The Journal of Contemporary Dental Practice

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2021 | May | Volume 22 | Issue 5

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Monal Yuwanati, Amol Gadbail, Shailesh Gondivkar, Gargi S Sarode

Why do Only Certain Cases of Oral Submucous Fibrosis Undergo Malignant Transformation?

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:2] [Pages No:463 - 464]

   DOI: 10.5005/jp-journals-10024-3101  |  Open Access |  How to cite  | 



Carlo Maiorana, Filippo Fontana, Marco Rasia dal Polo, Stefano Pieroni, Luca Ferrantino, Pier Paolo Poli, Massimo Simion

Dense Polytetrafluoroethylene Membrane versus Titanium Mesh in Vertical Ridge Augmentation: Clinical and Histological Results of a Split-mouth Prospective Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:8] [Pages No:465 - 472]

   DOI: 10.5005/jp-journals-10024-3091  |  Open Access |  How to cite  | 


Aim and objective: The aim of the present split-mouth prospective study was to evaluate clinically and histologically the bone regeneration obtained following preprosthetic vertical bone augmentation performed with titanium-reinforced dense polytetrafluoroethylene membrane (d-PM) compared to titanium mesh (TM). Materials and methods: Healthy adult patients presenting with bilateral partial edentulism in the posterior mandible requiring vertical ridge augmentation for implant placement purposes were consecutively included. One side of the mandible was randomly assigned to the use of d-PM, the other to TM. The graft consisted in a mixture of autogenous bone harvested nearby the surgical site and deproteinized bovine bone mineral particles in a 1:1 ratio. On each side during bone augmentation surgery, a 2-mm diameter mini-implant was inserted for clinical and histological analyses. After a healing period of 8 months, the second surgical phase was carried out to remove the nonresorbable barriers, to evaluate clinically the vertical bone gain, and to collect a bone biopsy that included the mini-implant. During the same surgical session, dental implants were inserted in a prosthetically guided position. Results: A total of five patients were enrolled. Eight out of 10 sites healed uneventfully. In the remaining two sites, premature exposure of the TM was observed. Mean vertical bone gain of 4.2 and 1.5 mm was achieved in d-PM and TM groups, respectively (p = 0.06). A mean mineralized tissue of 48.28 and 35.54% was observed in d-PM and TM groups, respectively (p = 0.51). Conclusion: The vertical bone gain, although not significantly, was higher in the d-PM group. Similar histological outcomes were noticed if exposure did not occur. In case of wound dehiscence, major resorption was observed. Clinical significance: Both d-PM and TM can be used to augment atrophic localized ridges vertically. The outcome of bone regeneration seems to be impaired by exposure of the device.



Jordan J Cimilluca, Kevin C Lee, Steven Halepas, Bridget Ferguson

COVID-19 Pandemic and its Impact on Dentistry: A Cross-sectional Survey of Practicing Dentists

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:6] [Pages No:473 - 478]

   DOI: 10.5005/jp-journals-10024-3092  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this study was to evaluate the economic impact and the dental practice changes associated with the coronavirus disease-2019 (COVID-19). Materials and methods: This was a cross-sectional survey conducted at the peak of the COVID-19 pandemic (May 2020). The study sample was derived from the Columbia University College of Dental Medicine Alumni network, which included the graduating classes between 1975 and 2015. Active dental practitioners were surveyed regarding changes to their current operations and protective safety measures through a 22 closed-ended questionnaire-based survey. Results: The response rate was 17%. Nearly 70.92% of respondents laid off at least one staff member during the COVID-19 pandemic, 51.80% expressed fear of permanent closure, and 79.43% applied for a small business administration loan. There were no significant associations between the amount of time in practice and the need to lay off staff members, the fear of going out of business, or the rates of application for the small business administration loan. Many practitioners bought at least one device geared toward reducing COVID-19 transmission, such as ultraviolet (UV) lights (26.21%), extraoral suctions (37.31%), and high-efficiency particulate air (HEPA) air filters (54.55%). Conclusion: At the peak of the pandemic, the majority of dental providers had to reduce staff and seek financial assistance. Concurrently, many of these practices also invested in new safety equipment with the intention of reducing viral transmission. Clinical significance: External mouth suctions, commercial air purifiers, and air exchange devices might be useful in the private practice setting. However, financially strained practitioners should recognize that these devices have not currently been proven to be effective against the COVID-19 virus.



Carlos RG Torres, Rayssa F Zanatta, Monique MM Godoy, Alessandra B Borges

Influence of Bleaching Gel Peroxide Concentration on Color and Penetration through the Tooth Structure

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:479 - 483]

   DOI: 10.5005/jp-journals-10024-3023  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this study was to assess the effect of hydrogen peroxide concentration on the bleaching efficacy and penetration through the tooth structure. Materials and methods: One hundred enamel/dentin specimens with cylindrical shape were obtained from bovine incisors. The surfaces were polished and the size standardized. They were divided into five groups (n = 20), following the concentration of hydrogen peroxide in the bleaching gels: 20, 25, 30, 35, and 40% (w/w). The specimens were placed over artificial pulpal chambers containing acetate buffer solution and bleached for 30 minutes (three applications of 10 minutes each). Aliquots of the acetate solution were collected, and the peroxide concentration was measured by an analytic spectrophotometer. The color of the samples was analyzed using a colorimetric spectrophotometer at the baseline and 7 days after the bleaching procedure. The color difference was calculated using the ΔEab formula. The data were analyzed by one-way ANOVA and Tukey's test (p <0.05). Results: The peroxide concentrations of 20–30% showed smaller bleaching effect than the higher concentrations (p = 0.001). The peroxide penetration was significantly higher (p = 0.001) for the more concentrated gels (35 and 40%). Conclusion: The higher peroxide concentrations enhance the bleaching efficacy, but also increased the peroxide penetration through the tooth structure. Clinical significance: In-office bleaching gels with higher concentrations of hydrogen peroxide (35 and 40%) present superior whitening efficacy. Nevertheless, they might also intensify the negative biological effects on the pulpal tissue, since they exhibit increased penetration potential.



Mohammed Mashyakhy, Thilla S Vinothkumar, Anandhi S Arthisri, Abdulwahab Alamir, Ahmed Juraybi

Ethnical Anatomical Differences in Mandibular First Permanent Molars between Indian and Saudi Arabian Subpopulations: A Retrospective Cross-sectional Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:7] [Pages No:484 - 490]

   DOI: 10.5005/jp-journals-10024-3100  |  Open Access |  How to cite  | 


Aim and objective: The variation in the anatomy of the root canal system has anthropological and demographic significances. The aim of this study was to compare the number of roots, root canals, and internal canal morphology of permanent mandibular first molars between Indian and Saudi Arabian populations. Materials and methods: A total of 523 (255 teeth of Indian sample and 268 teeth of Saudi Arabian sample) mandibular first molar (M1) were included for comparative analysis using cone-beam computed tomography images based on the inclusion criteria. The external and internal morphologies were assessed and compared by trained endodontist and the data was recorded. Results: M1 with three roots were found in 3.9% of the Indian population and 6% of the Saudi population. Overall, high prevalence was observed in two roots (95.0%), three canals (70.4%), Vertucci type IV of the mesial root (56.0%), and Vertucci type I of the distal root (76.7%). Comparison between Indian and Saudi Arabian molars revealed significant differences in relation to the number of canals (p <0.001), Vertucci types of the mesial root (p = 0.008), and Vertucci types of the distal root (p <0.001). Differences between genders for the whole sample revealed significant differences in relation to Vertucci types of the distal root (p = 0.025) with a relatively high male prevalence of type I (54.4%) and type IV (57.1%). Conclusion: The predominant parameters of M1 were two roots, three canals, Vertucci type II and IV mesial root configuration, and type I distal root configuration irrespective of both populations. The root canal morphology of Indian and Saudi Arabian populations shares a common trait of Asian origin. Clinical significance: The likelihood of predicting the complex system of the root canal with marked preference to ethnic identity would be a clinical benefit for the dentist performing root canal treatment.



George TM Candeiro, Jiovanne R Neri, Bruna MDF de Carvalho, Camila P Feijão, Rafael L Avelar, José VM Lemos, Anya PGF Vieira-Meyer

Repercussions of COVID-19 in Brazilian Dentists’ Personal and Professional Routines: An Online Survey

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:10] [Pages No:491 - 500]

   DOI: 10.5005/jp-journals-10024-3096  |  Open Access |  How to cite  | 


Aim and objective: This study evaluated the repercussions of coronavirus disease-2019 (COVID-19) in Brazilian dentists’ personal and professional routines. Materials and methods: Brazilian dentists were invited to participate in an online survey with questions pertaining to COVID-19 and its repercussions in dental practice. Sample calculation was performed using the Survey Monkey software ( The minimum sample required to obtain a 95% confidence level (CI) and 1% margin of error was 4,214. The eligibility criteria were dental professionals, of any gender and age, who were working in dentistry in a public, private, or university environment, regardless of the time of experience in the profession, and agreed to participate in the study. The survey was structured such that all the Brazilian regions were touched upon, thereby aiming at covering and collecting the representative data of the region. Responses were analyzed using chi-square tests, t-tests, and one-way analysis of variance, with statistical significance at p <0.05. Results: A total of 15,813 dentists responded to the survey, representing all Brazilian regions. Complete social isolation was practiced by 96.21% of the respondents, and approximately 25% knew someone who had contracted COVID-19. Public health specialists were the most likely to provide emergency treatment (71.90%, p <0.001). In the Northeast region, 79.80% of respondents agreed that conventional personal protective equipment (PPE) was insufficient to prevent COVID-19 transmission, and 79.10% considered their biosecurity measures insufficient (p <0.001). In the North region, most dentists continued to perform elective dental procedures (p <0.001). Conclusion: It is possible to conclude that Brazilian dentists demonstrated high knowledge of COVID-19's main symptoms and the risks of transmission through dental procedures. Most respondents practiced social isolation, although some did continue to provide emergency dental care. Clinical significance: To improve infection control in dental care settings against COVID-19, it is necessary to educate and raise awareness among professionals.



Satya Ranjan Misra, Anne Segonds-Pichon

Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:501 - 505]

   DOI: 10.5005/jp-journals-10024-3036  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. Materials and methods: The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January–March 2020) and after lockdown (June–August 2020), were included retrospectively and compared. Results: The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. Conclusion: The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. Clinical significance: This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis.



Khalil I Assiri, Muhammed Ajmal, Buthainah M Al-Ahmari, Hatoon S Abumelha, Rahaf A Almobty, Reema A Almobty, Saeed Arem, Sandeepa N Chalikkandy

Oral Hygiene Myths and its Association with Gingival Health Status among Patients in Aseer Region of Saudi Arabia: A Cross-sectional Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:506 - 510]

   DOI: 10.5005/jp-journals-10024-3062  |  Open Access |  How to cite  | 


Aim and objective: The aim of the study is to assess “Myths in dentistry related to Oral Hygiene and its association with Gingival Health Status among patients visiting Institutional diagnostic clinic in Aseer region of Saudi Arabia.” Materials and methods: The present study was a cross-sectional study done on 152 subjects attending Institutional diagnostic clinic in Aseer region Saudi Arabia. Myths in dentistry related to oral hygiene were assessed by using a ten-item, multiple-choice, close-ended structured questionnaire and Gingival Health Status was assessed using gingival index described by Loe and Silness on the Ramfjord teeth. For the comparison of proportions, a Chi–Square test was used with continuity correction whenever appropriate. “p” value of <0.05 was taken to be statistically significant for the purpose of analysis. Results: A total of 152 study subjects were included in the study, of which 60.5% were males and the rest 39.5% were females. Eighty-two percent of the study subjects believed that myths do affect the oral hygiene of the person. Combinational use of household ingredients (like apple vinegar, turmeric, lemon, baking soda, coal, honey, and sodium bicarbonate) was seen among 40% of the subjects. A majority of 48% learned from family as a source of information and 53% believed that use of household ingredients would improve the esthetical value (bleaching) of the tooth. Eighty-two percent of the study subjects believed that myths do affect the oral hygiene of the person. 40.8% had some form of gingival health problem. There was no statistically association observed between myths in dentistry related to oral hygiene and gingival health. Conclusion: The present study revealed that myths in dentistry related to oral hygiene are quite prevalent in society. The use of household ingredients can influence oral health status and one has to ensure the judicious use if good oral health is to be expected. Clinical significance: Myths in dentistry related to oral hygiene can influence a lot on oral health and this can augment the health of the individual in any direction. So as a responsible clinician, it is very important to address these issues and bring in more health awareness among the study population to achieve the social goal—“health for all.”



Shalan Kaul, Ajay Kumar, Ankush Jasrotia, Kamna Gorkha, Stuti Kumari, Sumaya Y Jeri

Comparative Analysis of Biodentine, Calcium Hydroxide, and 2% Chlorhexidine with Resin-modified Glass Ionomer Cement as Indirect Pulp Capping Materials in Young Permanent Molars

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:6] [Pages No:511 - 516]

   DOI: 10.5005/jp-journals-10024-3084  |  Open Access |  How to cite  | 


Aim and objective: This study was carried out to compare the effectiveness of biodentine, calcium hydroxide, and 2% chlorhexidine gluconate used along with resin-modified glass ionomer cement (RMGIC) as indirect pulp capping (IPC) materials in young permanent molars. Materials and methods: In this study, 54 patients were selected. Among these patients, 72 young permanent molars were selected randomly in which IPC was required. These teeth were randomly categorized into three different groups and each group consisted of 24 teeth. The first group was group A consisting of teeth treated with biodentine, the second group was group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC, while the third was group C consisting of teeth treated with calcium hydroxide. All cases were subjected to follow-up for clinical and radiographic evaluation at 4, 8, and 16 months. The data were recorded and analyzed statistically by utilizing the Chi-square test. Results: After 16 months, 95.83% of cases in group A consisting of teeth treated with biodentine showed successful results both clinically and radiographically. While 87.5% of cases in group B consisting of teeth treated with 2% chlorhexidine gluconate being followed by RMGIC showed successful results. And finally, 91.66% of cases in group C consisting of teeth treated with calcium hydroxide showed successful results. Conclusion: Biodentine can be efficiently used as an IPC agent in young permanent molars although all three materials were effective in IPC with a nonsignificant difference statistically. This study highlights the success of IPC in young permanent molars and the choice of better IPC material can be biodentine. Clinical significance: Indirect pulp capping is one of the procedures in which preservation of carious affected dentin nearest to the pulp is carried out to protect the pulp. Several new IPC agents like biodentine have been introduced. Hence, it is necessary to evaluate their effectiveness.



Abhijit Patil, Navjot K Boparai, Swapnil B Shankargouda, Mallikarjun H Doddamani, Ankeet Vora, Twisha Dave

Candida dubliniensis: The New Culprit on the Block Causing Denture Stomatitis? An In Vivo Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:517 - 521]

   DOI: 10.5005/jp-journals-10024-3099  |  Open Access |  How to cite  | 


Aim: The present study aimed to carry out DNA extraction and polymerase chain reaction (PCR) amplification to isolate the physiological and phenotypic traits of Candida albicans and Candida dubliniensis in denture wearer patients with and without denture-induced stomatitis. Materials and methods: A total sample size of 160 participants were divided into two equal groups (80 each), patients in the study group having 40 males and 40 females with Newton type II denture stomatitis, and in the control group, healthy 40 males and 40 females those who wear complete denture were selected. All the samples were collected from the hard palate with a sterile swab and inoculated on CHROM agar plate; samples that displayed dark green colored colonies were selected for DNA extraction. DNA isolation was done on agarose gel using electrophoresis. Biorad gene identification was used. Strands depicting the presence of DNA in particular samples were identified, and further standardization of the procedure was done. PCR amplification was done using Candida species-specific primer, preset to the hyphal wall of the protein 1 gene with the CRR forward and reverse primers, under strict standard conditions with reverse transcriptase technique. Results: Results showed that prevalence of C. albicans was more in females with denture stomatitis which was 67.50% than in males, i.e., 52.50%, and prevalence of C. dubliniensis was found in one female and in one male who were having denture stomatitis and it was not isolated from patients without denture stomatitis. Statistical analyses were performed using the Chi-square test. Conclusion: Denture stomatitis is the most common problem faced by long-term denture wearers, with C. albicans as one of the causative organisms. However, recent findings show an emerging pathogenic yeast species, C. dubliniensis, which was isolated from denture-induced stomatitis candidates in the present study, which is closely related to the C. albicans species. The identification of candidal strains causing denture stomatitis with DNA extraction and PCR amplification and its management by determination of its susceptibility to antifungals may improve the treatment outcome of the same. Clinical significance: Candidiasis is the most frequently seen mucocutaneous infection of the oral cavity especially in denture wearers. It is caused mainly by the genus Candida. C. dubliniensis is phenotypically similar but genotypically different from C. albicans. This affects the treatment outcome drastically as there is enough literature suggesting resistance to the common antifungal drugs. Hence, drugs like fungus-specific calcineurin inhibitors should also be considered in resistant patients. Therefore, DNA identification of Candida genus plays a major role in deciding the treatment outcome.



Nashwan H Al-Tairi, Yaser A Al-Sharaee, Mohammed N Alhajj

Lateral Pterygoid Muscle Location in Relation to Preauricular Skin Measured from CT Scans among a Sample of Yemeni Adults

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:522 - 526]

   DOI: 10.5005/jp-journals-10024-3098  |  Open Access |  How to cite  | 


Aim: The aim of this study was to determine the lateral pterygoid muscle (LPM) in relation to preauricular skin measured from computed tomography (CT) scan measurements. Materials and methods: CT scans of 160 patients aged between 18 and 75 years were retrospectively collected and analyzed, and the distances were measured to determine the location of the LPM center in relation to the preauricular skin. On axial CT crossing the maximum muscle width, two lines [the first line is below the center of the zygomatic arch (first position), while the second line was 5 mm posterior to the first one (second position)] were drawn from the preauricular skin to the medial border and then extended to the lateral border of the muscle. These measurements were used to calculate the distance to the center of the muscle mathematically. Data were statistically analyzed, and the differences between both genders and both sides were investigated. The level of significance was set at p-value <0.05. Results: Males displayed larger mean values in two positions (36.6 ± 2.25 and 35.97 ± 4.19, respectively) than females (33.66 ± 4.46 and 32.80 ± 3.21, respectively). The difference between both genders was found to be statistically significant. Measurements on the right side were also larger than those on the left side, but with no significant difference. Conclusion: LPM center can be approached safely in males by inserting the needle about 36 mm at the first position and 33 mm at the second position. However, in females, these distances are located 3 mm shorter in both positions. Clinical significance: The outcome of this study will provide the clinicians with measurements that can help in directing the needle or electromyography (EMG) electrode during the extraoral injection technique of the LPM.



Saurabh Mankeliya, Rajnish K Singhal, Anushri Gupta, Vivek K Pathak, Ashish Kushwah

A Comparative Evaluation of Smear Layer Removal by Using Four Different Irrigation Solutions like Root Canal Irrigants: An In Vitro SEM Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:527 - 531]

   DOI: 10.5005/jp-journals-10024-3064  |  Open Access |  How to cite  | 


Background: The present study aimed to evaluate and compare the efficacy of 17% ethylenediaminetetraacetic acid (EDTA), 18% etidronic acid, 10% citric acid, and 7% maleic acid in the removal of smear layer at the apical third of the root canals. Materials and methods: Sixty single-rooted teeth were equally divided into four study groups (n = 15), according to the type of irrigant used (17% EDTA, 18% etidronic acid, 10% citric acid, and 7% maleic acid) to remove the smear layer effectively from apical third of root canal. In each group, respective irrigant was used with 5.25% of sodium hypochlorite during instrumentation. Each study sample was then sectioned longitudinally and removal of smear layer was observed using a scanning electron microscope (SEM) at 2000×. Results: A 7% maleic acid revealed better smear layer removal than all other three groups at apical third. A 10% citric acid was found to be more efficient than EDTA and etidronic acid. The intergroup comparison was performed using Mann–Whitney U test, and there was no significant difference between all the study groups, except maleic acid. Conclusion: The present study compared the effect of various irrigants as an adjunct with 5.25% of sodium hypochlorite for root canal irrigation during and after instrumentation. The use of irrigants aids in the removal of the smear layer from the root canals, thereby increasing the success rate of endodontic therapy. Clinical significance: This study supports the hypothesis that a thorough use of root canal irrigants can efficiently remove the smear layer which is the key for successful root canal treatment. The present study helps in choosing an appropriate irrigant that can ensure complete root canal debridement from all thirds, especially from the apical third of the root canal.



Aya A El Tahlawy, Dalia A Saba, Nahed G Bakir

Avian Eggshell Slurry as a Dentin Desensitizing Agent: An In Vitro Assessment Using Two Techniques

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:6] [Pages No:532 - 537]

   DOI: 10.5005/jp-journals-10024-3086  |  Open Access |  How to cite  | 


Aim: This study aims to evaluate the efficacy of avian eggshell slurry as a desensitizing agent compared to casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing Tooth Mousse. Materials and methods: Eggshell powder was prepared and characterized using a scanning electron microscope (SEM), transmission electron microscope (TEM), X-ray diffraction (XRD), and energy-dispersive X-ray spectroscopy (EDX). Forty dentin disks were immersed in 6% citric acid for 2 min to simulate hypersensitive dentin (baseline). Disks were then divided into two groups (n = 20) according to treatment received: eggshell slurry and commercially available Tooth Mousse desensitizing agent. Each group was further divided into two subgroups (n = 10). In subgroup 1, dentin discs were immersed in artificial saliva for four weeks whereas, in subgroup 2, discs underwent acid challenge. Environmental scanning electron microscope (ESEM) analysis and hydraulic conductance test were utilized to calculate dentinal tubules occlusion and reduction of dentin permeability percentages, respectively. Statistical analysis was performed using SPSS 22.0 at a significance level p ≤ 0.05. Results: After application of desensitizing agents, the eggshell slurry group showed a significantly higher percentage of dentinal tubules occlusion compared to the Tooth Mousse group, whereas no significant difference existed in the percentage reduction of dentin permeability between both groups. After both immersion protocols, the eggshell slurry significantly occluded more dentinal tubules compared to Tooth Mousse. On the contrary, results of percentage reduction of dentin permeability revealed no significant difference between both subgroups after acid challenge. After artificial saliva immersion, Tooth Mousse showed a significantly higher percentage reduction of dentin permeability compared to the eggshell slurry. Conclusion: Avian eggshell slurry can effectively occlude open dentinal tubules compared to commercially available Tooth Mousse desensitizing agent. Clinical significance: Avian eggshell slurry can be considered a promising material for the treatment of dentin hypersensitivity.



Natheer H Al-Rawi, Ala Yacoub, Ala Zaouali, Lina Salloum, Noura Afash, Omar A Shazli, Zeina Elyan

Prevalence of Burnout among Dental Students during COVID-19 Lockdown in UAE

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:7] [Pages No:538 - 544]

   DOI: 10.5005/jp-journals-10024-3072  |  Open Access |  How to cite  | 


Aim: To estimate the prevalence of burnout among dental students in two major universities in the United Arab Emirates during the coronavirus disease-2019 (COVID-19) lockdown. Materials and methods: In this cross-sectional observational study, the burnout clinical subtype questionnaire (BCSQ-12-SS) (English version) was used. It consists of 12 questions covering domains of overload (4 questions), lack of development (4 questions), and neglect (4 questions). The questionnaire was sent to 500 dental students from the University of Sharjah (UOS) and Ajman University of Science and Technology (AUST). The association between burnout and sociodemographic variables was also investigated. Results: The majority of responders were females (74%). Socio-demographic and study characteristics of dental students from both universities were not remarkably different. However, the responses to the BCSQ-12-SS questions were not very different. In this study, there was no significant association between burnout and demographic variables, such as age, gender, relationships, distance from family, residency, year of study, studying hours, and number of failed subjects. However, there was a significant association between burnout and receiving a scholarship and family support. Conclusion: Identifying individuals at risk for burnout may provide a potential intervention strategy and counseling to assist in dental student development, as it has good psychometric properties. Clinical significance: Burnout among dental students could develop into anxiety and depressive disorders. Early identification and prevention will protect the psychological well-being of dentists.



Vishal A Nalawade, Sumaya Y Jeri, Bhagabati P Dash, Sanjay Narayanamurthy, Jafer S Mohammed, Manju Babu

Effectiveness of Various Remineralizing Agents on White Spot Lesions after Orthodontic Treatment: A Comparative Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:4] [Pages No:545 - 548]

   DOI: 10.5005/jp-journals-10024-3067  |  Open Access |  How to cite  | 


Aim and objective: To evaluate and compare the ability of three commercially available remineralizing agents on the surface microhardness (SMH) of enamel after induction of white spot lesions (WSLs) by demineralization. Materials and methods: About 80 sound mandibular human premolars that were later removed as a part of orthodontic treatment were employed in this research under the inclusion criteria. After cleaning and disinfecting the teeth, their crowns were mounted in acrylic resin and painted with nail varnish, not including a 3 mm × 3 mm window in the middle of the buccal surface. Each tooth was soaked in 15 mL of a demineralizing solution at a pH of 4.5 that was prepared for this study and left in a place for 10 subsequent days to permit the formation of WSLs after which the SMH was again assessed. The premolar teeth were then randomly allocated and equally divided into one of the four groups of 20 each depending on the treatment they received as Group 1: control group, Group 2: Colgate sensitive Pro-Relief toothpaste group, Group 3: Amflor group, and Group 4: Enafix group. After 15 days, the microhardness of all samples was estimated and alterations in the same were noted. Scanning electron microscopy (SEM) was used to evaluate the surface morphology. Results: Enhanced and highest mean SMH was present in the Colgate sensitive Pro-Relief group (53.26 ± 0.10) followed by Enafix group (47.72 ± 0.21), Amflor group (44.84 ± 0.66), and control group (39.52 ± 0.32), respectively after application of remineralizing agents. Except for Group 3 vs Group 4, statistically significant differences (p < 0.05) were noted in all the groups. Conclusion: All the three agents employed in this study, that is, Colgate sensitive Pro-Relief toothpaste, Amflor, and Enafix improved the SMH of teeth after the therapy given over 15 days compared to the microhardness following demineralization. Clinical significance: White spot lesions often occur on labial surfaces of teeth after orthodontic treatment. Hence, these lesions pose esthetic challenges thereby affecting treatment satisfaction perceived by the patient. As esthetics and appearance are of foremost significance after orthodontic treatment, elimination protocols for remineralization of WSLs are of utmost importance employing economic means.



Thiyezen A Al Dhelai, Manea M Al-Ahmari, Hafiz A Adawi, Mannaa K Aldowsari, Nasser M Al Ahmari, Lujain I Aldosari, Ramzi F Alqatta, Mohammed M Al Moaleem

Dental Anxiety and Fear among Patients in Jazan, Kingdom of Saudi Arabia: A Cross-sectional Study

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:8] [Pages No:549 - 556]

   DOI: 10.5005/jp-journals-10024-3066  |  Open Access |  How to cite  | 


Aim: The current study aims to address the patient's dental anxiety (DA) And dental fear (DF) under the treatment of a general practitioner (GP) among different parameters. Materials and methods: The cross-sectional study included 500 patients recruited from different clinics in Jazan, Saudi Arabia. Data were collected through a questionnaire-based form consisting of three parts; the first part was personal and demographic questions whereas the second and third parts were a modified dental anxiety scale (MDAS) and a dental fear survey (DFS) to measure DA and DF among patients. Spearman's correlation was used to measure the relation between DA and DF as well as Chi-square tests and logistic regression analyses for analyzing the effect of each variable on DA and DF. Results: All patients fulfilled their eligibility criteria. A high percentage was found in moderate anxiety (36.8%) as well as in moderate fear (46.2%) among different anxiety and fear scales. The association between DA and DF was positively significant (p <0.01). There was a significant effect of gender, age, education, khat use, marital status, monthly income, and type of clinic on patients’ DA and DF. Conclusions: There is a positive relation between MDAS and DFS, thus the DA affects the DF. Female patients had a lower DA and DF than male patients. Furthermore, the government clinics had the highest DA and DF prevalence levels for patients. Moreover, the high school–graduated patients seem to have a high DA and DF vs other patient educational levels. Clinical significance: It would be beneficial to include an educational training program about psychological patient management in the study curriculum as well as to be offered as a special course to newly graduated dentists. This modification will aid to improve the GPs to get rid of DA and DF patients.



Rafael S Beolchi, Deepak Mehta, Bruno Pelissier, Luis A Gênova, Anderson Z Freitas

Influence of Filler Composition on the Refractive Index of Four Different Enamel Shades of Composite Resins

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:5] [Pages No:557 - 561]

   DOI: 10.5005/jp-journals-10024-3040  |  Open Access |  How to cite  | 


Aim and Objective: The purpose of this study was to measure the refractive index of four commercially available enamel resin composites, using optical coherence tomography (OCT) and their relationship with the atomic composition of the composite resin fillers utilizing an energy-dispersive X-ray fluorescence spectrometer (EDX). Materials and methods: Four different enamel composites, namely Enamel HRi color UE3, Enamel HFO color GE3, Vit-l-escence color Pearl Frost, and Amelogen Plus color Enamel White were tested. For each composite, disks with different thicknesses were fabricated and then light-cured according to the manufacturer's instructions. The disks were then stored in deionized water under 36.5 °C for at least 7 days. Each of the samples from the four different groups was measured in five distinctive points to analyze the optical and physical length using optical coherence tomography (OCT). Elemental analysis of all four different enamel shades of the composite was done using an EDX. Results: The filler contents showed interesting differences in elemental composition and concentration; however, Si seemed to be a common filler component. The HRi composite presented a distinctive composition compared to other materials and was the only composite that showed a smaller percentage of SiO2, and also was the only composite that contained compounds, such as P2O5, ZnO, CaO, La2O3, and V2O5. The optical coherence tomography analysis showed the refractive index values of all tested enamel composites. Among the four different enamel composite resins tested, the enamel HRi composite demonstrated the most ideal refractive index to mimic natural enamel. Conclusion: The enamel HRi composite demonstrated a distinctive filler composition and this could be the main reason behind its higher refractive index. Nonetheless, it remains unclear how much of an impact this feature has in the final esthetic outcome of anterior composite restorations, where many other optical phenomena are also important. Clinical significance: The clinical success of any esthetic restorative procedure depends on diagnosing the proper treatment plan and also on executing this treatment with the right materials. On direct esthetic restorations, knowing the optical properties of such materials is fundamental, as they should be able to replicate both natural enamel and dentin.



Yang Yang, Bo Zhang, Chunpeng Huang, Rui Ye

Intentional Replantation of a Second Premolar with Internal Resorption and Root Fracture: A Case Report

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:6] [Pages No:562 - 567]

   DOI: 10.5005/jp-journals-10024-3087  |  Open Access |  How to cite  | 


Aim: This case aims to detail intentional replantation as a last resort to save an otherwise hopeless premolar with perforated internal resorption and root fracture. Background: Internal root resorption, progressive destruction of intraradicular dentin, is a condition that sometimes renders a tooth non-restorable. In the rare cases reported where severe internal resorption leads to root fracture, extraction of the tooth seemed to be a common treatment of choice, and a few literatures had reported endodontic surgery as an alternative treatment option. To date, there had been no report of treating internal root resorption using intentional replantation. Case description: A 20-year-old male presented swelling at the buccal region of his left maxillary second premolar (#13). Clinical examination revealed a sinus tract and fractured dens evaginatus at the occlusal surface of the tooth. Radiographically, a large area of radiolucency was detected within the middle third of the root, where root fracture was present, leaving a triangular-shaped mature root apex. The condition was diagnosed as internal root resorption and root fracture. Endodontic surgery was excluded from treatment choices due to potential damage of periodontal bone. Instead, intentional replantation was performed, with the application of biomaterials including mineral trioxide aggregate (MTA) and platelet-rich fibrin (L-PRF). The tooth achieved satisfactory healing and remained asymptomatic after 2 years of follow-up. Conclusion: The successful outcome of the case suggests that intentional replantation could preserve a fractured tooth caused by internal root resorption. Incorporated application of biomaterials, such as MTA and L-PRF, might as well improve the chances of saving this otherwise hopeless tooth. Clinical significance: Through careful planning and execution, intentional replantation is a viable alternative treatment option to preserve a fractured tooth caused by internal root resorption, while leaving periodontal bone architecture almost intact.



Mikhail Stepanov

Free Gingival–Bone Graft in the Anterior Maxilla: A Clinical Case Report

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:4] [Pages No:568 - 571]

   DOI: 10.5005/jp-journals-10024-3097  |  Open Access |  How to cite  | 


Aim: To present the healing, development, and long-term clinical results after a combined gingival–bone graft as an alternative treatment for the management of critical extraction sites in the esthetic zone. Background: To enhance the knowledge of in vivo soft and hard tissue remodeling, in this case report, we observed the healing, development, and long-term clinical results after a case of a combined gingival–bone graft as an alternative treatment for the management of critical extraction sites. Case description: Autogenous grafts of gingival and bone tissue were placed in a 56-year-old female patient, where a hopeless upper left central incisor with an evident loss of both the buccal and the palatal bony plates and with endodontic problems was due for extraction. In order to obtain enough autogenous tissue for filling the defect, a cylindrical free gingival and bone graft was retrieved from the retromolar area with a trephine drill, to obtain hard and soft tissues for grafting the postextraction defect. After 6 months, following soft tissue maturation and once esthetic and natural gingival contours were achieved, the surgical site was prosthetically restored with a porcelain fused to a metal bridge and scheduled for regular follow-up. Conclusion: No complications were observed either from the donor site or from the recipient site. The post-treatment result was esthetically pleasing, based upon successful architectural stability of both hard and soft tissues. Although more studies are needed to confirm the beneficial use of this approach, the procedure can be considered a viable option in the management of soft and hard tissue remodeling in esthetically compromised cases. Clinical significance: The gingival–bone graft may be considered as an alternative treatment for the management of critical extraction sites in the esthetic area.



Mahmoud K AL-Omiri, Mohammad H Al-Shayyab, Abdullah A Al Nazeh, Islam A Alraheam, Ziad A Malkawi, Abdallah K Alomiri, Ibrahim A Alzoubi, Edward Lynch

COVID-19 and Dentistry: An Updated Overview of Dental Perspectives and a Recommended Protocol for Dental Care and Emergency Dental Treatment

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:15] [Pages No:572 - 586]

   DOI: 10.5005/jp-journals-10024-3076  |  Open Access |  How to cite  | 


Aim and objective: This manuscript aims to provide an overview of the coronavirus disease-2019 (COVID-19) pandemic from dental perspectives, and presents standards and guidelines of dental care provision based on available research in this field as well as clinical experience and practice. Background: The current COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spreading around the globe and interferes with the provision of dental care for many individuals from different communities and backgrounds. A search for the literature on PubMed, ISI Web of Science, Scopus, EMBASE, and Cochrane Library from March 1, 2020 to December 30, 2020 was conducted. Also, the bibliographies included in the indicated articles were used to identify further literature. Recommendations by health authorities in different countries were also consulted. Results: COVID-19 is causing many fatalities and is disrupting people's daily life and the economy in many countries around the world. Due to the potential of cross-infection through dental treatments, especially dental aerosol generation procedures, the dental profession has been disrupted during this pandemic. Dental care provision has been ceased completely or partially (limited to emergency or urgent treatment) in most countries around the world. Until this pandemic is controlled by new suitable treatments and/or vaccination, there is an urgent need to adopt immediate guidelines and standards for the safe provision of dental care to meet patients’ demands, especially for the dental aerosols. Conclusion: Guidelines and standards for dental treatment amidst the COVID-19 pandemic are required. This manuscript provides an overview of the COVID-19 pandemic from dental perspectives and presents standards and guidelines of dental care provision based on available research in this field as well as clinical experience and practice. Clinical significance: This manuscript provides guidelines and standards for dental treatment and clinical management within dental settings amidst the COVID-19 pandemic, and resembles part of the quest to set the golden standards for dental care during the current circumstances.



Luiz O Purger, Sandro JO Tavares, Renato LCH Martinez, Isleine Caldas, Lívia AA Antunes, Miriam Z Scelza

Comparing Techniques for Removing Fiber Endodontic Posts: A Systematic Review

[Year:2021] [Month:May] [Volume:22] [Number:5] [Pages:9] [Pages No:587 - 595]

   DOI: 10.5005/jp-journals-10024-3083  |  Open Access |  How to cite  | 


Aim: This systematic review aimed to establish the available techniques for fiber post removal, pointing out where each method stands out evaluating its advantages, and where they fall short indicating the possible harmful effects. Materials and methods: This systematic review was registered in PROSPERO (CRD42020193799). A broad search of the electronic databases PubMed, Web of Science, Scopus, and Virtual Health Library was carried out before April 27, 2020, for in vitro studies about techniques for removing fiber posts luted with resin cements of endodontically treated teeth. The methodological quality of included studies was evaluated based on the critical assessment tool for in vitro studies. Results: Thirteen articles were selected and included after applying the inclusion and exclusion criteria. All included studies received an assessment of methodological quality between high and moderate. Most studies used ultrasonic inserts as a strategy to remove fiber posts, manufactured removal kits and drills were also widely used, only one study evaluated the removal capacity of the Er:YAG laser. Ultrasonic inserts seem to lead to a greater working time for removal of the fiber post, tend to generate significant volume changes in the root structure and increase the temperature on the root canal and clean the root canal walls further. Conclusion: Although the results tend to show greater agility in removing fiber posts with manufactured removal kits and the ultrasonic inserts seem to work better in removing fiber remains and luting agent, there is still no consensus in the literature as to which technique is the best. Clinical Significance: In some cases, clinicians may be faced with the need to remove fiber posts in order to regain access to the root canal due to the need for endodontic retreatment which directly implies the search for the most appropriate removal technique.


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