used to collect data. The questionnaire included items about participants’ sociodemographic characteristics, knowledge, attitude, and practices in CRA and management. Attitude and practices were rated using different Likert scales. Descriptive statistics, Chi-square/Fisher's exact and one-way analysis of variance (ANOVA) with post-hoc Bonferroni tests were used to analyze the data. The significance level was set at p <0.05. Results: About 60.7% of the participants were public health dental officers with a median age of 30 years (interquartile range [IQR], 27–60). Overall, the participants were familiar with the current concepts regarding CRA and management. More than 70% of the participants correctly identified risk factors and indicators of dental caries. Most participants (98.5%) had a positive attitude toward performing CRA. However, their practices regarding caries management were inadequate as majority (>75%) of participants reported that they never or occasionally recommended evidence-based products like topical fluoride, probiotics, or xylitol products in the prevention and management of dental caries. Dental surgeons had significantly better knowledge and practices than public health dental officers (p <0.05). Conclusion: In the present study, the participants were familiar with the current concepts about CRA and had a positive attitude toward CRA. However, their practices regarding caries prevention and management were inadequate. Clinical significance: The study provided baseline data about knowledge, attitude, and practices regarding CRA and caries management among dental practitioners in Uganda. It is recommended to design training courses in evidence-based protocols in the prevention and management of dental caries for dental practitioners in Uganda.



Mohamed RW Ali, Manal Mustafa, Asgeir Bårdsen, Maryam A Gharaei, Inge Fristad, Athanasia Bletsa

Differential Responses of Human Dental Pulp Stromal Cells to Bioceramic Materials: A Comparative In Vitro Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:7] [Pages No:1386 - 1392]

Keywords: Angiogenesis, Dental pulp calcification, Endodontic inflammation, Gene expression, Mineral trioxide aggregate, Pulpitis, Pulpotomy, Stem cells, Tricalcium silicates

   DOI: 10.5005/jp-journals-10024-3216  |  Open Access |  How to cite  | 


Aim: The aim of this study was to compare the effects of white MTA-Angelus (wMTA), Biodentine® (Biodentine) and TotalFill® BC Root Repair MaterialTM putty (TotalFill) on human dental pulp stromal cells (hDPSCs) in vitro. Materials and methods: hDPSCs were isolated from third molars of healthy young adults. Material elutes at different concentrations were prepared. Cells were exposed to the eluates for 1, 3, and 7 days. Cell proliferation was evaluated using 3-(4,5-dimethyl-thiazoyl)-2, 5-diphenyl-tetrazolium bromide assay. The expression of alkaline phosphatase (ALP), osteoprotegerin (OPG), osteocalcin (OC), collagen1A (Col1A), runt-related transcription factor 2 (RUNX2), vascular endothelial growth factor-A (VEGF-A), fibroblast growth factor-1 (FGF-1), interleukin 6 (IL6), tumor necrosis factor alpha (TNFα), and interleukin-1-beta (IL1β) was determined by reverse transcription-polymerase chain reaction (RT-PCR). VEGF-A protein levels and ALP activity were quantified in the culture supernatant. Data were analyzed by two-way analysis of variance (ANOVA). p values <0.05 were considered statistically significant. Results: hDPSC proliferation was decreased in a dose-related manner for all materials on day 3. The same effect was observed with wMTA and TotalFill on day 7. RT-PCR showed that Biodentine increased the expression of the osteogenic markers ALP, OPG, and OC. TotalFill decreased the ALP expression and activity, enhanced the production of angiogenic VEGF-A, and downregulated the inflammatory IL6 on day 7. Conclusion: Although the tested materials are used interchangeably in vital pulp therapy, the findings showed varied hDPSC responses. Biodentine did not affect cell proliferation and increased the expression of osteo-/odontogenic markers compared to wMTA and TotalFill, whereas TotalFill decreased cell proliferation and exhibited enhanced angiogenic and anti-inflammatory effects over time. Clinical significance: The clinical significance of the results needs further investigation in an attempt to provide recommendations on the selection of bioceramic pulp capping material under different scenarios of pulpal pathosis.



Pushpraj Singh, Akhilesh S Parate, Nishath S Abdul, Chetan Chandra, Shivanand B Bagewadi, Darpankumar R Hirpara

Retrospective Evaluation of Incidental Findings of Temporomandibular Joint Region in CBCT Scans

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:6] [Pages No:1393 - 1398]

Keywords: Cone-beam computed tomography, Imaging, Incidental finding, Temporomandibular region

   DOI: 10.5005/jp-journals-10024-3221  |  Open Access |  How to cite  | 


Aim: The present study was undertaken to investigate the occurrence of incidental findings (IFs) in the temporomandibular joint region in cone-beam computed tomography (CBCT) scans. Materials and methods: A total of 1,850 randomly selected scans were examined for IFs in the temporomandibular joint (TMJ) area. IFs of flattening of condyle, condylar hyperplasia, condylar hypoplasia, osteophyte, osteoarthritis, bifid condyle, subchondral pseudocyst, subchondral sclerosis, and soft tissue calcification were evaluated. Data analysis was done using SPSS version 21.0. Results: A prevalence of 59.89% of IFs was noted in the present study. Flattening of the condyle was the most reported IF found in 369 (35.6%). Soft tissue calcifications were found in 294 (28.3%) and cysts in 143 (13.8%). When gender-wise distribution of TMJ IFs was evaluated, highly significant differences were noted between the gender for flattening of condyle, hyperplasia, and osteophytes at p <0.001. Conclusion: Dentists must critically evaluate CBCT images for evidence of IFs, so as to ensure comprehensive treatment package and early diagnosis of any disorders. Clinical significance: CBCT in the recent times is widely used in dentistry for diagnostic purposes. It not only reveals a valuable diagnostic information of the intended site but also the region surrounding it. Findings obtained in the region beyond the intended site are described as IFs, which becomes important in determining an appropriate therapeutic plan. The study was conducted to evaluate the occurrence of IFs in the temporomandibular joint region.



Sudalaimani Paulpandian Saravana Dinesh, Arvind Sivakumar, Abdulrahman Alshehri, Wael Awadh

Evaluating the Effect of Denosumab in Preventing Anchorage Loss: A Split-mouth Randomized Controlled Trial

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:7] [Pages No:1399 - 1405]

Keywords: Anchorage, Denosumab, RANKL inhibitor, Tooth movement

   DOI: 10.5005/jp-journals-10024-3256  |  Open Access |  How to cite  | 


Aim: The trial was focused on assessing the effect of Denosumab in preventing anchorage loss during en-masse anterior retraction and evaluating its effect on the retraction. Materials and methods: This was a split-mouth randomized controlled trial. Ten subjects were randomly allocated with equal probability for Denosumab and control interventions in the contralateral quadrants using computer-generated randomization sequence. During the start of retraction, Denosumab (5 mg/0.2 mL) and injectable sterile water were administered locally on the intervention and control sides, respectively. Lateral cephalograms taken during the start of retraction and later in the 3rd and 6th months into retraction were used to evaluate anchorage loss and retraction. Independent sample t-test and Mann-Whitney U test compared anchorage loss and retraction between the two groups in the maxilla and mandible. Paired t-test and Wilcoxon signed-rank test assessed the anchorage loss and retraction during the first and the second 3 months of retraction. Results: In the maxilla, Denosumab was effective in preventing anchorage loss with a p-value of 0.001 whereas it was not effective in the mandible (p-value—0.172). A significant reduction in anchorage loss was observed with Denosumab in the second 3 months of retraction compared to the first 3 months. There was no significant difference in the retraction among both groups. Conclusion: Denosumab was effective in minimizing the anchorage loss in the maxilla without affecting the anterior retraction. Clinical significance: Denosumab can be effectively used for reinforcing anchorage in the maxilla during en-masse anterior retraction.



Mohammed Mustafa

Comparative Evaluation of Canal-shaping Abilities of RaceEvo, R-Motion, Reciproc Blue, and ProTaper Gold NiTi Rotary File Systems: A CBCT Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:7] [Pages No:1406 - 1412]

Keywords: Canal-centering ability, Canal transportation, Cone-beam computed tomography, Continuous rotation, ProTaper Gold, RaceEvo, R-Motion, Reciproc Blue, Reciprocating motion

   DOI: 10.5005/jp-journals-10024-3217  |  Open Access |  How to cite  | 


Aim: To evaluate the canal transportation, canal-centering ability, and touched and untouched surfaces of the root canal dentin after instrumentation with various newer file systems in continuous rotation and reciprocating motion using cone-beam computed tomography (CBCT) imaging. Materials and methods: This in vitro study was conducted on one hundred recently extracted human mandibular molars, which were selected and instrumented using the following rotary NiTi file systems: RaceEvo, R-Motion, Reciproc Blue, and ProTaper Gold. The canal preparations for all four (04) experimental groups were done according to the manufacturer's instructions; the CBCT imaging was done for all the teeth compared at different levels of 2 mm, 5 mm, 8 mm from the apex, before and after the canal preparations. The data thus collected were evaluated for variation where p <0.05 was calibrated as significant using “ANOVA and Mann–Whitney” statistical tests. Result: When the file systems were compared at different levels of the canal i.e. 2 mm, 5 mm, 8 mm from the apex, we observed a statistically significant difference for all the experimental groups (p = 0.021, 0.023, 0.032) respectively for the canal transportation (CT), (p = 0.045, 0.040, 0.037) respectively for the canal centering ability (CCA), (p <0.001) respectively for the touched (TS) and untouched (US) surfaces. R-Motion showed the least CT, greater CCA, with maximum TS, and the least US dentinal surfaces in the root canal preparations followed by RaceEvo, Reciproc Blue, and ProTaper Gold. Conclusion: R-Motion exhibited better canal centering ability, lower canal transportation due to its improved cutting efficiency down to the apex while preserving the dentin of the root canal walls and also exhibits lesser stress on dentin. The newer rotary file systems of R-Motion and RaceEvo described in this study could be recommended for clinical use during endodontic treatment. Clinical significance: The newly introduced R-Motion and RaceEvo showed better preparations of the root canal compared to other file systems and could be used as a reliable alternative to the ProTaper file systems which is considered as the gold standard in rotary endodontics.



Shobana Panneerselvam, Ramakrishnan Theyagarajan, Vidya Sekhar, Indhu Krishnamurthi, Parthiban Saketharaman

Evaluation of Systemic Markers Related to Anemia in Aggressive Periodontitis Patients before and after Phase I Periodontal Therapy: An Interventional Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:4] [Pages No:1413 - 1416]

Keywords: Aggressive periodontitis, Anemia of chronic disease, Nonsurgical periodontal therapy

   DOI: 10.5005/jp-journals-10024-3197  |  Open Access |  How to cite  | 


Aim: The main aim of the study was to evaluate the systemic markers related to anemia in generalized aggressive periodontitis (GAgP) patients before and after phase I therapy. Materials and methods: Based on the inclusion criteria, 15 patients with GAgP were allocated to two groups, group A (before phase I periodontal therapy) and group B (after phase I periodontal therapy). After 3 months, clinical parameters and hematological parameters were reevaluated. Results: The hematological parameters like hemoglobin (Hb) and red blood cell (RBC) counts were increased significantly after therapy in group B with a significant improvement in the plaque index score, gingival bleeding index score with a reduction of probing depth, and a gain in clinical attachment levels. Conclusion: Within the limitation of this study, it could be concluded that GAgP was associated with reduced RBC parameters suggesting that it may tend toward anemia of chronic disease (ACD). Nonsurgical periodontal therapy (NSPT) not only reverses the periodontal health by reducing the inflammation but also improves the anemic status. Clinical significance: Based on several studies, it was concluded that chronic periodontitis is associated with ACD. This study results indicate that like chronic periodontitis, aggressive periodontitis is also associated with reduced RBC and Hb count suggesting the risk for ACD. So when a patient is diagnosed to have any chronic infectious disease that might lead to ACD, then it is mandatory to treat that particular disease in order to reduce the infection so as to reverse the anemic status of an individual.



Mona A Kamil, Khulud A Hamzah, Aishah O Awaji, Wafa Y Harbi, Maryam H Mugri, Nahid MH Elamin

Dental Practices and Awareness toward the Impact of Periodontal Disease on Systemic Health among Medical Doctors in Jazan, Saudi Arabia

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:5] [Pages No:1417 - 1421]

Keywords: Attitude, Awareness, Periodontal disease, Systemic impact

   DOI: 10.5005/jp-journals-10024-3246  |  Open Access |  How to cite  | 


Aim: To evaluate knowledge and awareness of medical doctors regarding the impact of periodontal disease on a set of systemic diseases. Materials and methods: A questionnaire-based cross-sectional study recruiting medical doctors in Jazan region. One hundred participants from four governmental hospitals in Jazan city responded to multiple-choice-question-type questionnaire. The obtained data were analyzed using SPSS version 20. For Chi-square test, p-value ≤0.05 was considered significant. Result: In our study, participants had a positive attitude toward their self-oral hygiene practices. Regarding knowledge, only 5% got their information from medical curricula. Most of the participants (90%) agreed that oral disease impacts general health; nevertheless, their awareness of the impact of periodontal disease on specific body systems was poor. There was a significant correlation between positive oral hygiene practices and gender, age, and experience. Conclusion: Our study showed limited knowledge of medical doctors about the association between periodontal diseases and general health. It also reflected poor medical curricula in this regard. It is strongly recommended to include oral health-relevant subjects in medical curricula and continuous medical education programs and to stress on the joint subjects that require multidisciplinary care. Clinical significance: Improving the awareness of medical health providers about the association between periodontal diseases and general health improves the well-being and patient management.



Jeswin M Thomas, Sherin S George, A Esai Amutha Prabha, Amala P Mohan, Haby M Somson

Effect of Tricalcium Phosphate and Calcium Sucrose Phosphate on the Inhibition of Streptococcus mutans: An In Vivo Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:4] [Pages No:1422 - 1425]

Keywords: Calcium sucrose phosphate, Dental caries, Mitis Salivarius agar medium, Streptococcus mutans, Tricalcium phosphate

   DOI: 10.5005/jp-journals-10024-3186  |  Open Access |  How to cite  | 


Aim: To determine the efficacy of tricalcium phosphate (TCP) and calcium sucrose phosphate (CSP) on the inhibition of Streptococcus mutans (SM). Materials and methods: Thirty healthy children between 13 and 18 years of age were divided into two groups of 15 each; Group I receiving TCP-containing cream and Group II receiving calcium sucrose phosphate-containing cream. On the first day of the study, 30 minutes after breakfast, baseline plaque samples were taken from the buccal surface of first mandibular permanent molar using a sterile wedge which was immediately transferred to sterile container containing 1 mL of saline, and were subjected to microbiological examination. On the following days, both the creams were applied to the respective groups. On the 16th day, plaque samples were collected from the same site, and colony forming units were recorded using agar plate as a culture medium. Results: The mean of S. mutans count before application of TCP-containing paste was 16.27 cfu per mL and before calcium sucrose phosphate-containing paste was 15.33 cfu per mL. The mean after application of TCP-containing paste and calcium sucrose phosphate-containing paste was 3.53 and 9.87 cfu per mL, respectively. And, there was a statistically significant difference found within the groups. Conclusion: Both TCP and CSP have an inhibitory effect on S. mutans. Clinical significance: This can be an effective preventive tool for children with high caries risk and even for special child. Both TCP and CSP deposit the mineral reservoir in plaque and saliva; it may help resist the future cariogenic challenges.



Mushir Mulla

Psychological Impact of the COVID-19 Pandemic on Dental Hygiene Students in Saudi Arabia: A Nation-wide Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:8] [Pages No:1426 - 1433]

Keywords: Anxiety, COVID-19, Dental hygiene student, Psychological impact, Saudi Arabia

   DOI: 10.5005/jp-journals-10024-3249  |  Open Access |  How to cite  | 


Aim: Worldwide healthcare professionals are experiencing constant stress during their day-to-day work due to coronavirus disease-2019 (COVID-19) pandemic. Students’ anxiety tendency has also been increased due to the disturbance of education. This study aims to evaluate the anxiety and depression levels of dental hygiene students in Saudi Arabia during COVID-19 lockdown period. Materials and methods: A cross-sectional study was conducted among the dental hygiene students in Saudi Arabia to assess the psychological impact of the COVID-19 outbreak. Questionnaire was distributed to the students, which consisted questions regarding demographics, knowledge, and fear related to COVID-19 and validated self-reported anxiety screening scale (GAD-7), to assess the psychological impact. All the data were then subjected to statistical analysis. Results: Students from King Abdul Aziz University and Prince Sattam University showed statistically higher anxiety score when comparing the GAD-7 questions. Students whose parents were unemployed during pandemic and the students from rural area had statistically greater anxiety level when compared to others. Also, anxiety levels were found to be significantly higher among students who slightly feared contacting the disease because of their profession. Conclusion: The present results demonstrate that dental hygiene students suffered from some form of anxiety ranging from mild anxiety to severe anxiety, reporting that they frequently felt nervous and were scared that something terrible would happen. Psychological well-being of healthcare professionals is necessary for the optimal treatment of patients. Clinical significance: Anxiety is considered as an important factor for healthcare students that may influence negatively on their personal and academic life. Thus appropriate assessment and offering immediate treatment will prove beneficial to prevent serious consequences.



Deepa Gurunathan

Effectiveness of Pre-administered Natural Sweet-tasting Solution for Decreasing Pain Associated with Dental Injections in Children: A Split-mouth Randomized Controlled Trial

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:4] [Pages No:1434 - 1437]

Keywords: Honey, Injection, Local anesthesia, Pain

   DOI: 10.5005/jp-journals-10024-3224  |  Open Access |  How to cite  | 


Aim: This study aimed to discern if a prior intake of a natural sweet remedy (honey) impacted pain perception during intraoral injections. Materials and methods: One hundred healthy children who needed the same treatment bilaterally in either arch which required local anesthetic administration (infiltration in maxillary arch and inferior alveolar nerve block in mandibular arch) were recruited. The patients’ demographic details were recorded. Local anesthesia was administered after taking 5 mL of honey solution on the test side and 5 mL of sterile water on the control side. Subjective pain perception during injection was measured using Wong–Baker Faces Pain Rating Scale and objective pain by sound, eye, body movement (SEM) rating scale. The parametric data were analyzed using a paired Student's t-test (p <0.05). Level of consensus between the two scales was assessed using Pearson's correlation. Results: The test side yielded lower mean Wong–Baker Faces Pain Rating Scale (3.72 ± 1.80) and SEM (4.12 ± 1.04) scores than the control side (6.00 ± 2.06 and 5.00 ± 1.45 respectively). This was statistically significant. Conclusion: The administering of a natural sweet solution such as honey before dental injections in children tends to reduce the discomfort and pain associated with the procedure. Clinical significance: Pain management is of utmost importance in dentistry, especially among children. The consumption of natural foods such as honey helps in decreasing injection pain perception, making the child cooperative, and thereby allowing the dentist to provide the best dental care.



Sonal Singh Arora, Manjunath Sushilamma Hemagiriyappa, Sonal Singh Thakur, Niharika Mishra, Nitin Manoharrao Lokhande

Comparative Evaluation of Antibacterial Efficacy of Silver and Cadmium Nanoparticles and Calcium Hydroxide against Enterococcus faecalis Biofilm

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:6] [Pages No:1438 - 1443]

Keywords: Antibacterial efficacy, Biofilm, Cadmium, Calcium hydroxide, Enterococcus faecalis, Nanoparticles, Silver

   DOI: 10.5005/jp-journals-10024-3222  |  Open Access |  How to cite  | 


Aim: The purpose of this study was to evaluate and compare the antibacterial efficacy of calcium hydroxide medicament, silver (AgNPs) and cadmium nanoparticles (CdSNPs) as medicament against the biofilms of Enterococcus faecalis on dentin sections. E. faecalis is commonly detected in asymptomatic and persistent endodontic infections. Methods: Twenty standard size dentin sections were prepared. E. faecalis was inoculated on these dentin sections for four weeks to form the bacterial biofilm. Twenty dentin sections were segregated into four different groups with five specimens in each group. Group I was kept as control group, and antibacterial efficacy was tested by treating biofilms with Ca(OH)2 medicament, 0.02% AgNP and CdSNP gels for 7 days. The ultrastructure of biofilms from each group was examined under scanning electron microscope and was visually evaluated and compared for different groups. Results: Ca(OH)2 exhibited a slight disruption of E. faecalis biofilm. Both AgNP and CdSNP medicaments disrupted E. faecalis biofilm effectively after 7 days of inoculation. AgNPs disrupted the biofilm more effectively than CdSNPs. Biofilms in control group, which was irrigated with saline, did not show any disruption of biofilm, which could be seen as homogenous layer over most of dentin sections. Conclusions: This study suggests that both AgNP and CdNP gels are effective against E. faecalis and can be used as a medicament to eliminate residual bacterial biofilms during root canal disinfection. AgNP medicament is more effective than CdNP, whereas Ca(OH)2 is not effective against E. faecalis biofilms. Clinical significance: Incomplete clearance and the development of antibiotic resistance in E. faecalis are the important factors for failure of root canal treatment. When cationic nanoparticles are introduced for the treatment of biofilms, it can interact with both extracellular polymeric substances and bacterial cells. The initial electrostatic attraction between positively charged nanoparticles and negatively charged bacterial surface leads to bacterial killing via the production of reactive oxygen species. Metal nanoparticles that are effective against E. faecalis have a significant potential role in the prevention and treatment of such cases, as bacteria do not develop resistance against metal nanoparticles.



Khaled A Shams, Mariem O Wassel

Prevention of Infective Endocarditis of Oral Origin in Children: A Call for Pediatric Dentists–Pediatric Cardiologists’ Collaboration in Egypt

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:7] [Pages No:1444 - 1450]

Keywords: Cardiac surgeons, Cardiologists, Dentists, Infective endocarditis, Pediatric

   DOI: 10.5005/jp-journals-10024-3254  |  Open Access |  How to cite  | 


Aim: To assess knowledge and practices of some Egyptian pediatric dentists and pediatric cardiologists/cardiac surgeons regarding prevention of infective endocarditis (IE) from oral origin in children. Materials and methods: Pediatric dentists or pediatric cardiologists/cardiac surgeons having their practice in Egypt were conveniently selected. An online questionnaire was constructed for each specialty practitioner in English using a web-based platform. Each survey tool collected data about demographics, knowledge, and practices concerning the prevention of IE of oral origin. Surveys were disseminated to potential respondents using direct messaging or posting surveys’ links on high-traffic areas (blogs, groups, or pages) of commonly known social media platforms. Results: Two-hundred and thirty-nine pediatric dentists and 71 pediatric cardiologists/cardiac surgeons’ responses were included in analysis. Some shortage in oral health knowledge and deviations in management protocol from known guidelines were evident in cardiologists’ responses, whereas 66.2 and 64.8% reported encountering IE of oral origin or canceling a cardiac surgery due to oral infection, respectively. Most pediatric dentists (65.7%) rely on physician referral before managing children at risk of IE despite following recognized guidelines for IE prevention which may reflect difficulty in understanding such guidelines. Ninety percent of children with heart diseases visit a dentist due to oral complaint and not for checkup. Conclusion: Identification of disparities and pitfalls in management of children with heart diseases, if appropriately addressed by pediatric dentists and cardiologists, may reduce the risk of IE from an oral origin. Clinical significance: Health education of both specialists and development of national guidelines based on national epidemiology and clinical experience of cardiologists are strongly needed to decrease oral disease burden, allow for a consensus of patient management, and minimize the need for cross-referral, thus facilitating dental management without undue delays.



Kaumudhi Kalla, Sudheer Arunachalam, Sidhartha Shakti Prasad Behera, Jagadish Konchada, Srikanth Lankapalli, Lakshmi Vanisetti

Effect of Surface Modifications on the Retention of Implant-supported Cement-retained Crowns with Short Abutments: An In Vitro Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:6] [Pages No:1451 - 1456]

Keywords: Bur modification, Cement-retained restoration, Circumferential groove, Glass ionomer cement, Implant-supported, Short abutments

   DOI: 10.5005/jp-journals-10024-3242  |  Open Access |  How to cite  | 


Aim: The study aimed to evaluate and compare the effect of incorporating one circumferential groove and bur modification on retention of cast copings on implant abutment cemented with glass ionomer cement. Materials and methods: Fifteen straight shoulder implant abutments casted of height 6 mm used with corresponding 12 mm long stainless steel implant analog. The abutments were divided into three groups of five abutments in each group. Group I: Control group, without any surface modification, Group II: Milling of a circumferential groove, and Group III: Bur modification by creating punches of size whole round bur diameter 5 per axial surfaces. Glass ionomer definitive cement was used to adhere the cast copings to each group of abutments. After thermocycling, the specimens were evaluated for retention using the Instron Universal Testing Machine's pull-out test. The data were analyzed using One-way ANOVA, followed by the Tukey post-hoc test to compare the load among the three groups. Results: According to the findings, the inclusion of a circumferential groove (Group II) increased the retention of glass ionomer cement maintained implant-supported crowns by 44.58%. The bur modification (Group III) boosted glass ionomer cement maintained implant-supported crown retention by 110.69% while retaining retrievability. Results were statistically significant. Conclusion: Bur modification revealed more retention when compared to the groove and control group. Clinical significance: Short abutments are used in the clinical situation where interarch space is less. To achieve adequate retention of the implant crowns, surface modification of the abutments is necessary while selecting a cement-retained prosthesis.



Narayan B Kulkarni, Bhavna H Dave

Morphometric Assessment of Third and Fourth Cervical Vertebra Based on Hassel and Farman Method: A Radiographic Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:5] [Pages No:1457 - 1461]

Keywords: Cervical vertebra, Hassel and Farman method, Morphometric

   DOI: 10.5005/jp-journals-10024-3263  |  Open Access |  How to cite  | 


Aim: To assess third and fourth cervical vertebra morphologic dimensions as per the cervical vertebral maturation stage proposed by Hassel and Farman from 7 to 18 years. Materials and methods: A cross-sectional radiographic study was conducted on 264 participants within an age-group of 7–18 years who were further categorized into six subgroups having an interval of 1 year and 11 months chronologic age. The maturation stage and morphometric evaluation of the cervical vertebra were assessed for the same patient. The maturation stage was assessed as per the morphologic classification given by Hassel and Farman. The morphometric evaluation was assessed by measuring the anterior (AH3 and AH4), vertebral body (H3 and H4), posterior heights, and anteroposterior width (APW3 and APW4) of third and fourth cervical vertebra in millimeters which was carried out with the help of “IC measure software.” One-way analysis of variance (ANOVA), Tukey's multiple comparison, and Spearman's correlation coefficient were utilized to determine the significance and correlation between the vertebral maturation and millimetric measurement between age-groups. The multiple comparison levels were set at 0.05 level of significance. Results: A high significant correlation was observed between PH3 and APW3 (r, 0.737**). Moderate significant correlation was observed with H3 and PH3 (r, 0.605**, 0.640*), and APW3, APW4 (r, 0.534**, 0.614*) in the initiation stage in both the vertebrae; AH3, H3 (r, 0.498**) and H3, APW3 (r, 0.576**) in deceleration stage. A negative moderate significant correlation between AH4, PH4 (r, −0.691**) was observed in the deceleration stage. The transition, maturation, and completion stages did not reveal any significant correlation. Conclusion: Significant morphologic difference was observed among all the stages of vertebral maturation. Higher dimensions were observed among males. Anteroposterior width had the highest dimension. Significant morphometric changes were observed in stages of maturation and transition stages. Clinical significance: The dimensions of anterior, vertebral, and posterior height of the third and fourth cervical vertebra can supplement in identifying the precise morphologic classification whenever there is an overlap in the opinion of staging cervical vertebral maturation based on Hassel and Farman.



Lilavanti L Vaghela, Rohan K Bhatt, Chhaya N Patel, Kaushal R Joshi

Clinical Performance and Parental Satisfaction with Composite Strip Crown and Prefabricated Zirconia Crown for Primary Anterior Teeth: A Randomized Clinical Trial

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:9] [Pages No:1462 - 1470]

Keywords: Early childhood caries, Likert scale, Strip crown, Zirconia crown

   DOI: 10.5005/jp-journals-10024-3264  |  Open Access |  How to cite  | 


Aim: To compare clinical performance and parental satisfaction with composite strip crown and prefabricated zirconia crown for primary anterior teeth. Materials and methods: The study compares clinical evaluation and parental satisfaction of two different crowns for primary anterior teeth. A total of 102 teeth in each group selected between ages 3 and 6 years, who met the inclusion criteria, were randomly allocated into two groups for further evaluation. Group A for strip crowns (55 teeth) and group B for zirconia crowns (47 teeth). The crowns were evaluated clinically with various criteria like—color match, crown retention, gingival health, crown contour, opposing tooth wear, marginal integrity, and recurrent caries. The samples were also evaluated for parental satisfaction based on 5-point Likert scale and child liking was also recorded with Smiley face Likert scale at baseline, 3 and 9 months. Statistical analysis was done using Chi-square test (p <0.05). Results: Zirconia crowns showed better color match, crown retention, crown contour, and gingival health. Strip crowns showed more discoloration and chipping of material over a period of time. None of the samples showed opposing tooth wear, open margins, and recurrent caries in strip and zirconia crown group. Parents and children both were highly satisfied with zirconia crowns. Conclusion: Clinically zirconia crowns showed higher success rate as compared to strip crowns and parental overall satisfaction was higher for zirconia crowns. Clinical significance: Zirconia crowns exhibited a higher clinical performance and parental satisfaction; hence, if affordability is out weighted, zirconia crown stands better with esthetics of the child.



Ola Alqahtani, Ammar AbuMostafa

Effect of Glide Path and Coronal Flaring on the Centering Ability and Transportation of Root Canals: Micro-CT In Vitro Study

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:6] [Pages No:1471 - 1476]

Keywords: Centering ability, Coronal flaring, Glide path, Micro-CT, Transportation

   DOI: 10.5005/jp-journals-10024-3265  |  Open Access |  How to cite  | 


Aim: To compare the effect of glide path and coronal flaring on the centering ability and transportation in curved canals prepared by different NiTi instruments using micro-CT. Materials and methods: The mesiobuccal canal of 48 extracted mandibular molars was selected and divided into two groups of 24 each according to the type of instrument used, either Race Evo or EdgeSequel. Each group was further divided into three subgroups: Group I: without glide path and coronal flaring (control); Group II: with glide path and without coronal flaring; Group III: with glide path and coronal flaring. Following access opening and working length determination, coronal flaring and glide path were done in the required groups. The canals were then prepared according to the assigned instruments and assessed using micro-CT at 3, 5, and 7 mm of the root canal. Data of pre- and postoperative measurements were statistically analyzed using SPSS. Results: The mean value of centering ability was 0.39 (SD 0.36) while the mean value of transportation ability was 0.002 (SD 0.153). Transportation and centering ability did not vary significantly among the tested groups of rotary instruments. Comparison of centering and transportation among root canal instrumentation groups at 3, 5, and 7 mm showed no statistical significance (p >0.05). Conclusion: No significant difference was found among the tested groups regarding transportation and centering ability. Clinical significance: This study provided data on the effect of glide path and coronal flaring on the centering ability and transportation on curved canals prepared by Race Evo and EdgeSequel. Coronal flaring and glide path did not affect the centering ability and transportation.



Pietro Costamagna, Giorgia Carpegna, Caterina Bianchi, Andrea Baldi, Damiano Pasqualini, Nicola Scotti, Mario Alovisi

Endodontic Treatment of a Molar with Peculiar Anatomy: Case Study with CBCT and 3D Printed Model

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:6] [Pages No:1477 - 1482]

Keywords: Cone-beam computed tomography, Endodontics, Image-guided endodontics, Root canal therapy, Three-dimensional printing

   DOI: 10.5005/jp-journals-10024-3175  |  Open Access |  How to cite  | 


Aim: The aim of the study was to achieve the endodontic treatment of a second maxillary molar with abnormal anatomy through cone-beam computed tomography (CBCT) analysis and three-dimensional (3D) printing. Background: A patient arrived referring recurrent abscesses, spontaneous pain, and the difficulty to eat properly; a diagnosis of tooth necrosis was made. The periapical X-ray showed an abnormal anatomy of the tooth. Case description: The preoperative analysis of the tooth morphology was performed through CBCT analysis. The 3D scans were reconstructed through a dedicated software application (Mimics) to visualize the abnormal anatomy and detect the root canal morphology. Moreover, a 3D printed model was created to plan the clinical stage. Canal shaping was achieved with ProGlider and ProTaper Next techniques, and the root canal filling was performed with a carrier-based technique. Conclusion: The limits of this case were the low definition of the CBCT owned by the patient and the difficulties during the scouting of the canals due to the abnormal endodontic space complicated by narrow and flat canals. The software reconstruction allowed a 3D high-definition preclinical analysis of the tooth anatomy. Clinical significance: Both digital analysis and printed models based on CBCT scans seemed fundamental to preclinically understand the abnormal endodontic anatomy.



Shanmugapriya Ramamurthy, Sheeja Varghese, Sabitha Sudarsan, Jayanandan Muruganandhan, Shazia Mushtaq, Prema B Patil, A Thirumal Raj

Moringa oleifera: Antioxidant, Anticancer, Anti-inflammatory, and Related Properties of Extracts in Cell Lines: A Review of Medicinal Effects, Phytochemistry, and Applications

[Year:2021] [Month:December] [Volume:22] [Number:12] [Pages:10] [Pages No:1483 - 1492]

Keywords: Anticancer, Anti-inflammatory, Antioxidant, Moringa oleifera

   DOI: 10.5005/jp-journals-10024-3187  |  Open Access |  How to cite  | 


Moringa oleifera (MO), or the common drumstick possesses antioxidant properties, and its pods, seeds, leaves, and bark have been used for the treatment of inflammatory and cancerous conditions. This systematic review attempts to synthesize original studies of MO extracts in cell lines to determine their specific antiproliferative, antioxidant, anti-inflammatory, and related effects. The literature was obtained from PubMed central, the Cochrane registry, and other sources including Google Scholar, and Embase. Studies fulfilling the inclusion criteria were selected. Custom data collection forms were employed and two independent evaluators compiled the relevant information. Eighteen studies were selected after applying inclusion and exclusion criteria. In most studies, MO leaves had more potent properties compared to other parts of the plant. Ethyl acetate and ethanolic extractions improved the potency of the extract. Effects were selective (different for normal cells and cancer cells) and dose-dependent. Anticancer and antioxidant activities were consistently reported, with effects exerted at the genetic and molecular levels. MO extracts potentially could be employed for therapeutic applications. The optimal sources, preparation protocols, and dosages have been researched, though further scrutiny is needed for a comprehensive formulation.


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