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2021 | April | Volume 22 | Issue 4

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Dentistry and the Pandemic: A Year of Reckoning

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:2] [Pages No:325 - 326]

   DOI: 10.5005/jp-journals-10024-3063  |  Open Access | 



James R Collins, Aydee Cruz, Evelina Concepción, Cristian López, Wei Hou, Georgios E Romanos

Connective Tissue Graft vs Platelet-rich Fibrin in the Treatment of Gingival Recessions: A Randomized Split-mouth Case Series

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:8] [Pages No:327 - 334]

Keywords: Connective tissue graft, Gingival recession, Platelet Rich Fibrin, Root coverage, Randomized Clinical Trial

   DOI: 10.5005/jp-journals-10024-3104  |  Open Access | 


Aim and objective: Coronally advanced flap (CAF) with connective tissue graft (CTG) has been considered the gold standard for obtaining complete root coverage. However, some limitations have been reported with the use of CTG, especially because it increases morbidity and leads to postoperative pain and bleeding. Recently, platelet-rich fibrin (PRF) has been used in periodontal plastic surgery for the treatment of gingival recessions (GRs). The aim of this study was to evaluate the outcome of PRF combined with a CAF (test) compared to de-epithelialized connective tissue graft (DeCTG) + CAF (control) for GR coverage. Materials and methods: Ten healthy patients exhibiting mandibular or maxillary Miller class I and II were treated with PRF + CAF or DeCTG + CAF. GR, probing depth (PD), and gingival thickness (GT) were evaluated at baseline, 6 weeks, and 28 weeks postoperatively. Results: GR, PD, and GT differences between the test and control groups at 28 weeks were not statistically significant. GR was 3.30 ± 1.25 mm and 3.00 ± 1.63 mm (control vs test) group (baseline) and -0.10 ± 0.32 vs -0.20 ± 0.42 mm (7 months), respectively. Conclusion: Within the limitations of the present study, it can be concluded that localized gingival recessions could be successfully treated with CAF + PRF or CAF + DeCTG. Clinical significance: This study suggests that PRF membrane may be an alternative and valid graft material for treating localized gingival recessions Miller class I and II.



Panagiotis Galiatsatos, Aristidis Galiatsatos, Gerasimos Phillipatos

Characterization of the Interface of Heat-pressed Glass–Ceramic Masses on Metal Support Cr–Co in Metal–Ceramic Prosthetic Restorations

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:7] [Pages No:335 - 341]

Keywords: Ceramic pressed to metal, Dental ceramics, Metal–ceramic restorations, PoM technique, Scanning microscopy

   DOI: 10.5005/jp-journals-10024-3078  |  Open Access | 


Aim and objective: The aim and objective of this study is to evaluate the interface between heat-pressed glass–ceramic masses on a Cr–Co metal substrate using a scanning electron microscope and an X-ray energy dispersion spectrometer. Materials and methods: A pressed porcelain–leucite-based ceramic (IPS InLine press-on-metal (PoM); Ivoclar Vivadent AG) was used. Three cylindrical metal specimens cast (diameter 5 mm, height 1.5 mm) in Co–Cr alloy and covered with pressed ceramic (height 1.5 mm), according to the instructions of the manufacturer. All the specimens were covered with conductive carbon and then examined with a scanning electron microscope. The interface areas were studied using projections from an ETD secondary emission detector and a reversing atomic SSD contrast beam at a magnification of 1200× and 2000×, with a voltage 25 kV acceleration and 110 mA climb current. The elemental analysis was done with genesis 3.5 software, without the use of templates. Surface mapping areas and linear line scan projections of elemental distributions during the interface were recorded. Results: The distribution of specific elements in the ceramic coating concludes the existence of ion diffusion from one side of the interface to the other, which leads to an initial conclusion of the development of primary bonds with oxygen bridges. Also, in the interface, there are ledges of the mass of opaquer on the metal substrate, which results in the creation of a mechanical bond. Therefore, the adhesive mechanism must be due to both micromechanical retention and wetting phenomena and is similar to the conventional layering technique. Conclusion: The PoM technique can be used as an alternative fabrication method for metal–ceramic restorations. Factors, such as material composition and properties, firing temperatures, cooling rates, operator's skill, porosities, and fabrication process, may affect the quality and strength of the bond between the core and the veneering materials. Clinical significance: The PoM technique can be used as an alternative fabrication method for metal–ceramic restorations.



Hend N Al-Nahedh

Effects of Resin-modified Glass Ionomer Cement and Flowable Bulk-fill Base on the Fracture Resistance of Class II Restorations: An Original Laboratory Experimental Study

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:7] [Pages No:342 - 348]

Keywords: Base material, Bulk-fill, Class II, Composite resins, RMGIC

   DOI: 10.5005/jp-journals-10024-3068  |  Open Access | 


Aim and objective: The purpose of this study was to investigate the fracture resistance of marginal ridges restored using different techniques (amalgam, open sandwich technique, and incremental placement) and to compare these with smart dentin replacement (SDR) bulk-fill. Materials and methods: Amalgam, dispersalloy; a nanohybrid resin composite (Tetric N Ceram), a resin-modified glass ionomer cement (RMGIC) base (Fuji II LC), and flowable bulk-fill composites (SureFil SDR) were used. Standardized class II (occluso-distal) OD cavities were prepared on 60 (n = 12) extracted premolars, and five different protocols were used to restore the teeth: group 1, dispersalloy; group 2, dispersalloy with 4 mm Fuji II LC base; group 3, incrementally placed Tetric N Ceram; group 4, Tetric N Ceram with 4 mm Fuji II LC base; and group 5, Tetric N Ceram with SureFil SDR. The restorations were thermocycled then fractured using a universal testing machine, the maximum fracture load of the specimens was measured (N), and the type of fracture was recorded. Statistical analysis was carried out using one-way analysis of variance. Results: Amalgam groups showed the lowest fracture resistance, with no significant difference between the based and nonbased groups. The highest fracture resistance was displayed by Tetric N Ceram with SDR base, and it was significantly higher than all the groups except the Tetric N Ceram nonbased group. The RMGIC based Tetric N Ceram displayed intermediate fracture resistance. The majority of the restorations showed mixed types of fracture except for nonbased amalgam, which mostly failed cohesively through amalgam. SDR-based composite was the only group that showed severe tooth failures. Conclusions: The use of a 4 mm thick RMGIC base had no detrimental effect on the fracture resistance of class II amalgam and composite restorations. Clinical significance: Bulk-fill SureFil SDR placed under a conventional resin-based composite had similar fracture resistance to incrementally placed composite but higher than amalgam and composite restorations based on RMGIC.



Suvarna Chandrakant Chavan, Anvi Shah, Rashmita Parida, Nisarga Kansar, Sheela Poojary

Assessment of Apical Extrusion of Debris during Root Canal Preparation with Different Ni–Ti File Systems: An In Vitro Study

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:4] [Pages No:349 - 352]

Keywords: Apical extrusion, Debris, Instrumentation, Ni–Ti file

   DOI: 10.5005/jp-journals-10024-3016  |  Open Access | 


Aim and objective: The aim of this study was to evaluate the apical extrusion of debris during root canal preparation with the use of different Nickel–Titanium (Ni–Ti) file systems. Materials and methods: Totally 60 single-rooted human mandibular premolar teeth with fully formed roots were chosen for the study. The coronal access cavity and all other preparations were done with the use of an access cavity kit and then 60 samples were randomly separated into three investigational groups (n = 20); group I: self-adjusting file, group II: WaveOne Gold, and group III: Mtwo rotary system. After instrumentation, the teeth were taken out from the tube and the root surface–adherent debris was collected by washing off the apical area of the tooth with distilled water (1 ml) into a centrifuge tube. The centrifuge tube was kept for 5 days in an incubator at 70°C to permit evaporation of the moisture prior to weighing the dry debris with the aid of an electrical analytical balance. Results: The highest quantity of debris extruded was by the Mtwo rotary system (0.0394 ± 0.880) followed by WaveOne Gold (0.0247 ± 1.030) and self-adjusting file (0.0198 ± 0.102). A statistically significant difference (p < 0.001) was found between the various file systems. Conclusion: After considering the drawbacks of this study, apical debris extrusion could be found with all three groups. However, the self-adjusting file demonstrated a significantly reduced quantity of apical debris extrusion compared to the Mtwo rotary system and WaveOne Gold. Clinical significance: The chief step during the procedure of root canal treatment is the preparation of the infected root canals biomechanically. This preparation may lead to forcing the apical debris into the periapical space through the apical foramen, resulting in host-initiated immunological response which leads to postoperative discomfort and pain. This consequently leads to selection of a specific rotary system for endodontic treatment.



Rudra Kaul, Sukhbir Kour, Neelu Kumari

Comparison between Mineral Trioxide Aggregate Mixed with Water and Water-based Gel Regarding Shear Bond Strength with Resin-modified Glass Ionomer Cement and Composite

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:4] [Pages No:353 - 356]

Keywords: Mineral trioxide aggregate, Shear bond strength, Water-based gel

   DOI: 10.5005/jp-journals-10024-3045  |  Open Access | 


Aim and objective: To compare between mineral trioxide aggregate (MTA) mixed with water and water-based gel regarding shear bond strength with resin-modified glass ionomer cement (RMGIC) and composite. Methods and materials: In this study, 40 blocks of cylindrical shape were prepared with acrylic. These blocks were divided into four groups with each group consisting of 10 blocks: group-1A: MTA + distilled water + composite, group-1B: MTA + distilled water + RMGIC, group-2A: MTA + polymer + composite, and group-2B: RMGIC + MTA + polymer. After that, a universal testing machine was used for the measurement of shear bond strength. The acrylic blocks were placed under this machine. A blade with a knife-edge was used to provide a crosshead speed of 1 mm/minute. This was continued till bond of MTA in both forms (distilled water/gel) and restorative material failed. Results: It was observed that a statistically significant difference was found between MTAw + composite and MTAg + composite resin but no statistically significant difference between MTAw + RMGIC and MTAg + RMGIC with p . 0.05. It was found that a statistically significant difference was present between the RMGIC and composite groups within the same MTA type with p . 0.05. Conclusion: It was concluded from the present study that MTA with a water-based gel has a better shear bond strength than composite resin and RMGIC materials. Clinical significance: It has been found that MTA has different properties when it is mixed with polymer and water. Very few studies have been conducted in the past to compare MTA mixed with water and water-based gel regarding the shear bond strength with RMGIC and composite.



Pragya Tripathi, Rajiv Mengi, Susheen M Gajare, Saswat S Nanda, Shahid Ali Wani, Anuraj S Kochhar

Evaluation of Remineralizing Capacity of P11-4, CPP-ACP, Silver Diamine Fluoride, and NovaMin: An In Vitro Study

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:4] [Pages No:357 - 360]

Keywords: CPP-ACP, NovaMin, SDF, Self-assembling peptide

   DOI: 10.5005/jp-journals-10024-3024  |  Open Access | 


Aim and objective: To determine and compare remineralizing efficacy of NovaMin, CPP-ACP, silver diamine fluoride (SDF), and P11-4. Materials and methods: Sixty permanent premolars were divided into four groups with 15 samples in each group; group I: self-assembling peptide (P11-4), group II: SDF, group III: Casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), and group IV: NovaMin. Mineral content was assessed using a scanning electron microscope at 7, 14, and 21 days after remineralization with each agent. Results: The mean remineralization in group I at 7 days was 1.73 ± 0.02, at 14 days was 1.79 ± 0.01, and at 21 days was 1.90±0.03. Mean remineralization in group II was 1.61 ± 0.01, 1.64 ± 0.02, and 1.73 ± 0.03 at 7, 14, and 21 days, respectively. Mean remineralization in group III was 1.62 ± 0.01, 1.65 ± 0.02, and 1.74 ± 0.05 at 7, 14, and 21 days, respectively. Mean remineralization in group IV was 1.59 ± 0.02, 1.62 ± 0.07, and 1.70 ± 0.09 at 7, 14, and 21 days, respectively. The maximum value was obtained on day 21. There was a significant difference in mean remineralization values between group I vs group II, group I vs group III, and group I vs group IV (p < 0.05). Conclusion: Self-assembling peptides showed maximum remineralization in tested specimens followed by CPP-ACP, SDF, and NovaMin-containing toothpaste. Clinical significance: CPP-ACP, SDF, and NovaMin-containing toothpaste can be indicated for remineralization of initial caries in clinical use.



Orlando Donfrancesco, Alessandro Mazzoni, Stefania Nottola, Giuseppe Familiari

Nickel–Titanium Rotary Instruments: An In Vitro Comparison (Torsional Resistance of Two Heat-treated Reciprocating Files)

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:4] [Pages No:361 - 364]

Keywords: EdgeOne Fire, Endodontics, Nickel–titanium file, Torsional resistance, WaveOne Gold

   DOI: 10.5005/jp-journals-10024-3081  |  Open Access | 


Aim and objective: The present study aims to evaluate the difference in torsional resistance of two reciprocating nickel–titanium (Ni–Ti) rotary files: WaveOne Gold and EdgeOne Fire. Materials and methods: A total of 40 nickel–titanium rotary instruments (n = 40): 20 WaveOne Gold Small (WOGS) and 20 EdgeOne Fire Small (EOFS) were divided into two groups. Each instrument was tested using a torsional resistance device already validated in previous studies to evaluate and compare torsional resistance. The static torsional test was implemented by blocking each instrument at 3 mm from the tip and rotating it until fracture with a reciprocating motion. Torque to fracture (TtF) and fragment length (FL) were measured and statistically analyzed. Results: Statistical analysis of TtF found significant differences between the two groups (p <0.05). The EOFS showed higher TtF if compared to WOGS, with a mean value and a standard deviation of 3.05 ± 0.07 (N cm) against 2.97 ± 0.08 (N cm). Data for FL showed no significant differences (p >0.05) between the two groups. Conclusion: According to the results of this study, it is reasonable to assert that EOFS instruments showed a higher torsional resistance if compared to the WOGS. Clinical significance: As evidenced by this study, EOFS should be considered as a safer solution, in terms of torsional resistance, if compared to WOGS, reducing the risk of intracanal separation due to excessive torsional load.



Nora AA Alzayyat, Randa M Hafez, Asmaa A Yassen, Shereen H Ibrahim

Accuracy of the Light-induced Fluorescent Intraoral Camera in Occlusal Caries Detection

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:8] [Pages No:365 - 372]

Keywords: Caries detection, Fluorescence camera, Initial caries, International caries detection and assessment system-II, Occlusal caries

   DOI: 10.5005/jp-journals-10024-3082  |  Open Access | 


Aim and objective: This study was conducted to evaluate the accuracy of a light-induced fluorescence intraoral camera vs the visual–tactile assessment method according to the modified International caries detection and assessment system-II (ICDAS-II) criteria clinically in the detection of initial occlusal caries. Materials and methods: Occlusal surfaces of 260 molar and premolar teeth from 52 adult participants were examined by two calibrated observers, using two diagnostic methods. Teeth were initially assessed visually according to the criteria of the ICDAS-II, and then by fluorescence camera (Soprolife®). Inter- and intraobserver agreements were measured using Cohen's kappa test. Correlation between methods was calculated using Wilcoxon signed-rank test, and effect size for comparison between the two modalities. The sensitivity, specificity, predictive values, diagnostic accuracy, likelihood ratios (LRs), area under the receiver operating characteristic (ROC) curve (AUC), and 95% confidence interval (95% CI) of the AUC for caries detection by Soprolife® were evaluated. Results: A significant positive correlation was found between the ICDAS-II and camera measurements (p-value <0.001, effect size = 0.572). The sensitivity of Soprolife® was 94.2%, specificity 84.2%, positive predictive value 87.1%, negative predictive value 92.8%, positive LR 6%, negative LR 0.07%, and the diagnostic accuracy 89.5%. AUC was 0.909 with 95% CI (0.863–0.955). There was a perfect intraobserver agreement (kappa = 1.00) for both testing modalities. There was moderate interobserver agreement (kappa = 0.520) with regards to ICDAS, while for Soprolife®, there was substantial interobserver agreement (kappa = 0.798). Conclusion: Soprolife® can be used as a valid and reliable assessment tool for occlusal caries detection. Clinical significance: Light-induced fluorescence intraoral camera is an efficient tool in the detection of initial occlusal caries.



Puja Singh, Tushar , Shishir Sharma, Sumaiya Nezam

Evaluation of Inflammatory Acute Phase Protein Level and Different Leukocyte Counts in Chronic Periodontitis Normolipidemic Patients after Nonsurgical Periodontal Therapy

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:5] [Pages No:373 - 377]

Keywords: C-reactive protein, Chronic periodontitis, Leukocyte count, Nonsurgical periodontal therapy

   DOI: 10.5005/jp-journals-10024-3043  |  Open Access | 


Aim and objective: To evaluate the effect of nonsurgical periodontal therapy on periodontal parameters, serum C-reactive protein (CRP) level, total leukocyte count (TLC), and differential leukocyte count (DLC) in normolipidemic patients with generalized chronic periodontitis. Materials and methods: A total of 60 subjects (38 males and 22 females) between 20 and 55 years of age were included in this study. Twenty subjects with generalized chronic gingivitis were assigned group I. Forty subjects with generalized chronic periodontitis were randomly divided into test groups, i.e., group II (n = 20) and control group, i.e., group III (n = 20). At baseline, clinical parameters (plaque and gingival indices, clinical attachment loss) were recorded and blood collected for lipid profile test, TLC, DLC, and CRP estimation. Patients with lipid values in the normal range continued the study. Groups I and II were provided nonsurgical periodontal therapy. Follow-up clinical examination and blood examination were done for CRP level, TLC, and DLC after 1 and 2 months. Results: A significant improvement in the clinical parameters was evident following scaling and root planning in group II as compared to group III. A decrease in serum CRP and TLC count was also observed, but the difference was not significant. Moreover, a reduction was observed in neutrophils, monocytes, eosinophils post therapeutically in group II but the decrease was significant only for monocyte count. Conclusion: Based on the findings of the study, it can be concluded that nonsurgical periodontal therapy can reduce the inflammatory component. Clinical significance: Periodontal diseases comprise a wide range of inflammatory conditions affecting the supporting structures of teeth. Effect of nonsurgical periodontal therapy on chronic periodontitis can be evaluated by measuring the CRP and leukocyte concentration.



C Lavanya, Dubhakunta Sriteja, Gayathri Bandari, Vatvatwar Rajasri, Chikurumalli Smriti, Nandiwada K Pradeep

Evaluation of Maxillary Anterior Teeth Width and Their Relation to the Calculated Values for Smile Designing

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:10] [Pages No:378 - 387]

Keywords: Golden mean, Golden proportion, Preston proportion, Smile designing, Ward formulas

   DOI: 10.5005/jp-journals-10024-3051  |  Open Access | 


Aim and objective: The present study was conducted to determine the golden proportion, golden mean, and the Preston proportion of the individuals between the widths of six maxillary anterior teeth and to determine which proportional formula exists in the population. Materials and methods: This study was conducted among 60 participants between 18 years and 30 years of age with an esthetic smile. They were grouped into 30 females and 30 males. Maxillary arch impressions were made using irreversible hydrocolloid material from each individual. The width of the anterior teeth on the graph paper was analyzed by using digital vernier caliper. The data were statistically analyzed by one way ANOVA test. Results: The study revealed that the formula of golden proportion and golden mean had no statistical differences between males and females but the Preston proportion has shown statistical differences in the total population. Conclusion: From the current study, it was concluded that the formulas of golden mean and golden proportion proposed by Ward can be used for smile designing and full mouth rehabilitations. Clinical significance: Demand for smiles has gained its importance with time. The golden proportion, golden mean, and the Preston proportion are the guidelines used by the professional for better esthetic proportion in the dentition.



Claire El Hachem, Nada El Osta, Melissa Haddad, Jean Claude Abou Chedid, Maha Daou

Characteristics of Pediatric and Medically Compromised Patients Treated under General Anesthesia in a Middle Eastern Country

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:6] [Pages No:388 - 393]

Keywords: Dental care for children, General anesthesia, Medically compromised patient, Retrospective study

   DOI: 10.5005/jp-journals-10024-3080  |  Open Access | 


Aim: This study aims to describe dental treatment provided to healthy and medically compromised patients treated under general anesthesia (GA) over a four-year period. Materials and methods: A total of 97 patients who received dental treatment under GA at the Saint Joseph University, Lebanon, from 2016 to 2019 were included in the study. The study population was analyzed according to the patient's age, medical status, and type of treatment done accordingly. Results: The mean age of the patients was 9.15 ± 8.84 years. About 58.8% were aged below 6 years (primary dentition) and 48.5% had medical problems. Dental procedures performed were mostly extractions (4.00 ± 4.15 per patient) followed by resin composite restorations (3.66 ± 3.02 per patient). The mean number of pulpotomies per patient (p <0.001) and stainless steel crowns (p <0.001) were significantly higher in primary dentition, whereas in permanent dentition, the mean number of endodontic treatments per patient (p = 0.016) was significantly larger. Also, there was a significant difference between the type of treatment done on healthy and medically compromised patients (p <0.001). Conclusion: Better emphasis on oral health education and preventive strategies for children and special need patients is essential. Clinical significance: Dental GA is a reliable treatment for young uncooperative children and medically compromised patients. A multidisciplinary treatment plan must be conducted to ensure optimal oral healthcare and avoid unnecessary extractions.



Gurpreet Kaur, Parvinder S Baweja, Ravinder S Saini, Ish Paul Singh, Tanvi Sharma, Simarpreet Singh

Assessment of Effect of Implant Angulation and Implant Number on the Dimensional Accuracy of Definitive Casts

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:6] [Pages No:394 - 399]

   DOI: 10.5005/jp-journals-10024-3053  |  Open Access |  How to cite  | 


Aim: To analyze the impact of implant angulation and implant number on the dimensional accuracy of definitive casts. Materials and methods: Seven definitive casts with implant analogs placed in a triangular pattern were made from dental stone. The groups were as follows: group 1 (control group) - all implant analogs perpendicular to the plane of the cast; the center implant analog (implant 2) being at 90° to the plane of the cast in all groups and implant analogs number 1 and 3 arranged in 5°, 10°, or 15° divergence from or convergence to the center implant (implant number 2). Three open-tray impressions of definitive casts were made in each group. Impressions were poured in type IV dental stone. Coordinates in the three planes were measured at the implant analog top surface and the base of the cast using a fine tip measuring stylus. The data were aligned and the angular differences between implant analog vectors from definitive and duplicate casts were calculated in degrees. Results: The impact of implant number on the dimensional accuracy of definitive casts was significant whereas for implant angulation it was nonsignificant. The correlation of angulation and the number of the implant did not show an interpretable pattern. The precision of duplicate casts (compared to definitive casts) is not affected by the combined interaction of implant number and implant angulation. Conclusion: The close proximity of implant angulation toward a right-angled direction results in higher precision of implant. In the impression, there is direct picking from the impression copings which decreases the discrepancies in implant angulation on impression and master cast. The interaction of implant angulation and the number shows a noninterpretable pattern. Clinical significance: Dimensionally accurate implant impressions can be made by using an open tray technique for three implants angled up to 15°.



Terry Zaniol, Alex Zaniol, Saverio Ravazzolo

The Low Window Technique: Comparison between Manual and CAD/CAM-guided Design

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:6] [Pages No:400 - 405]

   DOI: 10.5005/jp-journals-10024-3079  |  Open Access | 


Aim: The aim of this bench study was to provide quantitative data addressing the difference between the manual low window design and the corresponding computer-aided design and computer-aided manufacturing (CAD/CAM)-guided design. Materials and methods: Five cone-beam computed tomography (CBCT) scans of as many patients (two males and three females, age range: 61–78 years) with partially edentulous maxilla to be rehabilitated through sinus augmentation, one- or two-step implant placement, and implant-supported prostheses were used to 3D-print the corresponding five maxillary stereolithographic models. Five independent highly skilled maxillofacial surgeons, who were provided with the patients’ orthopantomographs, drew on the models the access windows for sinus augmentation according to the “high” (standard) and the low window design both by free-hand and using a surgical guide prepared by computer-guided design. Accuracy and inter-operator variability were analyzed. Results: The results of this study showed that the manual design is associated with a clinically relevant shift in the low window shape, size, and positioning compared with the CAD/CAM-based positioning. All four directions (apical, coronal, mesial, and distal) showed on average the same extent of placement error (approximately 3 mm). Overall, the intra-operator variability was very similar, and measurements were not influenced by the operator (low inter-operator variability). Conclusion: The compromised accuracy and reproducibility in the manual design may limit the advantages of the low window technique. Thus, within the limits of this study, the computer-guided approach should be preferred vs the manual approach when performing a low window sinus lift. This may limit intra- and postoperative complications, as well as patient discomfort. Clinical significance: The “best option” CAD/CAM-guided design should be chosen when performing a low window sinus lift because it reduces discrepancies in selected parameters both between and within groups. This should facilitate the achievement of better results by dentists who have insufficient experience performing implant surgery.



Syed Sarosh Mahdi, Raheel Allana, Francesco Amenta

Teledentistry-based Program to Improve Oral Hygiene Indicators in Rural Pakistan—A Protocol

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:6] [Pages No:406 - 411]

   DOI: 10.5005/jp-journals-10024-3074  |  Open Access | 


Aim: The primary aim of this research protocol is to secure funding to initiate a teledentistry pilot project in order to improve the oral hygiene conditions of the most vulnerable population of rural Sindh in Pakistan, through hands-on training of 1,000 lady health workers by dentists and community dentistry specialists of other colleges led by Jinnah Medical and Dental College. Materials and methods: Training courses on digital health consultation would be given to participating healthcare workers. The trainees would be trained on all aspects of dental hygiene including precautions, tooth brushing techniques, and oral care. During the 2-day-long course, lady health workers will be taught various tooth brushing techniques, as well as basic instructions about oral hygiene and how to address queries of people regarding oral health. They will also get guidance about the various multimedia softwares in the phone and how to use them. The study would also include teledentistry consultation as a real-time patient learning tool for patients, healthcare workers, and trainees. Results: Results will be made available when the trial has been completed in 2021. The program will be evaluated by assessing its usability, acceptability, knowledge, and satisfaction of users. Conclusion: The protocol is designed to illustrate the underlying concept that a more reliable and robust model can be built through creating interactive communities of practice for consumers of telehealth in dental education. The Telehealth Skills Coaching and Delivery Initiative would incorporate and test a technically oriented paradigm of Internet-based medical education for vertically incorporated, community-based learning environments. Clinical significance: Teledentistry has the ability to expand access to oral health care, increase the provision of oral health care, and decrease costs. In view of the immense advances made in this field, teledentistry can continue to promote specialized health care in the remotest corners of the world. Many countries have already embraced virtual health care (telemedicine) in the face of an increase in cases of COVID-19; however, teledentistry has yet to play its role in this pandemic by enhancing the accuracy and efficiency of dental treatment. In the case of LMICs such as Pakistan, which lack advanced technologies such as teledentistry within their national healthcare network, the COVID-19 pandemic is a challenge to introduce the requisite legislative changes to promote the widespread use of teledentistry.



Toyoaki Takagi, So Shimizu

Surgical Orthodontic Treatment of Skeletal Mandibular Protrusion with Multiple Impacted Ankylosed Teeth Treated with Alveolar Corticotomy

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:10] [Pages No:412 - 421]

   DOI: 10.5005/jp-journals-10024-3071  |  Open Access | 


Aim: To present a case of skeletal mandibular protrusion with multiple impacted ankylosed teeth, which were treated with conventional orthognathic surgery and alveolar corticotomy, respectively. Background: Tooth ankylosis is characterized by the fusion of a root surface with the surrounding alveolar bone. Various treatment modalities for tooth ankylosis have been developed and are used commonly in the clinic. Corticotomy is defined as the application of intentional surgical injury to the cortical bone to mobilize a tooth with the adjacent bone and soft tissues. The corticotomy technique has been improved in recent years to avoid possible risks such as periodontal damage, tooth devitalization, and osseous necrosis due to an inadequate blood supply. Case description: A female patient aged 16 years and 3 months was diagnosed with anterior crossbite and the impaction and ankylosis of multiple canines. After the confirmation of ankylosis, alveolar corticotomy was performed on the maxillary left and mandibular right canines. After 6 months of traction (patient age, 19 years and 7 months), both canines had extruded successfully. After the completion of preoperative treatment, bilateral intraoral vertical ramus osteotomy was performed to correct the anterior crossbite involving a skeletal mandibular protrusion. The amounts of mandibular setback on the right and left sides were approximately 7 and 5 mm, respectively. The total treatment period was 55 months. Acceptable occlusion with a balanced profile was maintained over a 5-year retention period, indicating the long-term stability and success of the treatment. Conclusion: Our results indicate that alveolar corticotomy should be considered to facilitate the treatment of multiple impacted ankylosed teeth. Clinical significance: This report proposes an efficacy of alveolar corticotomy for extrusion of impacted ankylosed teeth.



Dimokritos Papalexopoulos, Theodora-Kalliopi Samartzi, Aspasia Sarafianou

A Thorough Analysis of the Endocrown Restoration: A Literature Review

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:5] [Pages No:422 - 426]

   DOI: 10.5005/jp-journals-10024-3075  |  Open Access | 


Aim: The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication. Background: Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the “gold standard” proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the “monoblock technique,” proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. Review results: Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure. Conclusion: Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique. Clinical significance: Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.



Maya Feghali, Edit Xhajanka, Pamela Kassabian, Marco Seracchiani

Incidence of Different Types of Intracanal Fracture of Nickel–Titanium Rotary Instruments: A Systematic Review

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:8] [Pages No:427 - 434]

   DOI: 10.5005/jp-journals-10024-3015  |  Open Access | 


Aim: The aim of this systemic review is to investigate these parameters by analyzing the characteristics of fractured instruments to determine which is the most relevant mechanical stress that induces intracanal separation in vivo. Background: The fracture of nickel–titanium (Ni–Ti) instruments is a result of flexural fatigue and torsional fatigue. An electronic search was conducted in MEDLINE database, Web of Science, and Cochrane following preferred reporting items for systematic reviews and meta-analyses guidelines. Data were collected and the key features from the included studies were extracted. Overview quality assessment questionnaire scoring assessed the quality of the articles. A total of 12 articles were selected, where the lowest score was 13. Review results: Considering Ni–Ti rotary instruments, this overall evaluation comprehends 939 broken instruments with an incidence of fracture of 5%. Out of the 12 selected articles, 10 studies revealed that flexural failure was the predominant mode (range of 62–92%). It appears that motion plays an important role when it comes to mechanisms of fracture. The majority of defects found in hand-operated instruments were in the form of torsional failure. Although the major cause of separation of rotary instruments is flexural fatigue, smaller instruments show more torsional fracture than the larger instruments. The average fragment length was found to be 2.5 mm and 3.35 mm, respectively, for torsional failure and flexural failure. The risk of bias depends on fractographic analysis. Conclusion: Flexural fatigue is the predominant mode of fracture in rotary Ni–Ti instruments. The type of motion and size of the instrument seem to affect the mechanism of fracture. Fragment length may show a strong association with the type of fracture mechanism. Clinical significance: This systemic review found that flexural fatigue is the most relevant mechanical stress that induces intracanal separation in vivo. Moreover, in clinical practice, the fragment length might be an excellent indicator of the type of fracture.



Nikunj Maniyar, Nilookumari Choudhary, Vini Mehta, Sujata Yerwadekar, Saurabh Joshi, Gowri Pendyala

Oral Cancer in Young vs Old Individuals: A Systematic Review

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:17] [Pages No:435 - 451]

   DOI: 10.5005/jp-journals-10024-3011  |  Open Access | 


Aim: To compare various parameters associated with oral cancer in young and old patients and systematically compile the data on prognosis or outcome of oral cancer in young and old patients that include case series, matched-pair analyses, institutional series, and database reviews. Background: Though oral cancer is considered a disease of old age, a recent clinical scenario witnesses its increasing incidence among young persons. When compared to old patients, young patients with oral cancer are exposed to the carcinogens for a very petite period of time suggesting underlying pathogenesis to be distinct from that in older individuals. Literature reports several studies about the occurrence of oral cancer in young patients; however, no unanimous opinion exists about its prognosis and treatment outcomes when compared to older patients. Keeping this in mind, we have extensively studied all the possible aspects (location, local and regional recurrence, nodal and distant metastasis, overall survival, etc.) from the English literature and systematically compiled the available data on prognosis or outcomes of oral cancer. Review results: The overall outcome of the case series shows poorer prognosis in young patients, matched-pair analyses, and institutional series suggesting no significant differences whereas the databases favored a better prognosis in young patients. The mean overall survival rate was found to be better for young patients in the database and institutional review whereas worse in the matched-pair analyses. The mean 5-year survival rate was found to be more in young individuals in matched-pair analyses, database reviews, and institutional series as compared to older oral cancer patients. Conclusion: Though data extracted from various study designs are heterogeneous, the present review gives a scoping view of the papers published on oral cancer in young vs old patients. More prospective studies are suggested with a larger sample size in the future. Clinical significance: The present review will help to better understand the nature, course, and biologic behavior of oral cancer in young patients leading to the development of specific treatment strategies to manage the patients based on their age-groups.



Gleice C Colombari, Matheus R Mariusso, Ludmila TC Ercolin, Sergio Mazzoleni, Edoardo Stellini, Francesco S Ludovichetti

Relationship between Breastfeeding Difficulties, Ankyloglossia, and Frenotomy: A Literature Review

[Year:2021] [Month:April] [Volume:22] [Number:4] [Pages:10] [Pages No:452 - 461]

   DOI: 10.5005/jp-journals-10024-3073  |  Open Access | 


Objective: Breastfeeding plays a key role in the development of the baby, in addition to the benefits to the mother and this dyad. Among the possible difficulties in this process, we have ankyloglossia. Some professionals opt for the frenotomy, although the literature is controversial. This paper aims to present how the literature provides subsidies for health professionals’ decision and action in the intersection of the themes: breastfeeding, ankyloglossia, and frenotomy. Materials and methods: The research on the platforms SciELO and PubMed used the terms: “ankyloglossia,” “frenotomy,” and “lingual frenulum” and the same ones associated with “breastfeeding.” A specific inclusion and exclusion criteria were applied and validated by the American Speech-Language-Hearing Association to reduce any bias in the analysis. In the end, 16 papers were included and, by thematic equivalence, divided into two domains: association between lingual frenulum alteration and breastfeeding and between frenotomy and breastfeeding. Results: The literature does not assure that the frenotomy is the “standard conduct” to be adopted in cases of difficulty in breastfeeding and ankyloglossia. Conclusion: Further studies are needed on the different types of ankyloglossia and their direct influence on the sucking function and lactation difficulties.


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