The Journal of Contemporary Dental Practice

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2021 | September | Volume 22 | Issue 9


Maurilio D'Angelo, Alessio Zanza, Shilpa Bhandi

An Update of Possible Radiation-free Imaging Techniques in Dentistry

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:2] [Pages No:973 - 974]

   DOI: 10.5005/jp-journals-10024-3192  |  Open Access |  How to cite  | 


Anuradha Rajkuwar, Ajay Verma, Hariharavel Vijayapandian, Prafful Kumar, Munish Dheeraj, Vivin Vincent

Prevalence of Tobacco Use and Oral Mucosal Lesions among Nicobarese Tribal Population in Andaman and Nicobar Islands

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:4] [Pages No:975 - 978]

Keywords: Nicobari population, Oral mucosal lesion, Tobacco user, Tribal

   DOI: 10.5005/jp-journals-10024-3176  |  Open Access |  How to cite  | 


Aim: To determine the prevalence of tobacco use and oral mucosal lesions among Nicobarese tribal populations in Andaman and Nicobar Islands, India. Materials and methods: Cross-sectional survey and oral examination were done in 400 Nicobari populations in Car Nicobar using the World Health Organization (WHO) format of Oral Health Questionnaire and Assessment forms. The data were then entered and statistical analysis was done using SPSS Inc.; Chicago, Illinois, USA, Version 20.0. Results: There is high prevalence of tobacco consumption (88.25%), especially the smokeless form of tobacco. Oral mucosal lesions were present in 25.75% of the total population, and keratosis was the most prevalent among oral mucosal lesions which was 56.3%. Conclusion: There is a statistical significance in the presence of oral mucosal lesions who consumes smokeless form of tobacco every day. There is no significance observed between male and female Nicobari tribes. Clinical significance: This high consumption of smokeless form of tobacco puts both genders in Nicobari tribal population equally at risk of developing precancerous and cancerous lesions. Early intervention and oral health education should be done frequently to prevent the development of oral cancer at early stages in tribal population.


Andrea Polesel, Francesco Favaro, Marianna G Arakelyan, Luca Solimei, Andrea Amaroli, Antonio Signore

Apical Leakage Evaluation of Two Different Coated Carrier Systems for Root Canal Obturation Using a Dye Penetration Evaluation Method

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:979 - 984]

Keywords: Apical dye leakage, Apical seal, Carrier-based obturation, GuttaCore Pink, Soft core

   DOI: 10.5005/jp-journals-10024-3170  |  Open Access |  How to cite  | 


Aim: The carrier-based obturation is a reliable technique for sealing the endodontic space. The GuttaCore with a pink internal core of cross-linked gutta-percha, named GuttaCore Pink, has been recently introduced into the market. The aim of this in vitro study was to compare the quality of the apical seal of two-carrier-based system, Soft Core and the GuttaCore Pink, through the measurement of apical dye leakage. Materials and methods: Eighty-six extracted human teeth with single canals were used. Samples were shaped using ProTaper Universal rotary files up to a #30 apical size and randomly divided into four groups. Group SC (n = 40) was obturated with #30 Soft Core Obturators; Group GCP (n = 40) was obturated with #30 GuttaCore Pink obturators; Group CT+ (n = 3) and CT– (n = 3) left nonobturated used as positive and negative controls, respectively. The samples underwent a process of passive/active dye penetration and after a clearing procedure. The extent of the dye was measured under stereomicroscope. Results: The Mann-Whitney U test showed a statistically significant difference (p <0.05) between Soft Core and GuttaCore Pink in terms of apical dye leakage, both considering the mean and the maximum infiltration value with a greater infiltration rate for Soft Core. Conclusion: In vitro GuttaCore Pink showed less apical dye leakage than Soft Core. Clinical significance: The apical leakage of carrier-based obturation materials, observed in both GuttaCore Pink and Soft Core, may be considered material-dependent.


Karim Corbani, Louis Hardan, Rita Eid, Hasan Skienhe, Nawal Alharbi, Mutlu Özcan

Fracture Resistance of Three-unit Fixed Dental Prostheses Fabricated with Milled and 3D Printed Composite-based Materials

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:985 - 990]

Keywords: CAD/CAM, Fiber reinforced composite, Fixed dental prosthesis, Fracture resistance, High-density polymers, 3D printing

   DOI: 10.5005/jp-journals-10024-3137  |  Open Access |  How to cite  | 


Aim: To evaluate the fracture resistance of three-unit fixed dental prosthesis (FDP) made of composite, high-density polymers (HDP), fiber-reinforced composite (FRC), and metal-ceramic (MC) using different fabrication methods. Materials and methods: A typodont model was prepared to receive a three-unit FDP replacing a missing second maxillary premolar. The prepared model was digitally scanned using an intraoral scanner (Trios3, 3Shape, Denmark). In total, 60 FDPs were fabricated and divided into four groups (n = 15) according to the materials and fabrication method: the subtractive method was used for the FRC (Trilor, Bioloren, Italy) and the HDP (Ambarino, Creamed, Germany) groups; the HDP group was monolithic, whereas the FRC group was layered with a nanocomposite (G-aenial Sculpt, GC). The additive method was used for the 3D printed (3DP) nanocomposite (Irix Max, DWS, Italy) and the Cr-Co (Starbond CoS powder 30) infrastructure of the MC groups. The FDPs were adhesively seated on stereolithography (SLA) fabricated dies. All samples were subjected to thermomechanical loading and fracture testing. The data for maximum load (N) to fracture was statistically analyzed with one-way analysis of variance (ANOVA) followed by Games-Howell post hoc test (α = 0.05). Results: The MC group reported the highest fracture resistance with a statistically significant difference (2390.87 ± 166.28 N) compared to other groups. No significance was noted between 3DP and HDP groups (1360.20 ± 148.15 N and 1312.27 ± 64.40 N, respectively), while the FRC group displayed the lowest value (839.07 ± 54.30 N). The higher frequency of nonrepairable failures was observed in the MC and FRC groups, while HDP and 3DP groups reported a high frequency of repairable failures. Conclusion: Significant differences were found in fracture resistance between the tested groups. The load-bearing capacity of the composite-based FPDs exceeded the range of maximum chewing forces. Clinical significance: 3D printed and milled composite-based materials might offer a suitable solution for the fabrication of FPDs.


Sotiria Davidopoulou, Maria Pikilidou, Maria P Yavropoulou, Thomas E Kalogirou, Pantelis Zebekakis, Sotirios Kalfas

Aggravated Dental and Periodontal Status in Patients with Sickle Cell Disease and Its Association with Serum Ferritin

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:7] [Pages No:991 - 997]

Keywords: Caries, Cross-sectional study, Ferritin, Periodontitis, Sickle cell disease

   DOI: 10.5005/jp-journals-10024-3189  |  Open Access |  How to cite  | 


Aim: The present study aimed to evaluate the possible consequences of sickle cell disease (SCD) on dental and periodontal health in middle-aged patients and to examine the association of certain cardiovascular parameters and serum ferritin with the dental and periodontal status. Materials and methods: Thirty-seven patients (mean age 43.2 years old) with SCD and 30 non-SCD and otherwise healthy individuals (mean age 38.9 years old) were examined for caries experience and periodontal status in addition to cardiovascular characteristics and ferritin level in serum. Results: Compared to controls, SCD patients exhibited higher plaque and gingival bleeding scores, higher prevalence of periodontal diseases, and higher caries experience. Multiple stepwise linear regression analysis showed that caries experience was predominantly determined by the presence of SCD and the age, while major determinants of periodontitis were the ferritin levels and the male gender. The results reveal an aggravation of oral health in SCD patients regarding both caries and periodontal diseases. Conclusion: A potential role of the increased central inflammatory response, reflected by the elevated ferritin level in serum, is suggested for the impaired periodontal health of SCD patients. Clinical significance: Compliance with precautionary dental checks and early management of dental complications is of great importance in order to improve oral health status and prevent general health complications in SCD patients.


R Tri Endra Untara, Widjijono , Widya Asmara, Diatri N Ratih

Proliferation of Fibroblast Cells in Periradicular Tissue Following Intentional Replantation of Vertical Root Fractures Using Two Materials

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:998 - 1002]

Keywords: Fibroblasts, Intentional replantation, Mineral trioxide aggregate, Self-adhesive resin cement, Vertical root fractures

   DOI: 10.5005/jp-journals-10024-3169  |  Open Access |  How to cite  | 


Aim: This study aimed to investigate the fibroblast cells proliferation in periradicular tissue using mineral trioxide aggregate (MTA) and self-adhesive resin cement as the adhesive material for vertical root fracture fragments following intentional replantation. Materials and methods: This study used 27 male New Zealand rabbits aged 8–12 weeks. The mandibular incisor of each rabbit was extracted, and to simulate vertical fracture, the incisor tooth was sectioned vertically from the cervical to the 2/3 apical. The samples were randomly divided into three groups of nine each. Group 1 (control group), no application of any material. Group 2, the fracture line was sealed using MTA. Group 3, with self-adhesive resin cement. All teeth in all groups were then inserted back (replanted) into the socket of the rabbits. Each group was further divided into three subgroups according to the duration of replantation, namely, group A: week 1, group B: week 2, and group C: week 3. Rabbits were sacrificed according to each duration of replantation for histological preparations. The number of fibroblast cells was evaluated by counting at the three viewpoints under the light-microscope (400× magnification) and Optilab camera; finally, the calculation results were averaged. Data were analyzed using a two-way ANOVA and post hoc LSD test, with a significance level of 95%. Results: Following MTA application in the third week produced the highest number of fibroblast cells (104 + 29.5) compared to other groups. Conversely, the lowest number of fibroblast cells occurred in the control group in the first week of observation (4.33 + 3.5). Conclusion: MTA produced the greatest fibroblast cell proliferation than self-adhesive resin cement, particularly in week 3 of vertical root fractures replantation. Clinical significance: As the adhesive material for vertical root fracture fragments, MTA generated greater fibroblast proliferation than self-adhesive resin cement. Therefore, it is recommended to use MTA to attach vertical root fracture fragments.


Pavithra K Ramanna, Deesha Kumari, Piyali Poddar, Maitri Shah, Arti Dixit

In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:1003 - 1007]

Keywords: Calcium hydroxide, Irrigation systems, Root canal, Scanning electron microscope

   DOI: 10.5005/jp-journals-10024-3142  |  Open Access |  How to cite  | 


Aim: The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals. Materials and methods: This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×. Results: An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant. Conclusion: Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system. Clinical significance: Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.


Samar Bou Assi, Antoine Hanna, Josephine Aybout, Anthony Macari

Orthodontic Treatment Effect on Inclination of Maxillary Incisors and Growth Axes in Adult Patients with Various Mandibular Divergent Patterns

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:1008 - 1013]

Keywords: Facial axis, Growth axis, Incisors, Mandibular divergence, Posttreatment

   DOI: 10.5005/jp-journals-10024-3191  |  Open Access |  How to cite  | 


Aim: To evaluate, in an adult population, the effect of orthodontic treatment on the inclination of maxillary incisors, facial, and growth axes in different mandibular divergence pattern. In addition, we aimed to determine if there is an association between the inclination of the maxillary incisors and facial and growth axes and if this association will change after orthodontic treatment. Materials and methods: Two-hundred and thirty-eight consecutive lateral cephalograms (119 at T1 and 119 at T2) of adult patients with an average age of 26.45 ± 9.11 years at T1 and 29.58 ± 9.36 at T2 were selected and digitized. Cephalometric maxillary incisors (I) inclination was measured to cranial base (SN), palatal plane (PP), nasion-A point (NA), nasion-basion (NBa), and true horizontal (H). Facial (FA) and growth (GA) axes’ inclinations were measured relative to NBa and H. The sample was stratified in three subgroups based on cephalometric mandibular divergence to anterior SN (MP/SN). A—Hypodivergent = MP/SN ≤27° (n = 28); B—Normodivergent = 27 < MP/SN < 37° (n = 49); C—Hyperdivergent = MP/SN ≥37° (n = 42). Associations were tested using Chi-square tests for categorical data. Paired sample t-tests and Pearson's correlation were computed for continuous data. Results: At T1, there was a tendency to have more proclined I in group A (I/SN = 105.59 ± 10.8°) and more retroclined in group C (I/SN = 99.06 ± 12.04°) with no statistical significance. However, at T2, maxillary incisors were statistically significant different between groups A and C (p = 0.002). Pre-treatment FA and GA were statistically significantly different among the three divergence groups (p <0.0001) with more increased angles in the group A (FA/Nba = 92.77 ± 5.07°) vs group C (FA/Nba = 86.28 ± 5.08°). This angle increases around 2° on average at posttreatment assessment (group A—p = 0.033; group B—p = 0.002). Correlations between I and facial/growth axes were not statistically significant at T1, whereas at T2 those correlations were higher and statistically significant between I/PP to FA/NBa (r = 0.408; p ≤0.0001). Conclusion: Correlations between the maxillary incisors’ inclination and the facial/growth axes were not statistically significant initially whereas after orthodontic treatment, those correlations were higher and statistically significant. Differences in FA existed between pre- and postorthodontic groups in all divergence groups. Clinical significance: Orthodontists should assess the inclination of the maxillary incisors, not only to the maxilla and anterior SN but also to FA and take it into consideration in their treatment objectives.


Surabhi Soumya, Gaurav Patri, Pratik Agrawal, Prasanti K Pradhan, Vijeta Patri

Radiological Appraisal of Biodentine and Pulpotec Individually or in Combination with Photo-activated Disinfection as Pulp-capping Cements in Mature Teeth

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:1014 - 1018]

Keywords: Biodentine, Direct pulp capping, Mature teeth, Pulpotec

   DOI: 10.5005/jp-journals-10024-3183  |  Open Access |  How to cite  | 


Aim and objective: The aim of the study was to evaluate and compare radiographically, Pulpotec cement and Biodentine as direct pulp-capping agents in mature teeth, individually and in combination with photo-activated disinfection (PAD). Material and methods: In the present study, 80 mature teeth with deep occlusal caries were selected for direct pulp-capping procedure and randomly assigned to one of the four groups [Pulpotec (I), Biodentine (II), Pulpotec + PAD (III), and Biodentine + PAD (IV)] allocating 20 teeth to each group. Direct pulp capping and cavity disinfection were performed based on the group allotted followed by permanent restoration with composite. The teeth were evaluated radiographically (densitometric analysis) at intervals of 3, 6, and 12 months. The radiographic gray values obtained at follow-up periods for each group were subjected to two-way analysis of variance (ANOVA) with repeated measures. Results: There was a significant improvement (p <0.0001) in the scores of all the groups at follow-ups as compared to the baseline. There was a significant difference between group I/group II with groups III and IV (p = 0.000) with group IV scoring highest at all follow-ups. However, the difference between groups I/II and groups III/IV was nonsignificant. Conclusion: Both, Biodentine and Pulpotec can be used for direct pulp capping of mature teeth. Furthermore, PAD prior to material application significantly improved the radiographical success of Biodentine and Pulpotec, with Biodentine showing better results than Pulpotec. Clinical significance: Biodentine and Pulpotec demonstrated comparable success as a pulp-capping agent and PAD application exhibited a synergistic effect when used in conjunction with these materials.


Soni Kumari, Nikita Raman, Sarika Sharma, Ashish K Srivastava, Gunja , Arunendra S Chauhan

Comparison between Different Shades of Monolithic Zirconia over Microhardness and Water Solubility and Sorption of Dual-cure Resin Cement

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:1019 - 1024]

Keywords: Dual-cure resin cement, Microhardness, Monolithic zirconia, Shade

   DOI: 10.5005/jp-journals-10024-3178  |  Open Access |  How to cite  | 


Aim and objective: To compare the different shades of monolithic zirconia over microhardness and water solubility and water sorption of dual-cure resin cement. Materials and methods: Eighty specimens were included in the study. They were categorized into four categories having 20 samples each. Category one: No ceramic disks were present in the control group; the cement was directly activated. Category two: Curing of the resin cement with one shade of monolithic zirconia topping. Category three: Curing of the resin cement with an overlaying layer A monolithic zirconia version with two shades. Category four: Curing of the resin cement with an overlaying layer A three-tone monolithic zirconia version. In each category, two subgroups were further created (n = 10). One subgroup consisted of conventional dual-cure resin-based cement, while the other subgroup consisted of self-adhesive dual-cure resin-based cement. Vickers microhardness, water solubility, and water sorption of resin cement sorption were precisely measured after 24 hours of storage in an incubator at 37°C. The statistical analysis was undertaken with the help of statistical tests like two-way analysis of variations (ANOVA), one-way ANOVA, independent t-tests, Tukey's test, and Tamhane's T2 test. The p ≤0.05 was considered statistically significant. Results: Microhardness was more excellent in conventional dual-cure resin-based cement in comparison with self-adhesive dual-cure cement. At the same time, the water solubility and water sorption were lower in conventional dual-cure resin-based cement than self-adhesive dual-cure resin cement. The effect of shade of monolithic variant of zirconia was significant over the microhardness of both dual-cure resin-based cement; however, the impact was nonsignificant over the water solubility and water sorption of the resin-based resin cement. Further, it was also observed that the use of a monolithic variant of zirconia led to a decrease in microhardness of both dual resin-based cement in comparison to the condition when no ceramics were used. Conclusion: The effect of shade of monolithic variant of zirconia was statistically significant over the microhardness of both dual-cure resin-based cement; however, the result was not significant over the water solubility and water sorption of the resin-based cement. The use of a monolithic variant of zirconia led to a decrease in the microhardness of both dual resin-based cement compared to the condition when no ceramics were used. Clinical significance: The quantity of polymerization in resin-based cement affects their clinical effectiveness for a more extended period. It is believed that the measurement of microhardness is a reliable and straightforward process for evaluating the amount of polymerization of resin-based cement. Very few studies have been conducted in the past to compare the shades of monolithic zirconia over the microhardness, water solubility, and water sorption of the dual-cure resin-based cement.


Varun Raj, Vinaya Bhat, Nivya John, Athma Shetty, Suja Joseph, Rene Kuriakose, Shifas Hameed

Assessment of Flexural Strength and Cytotoxicity of Heat Cure Denture Base Resin Modified with Titanium Dioxide Nanoparticles: An In Vitro Study

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:1025 - 1029]

Keywords: Biocompatibility, Cytotoxicity, Denture base resin, Flexural strength, Polymethyl methacrylate, Titanium dioxide

   DOI: 10.5005/jp-journals-10024-3157  |  Open Access |  How to cite  | 


Aims: To assess the effect of titanium dioxide nanoparticles (NPs) on flexural strength and cytotoxicity of heat-cured polymethyl methacrylate (PMMA) resins. Methodology: Sixty-four rectangular and 12 circular specimens were fabricated from metal dies to test flexural strength and cytotoxicity, respectively. The rectangular specimens were grouped into four (16 specimens each)—control group (Group 1), Group 2 with 3% TiO2, Group 3 with 5% TiO2, and Group 4 with 7% TiO2. They were tested for flexural strength using universal testing machine. The circular specimens were grouped into two (six specimens each)—control group and the test group which included the group which showed a highest flexural strength. They were tested for cytotoxicity using MTT assay. The analysis of variance (ANOVA) test was used to analyze the mean flexural strength of each group and Tukey's post hoc test, for pairwise group comparison (p <0.05). An independent sample t-test was used to analyze the cytotoxicity between the groups (p <0.05). Result: The study showed that there was a significant decrease in the flexural strength from the control group (mean: 298.95), which reduced as the concentration of TiO2 increased. However, the toxicity reduced considerably from 24 hours to 7 days in both groups while the test group showed better cell viability (%) than the control group. Conclusion: The flexural strength of heat cure acrylic resin (modified and unmodified) was much higher than the recommended flexural strength for these resins. On adding TiO2 NPs, flexural strength decreased when compared to the control group. However, with 3% TiO2 NPs, there was no significant decrease in flexural strength as compared to conventional resins. TiO2 NP-modified heat cure acrylic resin showed less toxicity on day 1 and even lesser toxicity after 7 days indicating that it is biocompatible. Clinical significance: TiO2 NPs incorporated at 3% concentration in denture base resin had less cytotoxicity and adequate flexural strength, to be used as a promising alternative to conventional denture base resin.


Sabari Murugesan, Prasanna Kumar, Bharath Naga Reddy, Karthikeyan Arumugam, Purushotham Mohankumar, Karthik Chandrasekaran

Novel Management of Hypersensitive Dentin Using Propolis-based Herbal Desensitizing Agents: An In Vitro Scanning Electron Microscopic Study

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:1030 - 1034]

Keywords: Casein phosphate, Dental varnish, Dentinal tubules, Propolis, Scanning electron microscope, Tricalcium phosphate

   DOI: 10.5005/jp-journals-10024-3154  |  Open Access |  How to cite  | 


Aim: The objective of this in vitro study was to assess the efficacy of novel propolis-based varnish against the two conventional varnishes on quantitative and qualitative assessments of occlusion of dentin tubules and resistance to erosive and abrasive wears employing scanning electron microscope (SEM). Methods: Thirty human premolars free from caries extracted due to orthodontic reasons were included in the study. Experimental group was done based on treatment received and divided into three groups. Group A: ClinProXT Varnish (n = 10), Group B: MI Varnish (n = 10), and Group C: Propolis Varnish (n = 10) were applied. Teeth were cleaned and decoronation of crown was done with dentin disks. Dentin specimens of dimension 4 × 4 × 2 mm were prepared and subjected to finishing and polishing. The sample specimens were submersed in EDTA solution for a period of five minutes to open up the dentinal tubules. This was followed by treatment with varnishes and subjection to acidic-abrasive challenge. The specimens were analyzed with an image analyzer connected to SEM for the verification of the number of opened dentin tubules. The parameter assessed in SEM includes size, topography and surface characteristics of dentinal tubule were assessed. The obliteration potential of dentinal tubules was assessed with SEM images. Additionally, the dentin surface loss and resistance to acidic and abrasive wear were also evaluated with SEM. Data were analyzed with two-way analysis of variance (ANOVA) with post hoc Tukey's test. Results: MI Varnish caused higher obliteration of dentin tubules followed by ClinproXT Varnish. Propolis Varnish showed the least obliteration of dentinal tubules among tested experimental groups. After acidic-abrasive challenge, Propolis Varnish was found to be more efficient with less material loss among the experimental groups tested. There was an insignificant difference among the MI Varnish and ClinProXT Varnish groups. Conclusion: Simulation of hypersensitive lesions mimicking the clinical scenario was a challenging task in this in vitro study. All varnishes tested in the study had good efficacy in the management of dentin hypersensitivity (DH). Propolis-based varnish had good resistance to material loss after subjection to acidic-abrasive challenge among the tested materials. The casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP)-based MI Varnish had good efficacy to obliterate the dentinal tubules among the tested materials. It was prudent to select the varnishes with good long-term efficacy to survive in the clinical scenario which still remains a challenging task for the clinicians. Clinical significance: The stability of the varnish plays a vital role in maintenance of its long-term efficacy. The chemical nature along with the ability of the material to interact with the substrate plays a major role in management of DH.


Kamyar Fathpour, Amirhosein Bazazzade, Hesam Mirmohammadi

A Comparative Study of Cervical Composite Restorations Microleakage Using Dental Universal Bonding and Two-step Self-etch Adhesive

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:1035 - 1040]

Keywords: Microleakage, Selective enamel etch, Self-etch bonding, Universal bonding

   DOI: 10.5005/jp-journals-10024-3171  |  Open Access |  How to cite  | 


Aim: The aim of this study is to compare microleakage of cervical restorations using universal bonding and two-step self-etch adhesive with or without enamel etching through a dye penetration testing method. Materials and methods: In this in vitro experimental study, 70 maxillary premolar teeth with no anomaly or decay were randomly divided into five groups of 14. Conventional cervical cavities were prepared with diamond bur on the facial surface of the teeth. The teeth were prepared using G-Premio Bond/self-etch technique, G-Premio Bond/total-etch technique, G-Premio Bond/selective-etch technique, Clearfil SE Bond/self-etch technique, and Clearfil SE Bond/selective-etch technique in Groups I to V, respectively, and restored with composite. Microleakage at the occlusal enamel margin and the cervical dentinal margin was ranked from 0 to 4 based on dye penetration using stereomicroscope (×32). Statistical analysis was carried out using Kruskal-Wallis and Mann-Whitney tests at a significance level of α = 0.05. Results: The mean occlusal microleakage in the five study groups was 1.07, 0.57, 0.57, 1.28, and 0.78, respectively. The mean cervical microleakage was 0.97, 0.85, 0.64, 1.35, and 1.14, respectively. Kruskal-Wallis test showed significant difference between the microleakage scores of different groups in enamel (p = 0.022) and dentin (p = 0.01). Clearfil SE Bond/self-etch technique group showed the highest mean score of microleakage in enamel margins, and G-Premio Bond/total-etch technique and G-Premio Bond/selective-etch technique groups showed lowest enamel microleakage mean. Clearfil SE Bond/self-etch group showed the highest mean score of microleakage in dentin margins, while G-Premio Bond/selective-etch technique group showed the lowest mean score of dentin microleakage. Conclusion: Selective etching of enamel will decrease enamel microleakage. G-Premio Bond shows better microleakage results in comparison to Clearfil SE Bond in dentinal margins. Clinical significance: A major problem in cervical composite restorations is the presence of microleakage in the cervical wall. Different adhesive systems have been designed to overcome this problem.


Alejandro Gago-García, Cayetana Barrilero-Martín, Pantelis Petrakakis, Joaquín de Elio-Oliveros, Mariano del Canto-Pingarrón, Miguel Ángel Alobera-Gracia, Jesús Seco-Calvo

Implant-prosthetic Rehabilitation with and without Platform Switching: A Retrospective Clinical Cohort Study

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:7] [Pages No:1041 - 1047]

Keywords: Crestal bone loss, Dental abutments, Implants, Insertion torque, Patient satisfaction, Platform switching, Screw loosening

   DOI: 10.5005/jp-journals-10024-3181  |  Open Access |  How to cite  | 


Aim: The study aimed to retrospectively compare peri-implant bone loss, prosthetic complications, and patient-reported outcome measures (PROMs) after implant-prosthetic treatment on abutments with platform switch or platform match. Materials and methods: Records of patients, who received implant-prosthetic treatment on abutments with/without platform switch in a single dental clinic between November 2015 and November 2018, were retrospectively analyzed. Analysis was restricted to the following patient selection criteria: no need for any bone grafting procedures before/during implant placement, and no serious systemic disease. Implants were conventionally loaded with screwed prosthetic restorations after a healing period of 3 months. Crestal bone loss was measured by digital radiography at implant placement and after at least 2 years under functional implant loading conditions. Patient satisfaction was recorded with the visual analogue scale (VAS) at the time of the follow-up examination. Results: Clinical records of 59 patients were available for analysis. Patients of the study cohort received in total 128 implants with different lengths and diameters according to the manufacturer's specifications. Prosthetic restorations were fixed either on abutments with platform switch (BEGO PS-UNI: n = 74; 57.8%) or platform match (BEGO SUB-TEC Universal: n = 54; 42.2%). No implant was lost and no failure of prosthetic restoration was recorded during follow-up, except for prosthetic screw loosening in 32 implants (25.0%). Abutment type and location (maxilla vs mandible) had a significant impact on peri-implant bone loss (OR = 3.4; 2.8). A significant reduced rate of bone loss was observed at implant sites, provided with abutments according to the platform switch concept (35.1 vs 64.8%). No significant correlation was recorded between less bone loss and a higher patient satisfaction, while loosening of the prosthetic screw was significantly associated with lower satisfaction scores. Conclusion: BEGO PS-UNI abutments with a platform switch design revealed significant less crestal bone loss after a mean observation period of 20.8 months. Clinical significance: Abutments with a platform switch design may lead to less peri-implant bone loss. In order to maintain a higher patient satisfaction, clinicians should focus on the quality of the implant-prosthetic connection in screwed restorations.


Balaguhan Balasubramanian, Neelakandan Ravanasamudram Sundaram, Srinivasan Boovaraghavan, Raja Sekar Gali, Sudhakar Venkatachalapathy, Kirthika Natarajan

Management of Class II Hyperdivergent Mandible by Surgically Altering Occlusal Plane Pattern through Counterclockwise Rotation of Mandible

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:7] [Pages No:1048 - 1054]

Keywords: BSSO, Class II hyperdivergent mandible, Counterclockwise rotation of mandible, Occlusal plane alteration

   DOI: 10.5005/jp-journals-10024-3146  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the facial esthetic of class II hyperdivergent mandible by altering the high mandibular plane angle into an orthognathic mandibular plane angle by counterclockwise (CCW) rotation of the mandible. Materials and methods: Five patients with class II hyperdivergent mandible were selected for this study. Initially, preorthodontics was done by aligning the teeth. Then, surgically, bilateral sagittal split osteotomy (BSSO) advancement with CCW rotation of mandible with a posterior open bite of 4 mm was done. Eleven linear and 11 angular measurements were taken. Pre- and postsurgical values were evaluated by composite cephalometric analysis, and the changes in the occlusal plane and facial height were statistically analyzed by using paired t-test. Jarabak ratio was calculated for facial height measurements. Further finishing will be done by postsurgical orthodontic procedures to get functional occlusion. Results: Change in occlusion to class I is seen in values of Jarabak ratio and Go-Gn. Jarabak ratio shows an increase in posterior and decreases in anterior facial height. Go-Gn, which implies the CCW movement of the mandible, has reduced the anterior open bite and created a posterior open bite of 4 mm for the supraeruption of teeth. Conclusion: BSSO with CCW rotation of mandible with a posterior open bite has conservatively involved in single-jaw surgery, thereby improving the facial esthetics of all the patients taken this study. Clinical significance: This innovative method of CCW rotation of mandible with open bite mainly prevents the bi-jaw surgery, improves the stability, and gives an esthetically good appearance.


Neveen A Shaheen, Nahla G Elhelbawy, Dalia A Sherif

Efficiency of Supplementary Contemporary Single-file Systems in Removing Filling Remnants from Oval-shaped Canals: An In Vitro Study

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:5] [Pages No:1055 - 1059]

Keywords: Filling remnants, Oval-shaped canal, TruNatomy, WaveOne Gold, XP-endo Finisher R

   DOI: 10.5005/jp-journals-10024-3198  |  Open Access |  How to cite  | 


Aim: This study investigated the performance of supplementary three single-file systems for eliminating root filling residue from oval-shaped canals utilizing cone-beam computed tomography (CBCT). Materials and methods: Thirty single-rooted human mandibular premolars with oval-shaped canals were chosen. After decoronation and working length determination, ProTaper Universal (PTUR) rotary files were used to prepare canals up to F3. Irrigation was fulfilled by 2.5% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and lastly distilled water. By utilizing the lateral compaction technique, canals were filled by gutta-percha and Endosequence BC Sealer. The PTUR retreatment system (D1, D2, and D3) eliminated the primary filling material sequentially. Subsequently, specimens were categorized into three groups at random: group I: WaveOne Gold (WOG) primary file, group II: TruNatomy (TRN) medium file, and group III: XP-endo Finisher R (XPF-R). The volume of residual left from filling material was quantified utilizing CBCT imaging before and after the supplementary retreatment. Statistical analyses were done by one-way analysis of variance (ANOVA) and Tukey's test at a 5% significance level. Results: The volume of removed root filling after using XPF-R was significantly higher than using WOG in all sections and TRN in the coronal third, while nonsignificantly higher than using TRN in the apical and middle. Conclusion: XPF-R as a supplementary technique revealed the highest percentage reduction of root filling material (73.13%) in comparison with the other systems (37.39% WOG and 44.16% TRN) in oval-shaped canals. Clinical significance: Neither one of the methods and tools used to remove filling material from oval-shaped root canals is perfectly efficient. The performance of supplementary techniques using contemporary single-file systems improves the cleaning and reshaping of root canal space that permits a proper disinfection to optimize the outcome of retreatment option.


Omar A Bawazir

Delayed Eruption of Permanent Lower Lateral Incisor in Relation to Compound Odontoma: A Case Report

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:3] [Pages No:1060 - 1062]

Keywords: Compound odontoma, Delayed eruption, Odontogenic tumor

   DOI: 10.5005/jp-journals-10024-3155  |  Open Access |  How to cite  | 


Aim: To report a delayed tooth eruption following late surgical removal of a compound odontoma in a 10-year-old child. Background: Odontomas are the most common odontogenic tumors. They are usually asymptomatic and discovered during routine radiographic examinations or during an assessment of delayed tooth eruption. Odontomas are classified into compound or complex based on the microscopic structure of dental tissues. Early diagnosis and surgical removal of odontomas is the keyword for favorable results. Case description: This paper describes a case of compound odontomas in a 10-year-old boy that prevented eruption of the permanent mandibular lateral incisor. Extraction of mandibular primary lateral incisors and surgical excision of the compound odontomas was performed. After 3 years of follow-up, at the age of 13 years, the permanent lateral incisor erupted and approached the occlusal plane. Conclusion: Late surgical removal of odontomas resulted in a delayed eruption of the affected teeth. Clinical significance: Surgical removal of odontomas and regular follow-up to monitor the eruption of the affected teeth should be considered for the teeth with an open apex before considering orthodontic traction.


Noura A Alsufyani, Adhwa A Altowaijri, Bashayer M Alshehri, Maha S Alsadhan

Systematic Review of Clinical and Radiographic Signs of Pediatric Pleomorphic Adenoma of Minor Salivary Glands

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:6] [Pages No:1063 - 1068]

Keywords: CT, Pediatric, Pleomorphic adenoma, Salivary gland, Systematic review

   DOI: 10.5005/jp-journals-10024-3168  |  Open Access |  How to cite  | 


Aim and objective: To examine the clinical signs, radiographical features, and demographics of pediatric pleomorphic adenoma (PA) in the minor salivary glands. Materials and methods: Several databases were searched for relevant studies. The included studies were assessed for methodological quality. Demographic, clinical, and radiographic data were collected. Results: Sixteen of 3,121 articles met the inclusion criteria (17 lesions). The mean age was 9.7 ± 3.9 years and majority were females n = 10 (59%). It is commonly presented as asymptomatic swelling n = 16 (94.1%), in the hard palate 13 (76.5%). Radiographically, most were well-defined n = 15 (93.7%) and 8 (47%) caused erosion or displacement of surrounding tissues. Conclusion: The small size and asymptomatic nature of pediatric PA can render these lesions undiagnosed. On rare occurrences, PA can show calcifications, MRI, or CT enhancement. MRI is the best imaging modality to depict soft tissue content but not subtle erosion of adjacent bony structures. Clinical significance: The dentist can be the first to detect PA in the mouth of a child. Augmenting clinical examination with radiographic examination is paramount to ensure adequate diagnosis of PA, examine effects on surrounding bone, and maintain close follow-up as watchful waiting is not safe in this population.


Bertrand Baumann, Pierre Saez, Rémi Curien, Marc Engels-Deutsch

Surgical Treatment of Voluminous Jaw Cysts with a Buccal Plate: A Study of 20 Clinical Cases

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:7] [Pages No:1069 - 1075]

Keywords: Bone flap, Cystectomy, Odontogenic cysts, Oral surgery

   DOI: 10.5005/jp-journals-10024-3184  |  Open Access |  How to cite  | 


Aim and objective: The aim of this paper is to present, with a series of clinical cases, some advantages of a modified surgical technique using fixed bone flaps in an approach to voluminous maxillary or mandibular odontogenic cysts (excluding keratocysts) and highlight the positive impact on the healing of mucus and bone tissues. Background: The surgical approach of the enucleation of voluminous maxillary cysts is generally realized with a subtractive osteoplasty. The major problem with this kind of procedure is frequent fibrous healing (or scar formation) of the cavity due to mucosal invagination, especially for large lesions more than 2 cm in diameter. Several techniques have been proposed to limit these side effects. Very contrasting results have been observed in the techniques with graft or exogenous materials, and the scarring effects on mucus and bone tissues are poorly described. In situations where a vestibular cortical bone remains, our modification of the former technique is the use of this bone like a repositioned flap. Technique: The present study is a cases series and was carried out on 20 adult patients with maxillary or mandibular cystic lesions larger than 25 mm. For all the patients, our modified technique consisted of using a bone flap to expose more widely the site and to carry out the enucleation of the cyst. Repositioning the flap in the final stage of the operation with osteosynthesis material allowed controlled mucosal and bone healing confirmed by clinical and radiographic follow-up. Conclusion: In all cases of our study, no invagination of the soft tissues in the cystic cavity was observed and postoperative bone volumes were identical to the initial state. Only minor postoperative complications were observed in three cases. Clinical significance: A bone flap approach seems to allow a tissue interception, thus better control of mucosal and bone healing, which is borne out by the clinical and radiographic controls 24 months after surgery.


Alka Banker, Varshin Vala, Bhagyashree B Desai

A Novel Technique for Accuracy in Horizontal, Vertical, and Axial Bracket Placement in Orthodontic Bonding

[Year:2021] [Month:September] [Volume:22] [Number:9] [Pages:3] [Pages No:1076 - 1078]

Keywords: Accuracy, AutoCAD software, Direct bonding, Fixed orthodontic treatment, Orthodontic brackets, Precision, Tooth shape, Tooth stickers

   DOI: 10.5005/jp-journals-10024-3190  |  Open Access |  How to cite  | 


Aim: The aim of the study was to develop a method which can help us achieve precise and accurate direct bonding (DB). Background: Proper and accurate bracket position during orthodontic bonding is one of the main concerns for the clinician. Proper bonding reduces the effort to achieve good finishing by minimizing the wire bending. Unwanted tooth movements like unplanned tip, torque, and rotation are minimized, so the treatment time is shortened. Commonly used techniques for bonding brackets to teeth are DB and indirect bonding (IDB). Technique: A new technique involving the innovative use of tooth-shaped stickers was suggested to combine the advantages of both the methods. Conclusion: There was an accuracy in horizontal, vertical, and axial positioning of the brackets using this method. Clinical significance: We found this as an effective method to achieve ideal bracket position by eliminating subjective bias and standardizing the bonding procedure, thus achieving better results in a shorter time by eliminating bonding errors.

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