The Journal of Contemporary Dental Practice

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2022 | February | Volume 23 | Issue 2

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Kiranam Chatti

Severe Acute Respiratory Syndrome Coronavirus 2 Nosode: A Potential Alternative Vaccine Platform

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:2] [Pages No:133 - 134]

Keywords: COVID-19, Nosode, SARS-CoV-2, Variolation

   DOI: 10.5005/jp-journals-10024-3272  |  Open Access |  How to cite  | 


Besides conventional vaccinations, viable alternatives are needed to elicit an immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We propose and highlight the value of a homeopathic approach known as the “nosode” for the prevention of coronavirus disease-2019 (COVID-19). Nosode is an extract prepared from disease-affected tissues which is subsequently processed and administered as an antidote for the same medical condition. This concept might be a crucial therapeutic approach for viral infections since infected tissues contain a wide range of important viral antigens that could induce a functional host response via immunological sensitization. Thereby, nosode preparation produced from SARS-CoV-2-affected tissues may provide protection against COVID-19. “SARS-CoV-2 nosode” warrants more scientific investigation as a viable alternative vaccination platform.



Tai T Tran, Tuyen D Hoang, Minh V Hoang, Nhu TQ Tran, Ngan GK Nguyen, Phuong M Hoang, Thang V Vo

Community-based Interventions to Prevent Dental Caries among Kindergarten Children in Vietnam: A 12-month Study of Field Trial

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:8] [Pages No:135 - 142]

Keywords: Comprehensive intervention, Early dental caries, Kindergarteners

   DOI: 10.5005/jp-journals-10024-3298  |  Open Access |  How to cite  | 


Aim: To investigate the status of dental caries and assess the effectiveness of dental caries prevention interventions in children from 3 to 5-year-old in Hue City, Vietnam. Materials and methods: The subjects were 464 children and their direct caregivers at some kindergartens in Hue City from June 2020 to October 2021. The study included two consecutive phases: the first one was a cross-sectional study to identify the rate of dental caries and related factors in the studied kindergartens, and phase 2 was a controlled comparative interventional study for a period of 12 months. Results: The mean of decayed, missing, filled, and DMFT index was 8.25, 0.09, 0.48, and 8.82, respectively, with no statistically significant difference in these figures between the living areas. The multivariable logistic regression model revealed some factors related to dental caries, including age, frequency of toothbrushing per day, parent-assisted toothbrushing, and eating and drinking sweets. Results showed the effectiveness of a community-based intervention for preventing dental caries, gingivitis, and plaque in the intervention group, compared to the control group. Conclusion: The rate of dental caries among Vietnamese children was remarkably high. A comprehensive intervention to prevent early childhood dental caries was effective and might be considered a necessary program in healthcare prophylaxis. Clinical significance: This intervention was consistent with the guidelines of WHO and based on evidences of related factors of dental caries identified in a previous cross-sectional study.



Raphael Lichaa, George Deeb, Rami Mhanna, Carla Zogheib

Comparison of Fracture Resistance between Single-cone and Warm Vertical Compaction Technique Using Bio-C Sealer® in Mandibular Incisors: An In Vitro Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:6] [Pages No:143 - 148]

Keywords: Compressive strength, Fracture resistance, Mandibular incisors, Single-cone technique, Warm vertical condensation

   DOI: 10.5005/jp-journals-10024-3311  |  Open Access |  How to cite  | 


Aim: The aim of the study was to compare the fracture resistance of the single-cone technique with the warm vertical compaction technique (WVCT) in mandibular incisors using Bio-C sealer®, by applying a compressive force using a universal testing machine (UTM) (Instron 5943; Instron, Norwood, Massachusetts, USA). Materials and methods: Twenty-two mandibular incisors were selected and divided into two groups after applying the same shaping protocol. To assess the influence of the wave vertical compaction technique on the fracture resistance, the first group was obturated by a single-cone obturation technique (SCOT) (n = 12), and the second group was obturated with a WVCT (n = 10). Bio-C sealer® (Angelus, Hague Netherlands) was used in the two obturation techniques. Wax-coated roots were put in an acrylic mold and loaded to compressive strength fracture in a mechanical material testing machine (UTM) (Instron 5943; Instron, Norwood, Massachusetts, USA), with Bluehill 3 software (version 3.15.1343) recording the maximum load at fracture. Fracture loads were compared statistically, and data were examined with the Mann–Whitney U test with a level of significance set at p ≤0.05. Results: No statistically significant difference was registered between the SCOT (264.97 ± 83.975 N) and WVCT (313.35 ± 89.149 N) concerning the endodontically treated mandibular incisors’ fracture resistance (p = 0.159). Conclusion: Warm vertical compaction technique (WVCT) did not affect the fracture resistance of endodontically treated mandibular incisors when compared to SCOT canal preparation. Clinical significance: General practitioners and endodontists face challenges during root canal treatment such as cracks and root fractures. This article aims to guide experts in choosing between the single-cone and the continuous WVCT aiming for higher long-term quality of root canal filling.



Janet Gutierrez

Comparison of the Microhardness of Surface Enamel Exposed to Anti-asthmatic Inhalants

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:5] [Pages No:149 - 153]

Keywords: Enamel surface, Inhalers, Microhardness

   DOI: 10.5005/jp-journals-10024-3295  |  Open Access |  How to cite  | 


Objective: To determine the effect of anti-asthmatic inhalers salbutamol and budesonide on the surface microhardness of bovine tooth enamel. Materials and methods: The study was experimental, prospective, longitudinal, and comparative. The sample consisted of permanent mandibular incisors, which were prepared in (n = 90) blocks of dental enamel of size 3 × 3 mm and 2 mm thick, separated into 6 groups of 15 specimens each in sterile bottles properly labeled and contained in artificial saliva at 37°C. Three measurements (baseline, 5 days, and 10 days) were performed after immersion to determine the microhardness using a Vickers microdurometer programmed to apply a load of 100 gm for 15 seconds. Results: It was observed that the enamel surface microhardness decreased after 5 and 10 days, after being in contact with the anti-asthmatic inhalers based on salbutamol and budesonide. In addition, it was evidenced that there is a greater decrease in the superficial microhardness of the enamel when comparing the values at the beginning and after 10 days; likewise, the reduction in the microhardness of enamel exposed to budesonide was greater (120.8 kg/mm2) compared to salbutamol (112.3 kg/mm2) (p <0.001). Conclusion: The two anti-asthmatic inhalers studied decreased superficial enamel microhardness, with the budesonide-based inhaler having a greater erosive effect. Clinical significance: This research allowed us to know the values of the microhardness of the superficial enamel after being exposed to different anti-asthmatic inhalers that are indicated in daily clinical practice. Therefore, it is important to evaluate this microhardness since the use of different inhalers is very prevalent.



Nasser M Al Ahmari

Influence of Arabic Qahwa Beverage on Optical and Mechanical Properties of Lithium Disilicate Glass Ceramics and Zirconia Restorative Materials

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:8] [Pages No:154 - 161]

Keywords: Arabic Qahwa, Biaxial fracture, Color changes, Color measurements, Lithium disilicate, Translucency parameter, Zirconia

   DOI: 10.5005/jp-journals-10024-3244  |  Open Access |  How to cite  | 


Aims: The study aims to assess the effect of Arabic Qahwa (AQ) on the color parameters of lithium disilicate glass ceramic (LDGC), IPS e.max computer-aided design (CAD), and multilayered zirconia CAD/computer-aided manufacturing (CAM) ceramic materials after immersion in AQ and also, to measure the biaxial fracture strength and fracture modes of the tested materials. Materials and methods: Sixty circular specimens were milled from LDGC and zirconia. Before AQ immersion, the color parameters of the specimens L, a, and b were measured and recorded using a spectrophotometer on white, black, and gray background and analyzed after AQ staining and aging for 14 days. Biaxial compressive forces and fracture types were recorded. The collected data were analyzed with SPSS for descriptive statistics, one-way analysis of variance, and post hoc tests. Results: The overall TP values were 16.79 and 15.85 for LDGC and zirconia, respectively. The recorded ΔE* values were 2.63 and 2.99 for LDGC and zirconia, which have no remarkable difference. The TP values after AQ staining were slightly lesser. Subgroup analysis revealed considerable differences in TP values among zirconia specimens under both backgrounds, whereas substantial differences in ΔE* values were observed between LDGC and zirconia under white background only. Lithium disilicate glass ceramic (LDGC) had higher biaxial fracture forces than zirconia. Reparable, semi-reparable, and non-reparable fractures comprised 60, 30, and 10% of the overall fracture modes, respectively, with significant differences between and within groups (p = 0.034). Conclusion: AQ staining had a marked effect on the TP and ΔE* values of the tested CAD/CAM materials, but the values were within clinically acceptable levels. The optical properties were dependent on the material. Lithium disilicate glass ceramic (LDGC) had higher biaxial fracture forces than zirconia. Reparable fracture was the dominant type among the examined materials. Clinical significance: Glazed surface for any CAD/CAM ceramic prostheses is highly recommended. Both tested materials are strongly recommended to be used for AQ consumers.



Siddhant Aloorker, Manoj Shetty, Chethan Hegde

Effect of Osseodensification on Bone Density and Crestal Bone Levels: A Split-mouth Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:7] [Pages No:162 - 168]

Keywords: Bone density, Dental implant, Osseointegration

   DOI: 10.5005/jp-journals-10024-3303  |  Open Access |  How to cite  | 


Background: Dental implants have become a popular alternative in the oral and maxillofacial rehabilitation after the introduction of the concept of osseointegration. A poor density bone can negatively influence the bone to implant contact (BIC) and delay osseointegration. Various osteotomy techniques and drilling procedures have been used to increase stability in low-density bone. But they have been associated with limitations such as trauma to the surrounding bone and difficulty in controlling the technique. Osseodensification has recently been developed. Densifying burs are specifically designed burs which help in preserving the bone by condensing the bone by rotating in the noncutting direction. Materials and methods: Split-mouth study was conducted on a total of 10 patients wherein implants were placed in the same patient bilaterally in maxillary posterior region where the left maxillary posterior region received implants through sequential osteotomy technique and the right maxillary posterior region received implants through a series of new multifluted tapered burs (Densah™). A cone-beam computed tomography (CBCT) was taken preoperatively, immediately after implant placement, and 3 and 6 months after implant placement. The bone density and crestal bone levels were measured. Results were analyzed by student's paired “t” test and Man-Whitney U test. Results: There is no statistical difference between the levels of the crestal bone between an osseodensified site as compared to a conventional osteotomy site. The width of the residual bone increases after osseodensification and remains in the increased dimension for 3 months and continues at 6 months. Thus, it can be concluded that osseodensification leads to bone expansion. Conclusion: The radiographic bone density adjacent to the implant is significantly increased after ossedensification and the bone there remains relatively dense over a period of 6 months aiding in a primary stability and eventual good osseointegration.



Rawda H ElAziz, Lamia K Gadallah, Reham S Saleh

Evaluation of Charcoal and Sea Salt–Lemon-based Whitening Toothpastes on Color Change and Surface Roughness of Stained Teeth

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:7] [Pages No:169 - 175]

Keywords: Charcoal-based whitening toothpaste, Color change, Natural whitening toothpastes, Sea salt–lemon whitening toothpaste, Surface roughness

   DOI: 10.5005/jp-journals-10024-3300  |  Open Access |  How to cite  | 


Aim: To compare the efficacy of two naturally based commercially available whitening toothpastes charcoal and sea salt–lemon on stain removal of teeth in terms of color change and surface roughness. Materials and methods: Twenty-seven intact bovine incisors were selected and randomly allocated into three main groups (n = 9) according to the tested toothpaste [I: Signal Complete 8 Charcoal; II: sea salt–lemon essence Closeup natural smile; and III: Signal Complete 8 Original (control)]. Following 4 successive days of staining protocol, each specimen in its corresponding group was brushed with the toothpaste using toothbrush simulator apparatus for three brushing cycles. Color assessment using Vita Easyshade spectrophotometer and surface roughness (Ra) measurement using contact type profilometer were performed for each specimen at baseline, after staining, and after each tooth brushing cycle. Results: Nonparametric color data and parametric surface roughness data were analyzed. The color difference (ΔE) from after-staining protocol to different tooth brushing cycles (1,2,3) showed no significant difference on each cycle between the tested groups (p >0.05). While for color difference (ΔE) from baseline to the last tooth brushing cycle 3, the difference between groups was statistically significant where group II, sea salt–lemon-based toothpaste, had a significantly lowest (ΔE00) value (p <0.001) indicating more whitening effect in relation to others. However, a significant increase in surface roughness was present in all tested groups (p <0.001); meanwhile, there was no significant difference between tested groups (p >0.05). Conclusion: After three tooth brushing cycles, none of the natural whitening toothpastes or conventional toothpastes produced had effective whitening results nor completely removed the stains back to the initial baseline tooth color. Sea salt–lemon-based whitening toothpaste had a whitening effect better than the charcoal-based toothpaste. All of the tested toothpastes increased the degree of surface roughness. Clinical relevance: Charcoal and sea salt–lemon-based whitening toothpastes do not guarantee to whiten nor completely remove the stains back to normal and their effects on enamel surface roughness should be highly clinically considered and managed.



Kamal Dhangar, Prashant Shetty, Saleem D Makandar, Pradeep A Bapna, Nik Rozainah Nik Abdul Ghani, Wan Zaripah Wan Bakar, Sandeep Metgud

Comparative Evaluation of the Percentage of Gutta-percha Filled Areas in Canals Obturated with Different Obturation Techniques

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:5] [Pages No:176 - 180]

Keywords: Guttacore, Lateral condensation, Single cone

   DOI: 10.5005/jp-journals-10024-3306  |  Open Access |  How to cite  | 


Aim: To evaluate the percentage of gutta-percha filled areas (PGFA) in canals obturated with guttacore system, single cone, and lateral compaction techniques. Materials and methods: A total of 60 single-rooted mandibular premolars were selected and randomly divided into three equal groups depending on the type of obturation technique used. After the obturation, the samples were marked at 2, 4, 6, and 8 mm distance from the apex and sectioned horizontally, and viewed under a stereomicroscope at 25×. The area of the canal and of the filling material was recorded, and the percentage of filling material on the canal wall was calculated. Results: Guttacore showed the highest percentage of root-filled areas followed by single cone and lateral compaction techniques at 2, 4, 6, and 8 mm from the apex. Conclusion: None of the filling techniques used in the study was completely able to fill the root canals with gutta-percha and sealer. The guttacore system had a maximum area of root canals filled as compared to the single cone and lateral compaction system. Clinical significance: Root canals are mostly oval, elongated, or irregularly shaped rather than being completely round. Hence, the obturation technique that fills the maximum area of the root canal must be selected according to the given clinical circumstances.



L Harsha

Comparative Assessment of pH and Degree of Surface Roughness of Enamel When Etched with Five Commercially Available Etchants: An In Vitro Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:5] [Pages No:181 - 185]

Keywords: Acid etching, Orthophosphoric acid, Surface roughness

   DOI: 10.5005/jp-journals-10024-3252  |  Open Access |  How to cite  | 


Aim: To evaluate the pH and degree of surface roughness caused by five commercially and readily available etchants on tooth enamel. Materials and methods: Five different etchants were chosen. An electric pH meter was utilized to test the pH of the etchants employed. Fifteen maxillary bicuspids that had been extracted were cleansed and stored in thymol solution. The samples were sorted into five groups of three each. A noncontact profilometer was employed to assess the microsurface changes of the pre-etched enamel. The teeth were then etched for 30 seconds with respect to the group to which they belonged before being cleaned and dried. The surface roughness after etching was analyzed, measured and values were tabulated. Descriptive statistics and paired t-test were done. Results: The pH of the etchants and surface roughness of the enamel are varied across the five groups, though they have the same composition of 37% orthophosphoric acid. Etchant from Group C was found to be most acidic while the one manufactured by Group E was least acidic. Ivoclar, DPI, and DTECH showed a statistically significant value in surface roughness parameter post-etching (p <0.05). A statistical difference that was significant was observed with the Kruskal–Wallis test for surface roughness parameter (p <0.05). Conclusion: All five etchants had varied pH and the amount of surface roughness was also varied though the composition was the same. Further elemental analysis of these etchants has to be done to validate the results obtained. Clinical significance: Etchants of the same composition should ideally produce the same effect on the tooth enamel surface, but etchants from different manufacturers produce different levels of surface roughness which could be due to differences in the composition of the prepared etchant. The study was conducted to assist in making an educated selection about the most cost-effective but efficient etchant for clinical application.



Sourav Boro Choudhary, Garima Asthana, Rupali Kalsi, Kumar Saurav, Shivesh Kumar Mishra, Shivjot Chhina, Hiba Peku, Zoya Ahmad

Comparative Evaluation of Ridge Width for Implant Placement Using Ridge Mapping on the Diagnostic Cast, Cone-beam Computed Tomography, and Direct Surgical Measurements

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:7] [Pages No:186 - 192]

Keywords: Alveolar ridge width, Cone-beam computed tomography, Dental implants, Ridge mapping

   DOI: 10.5005/jp-journals-10024-3294  |  Open Access |  How to cite  | 


Aim: This study was undertaken with an objective to find out the accuracy and reliability of presurgical ridge mapping (RM) on a diagnostic cast for linear measurements in the horizontal direction on cone-beam computed tomography (CBCT) and direct surgical assessment. Materials and methods: In total, 25 patients based on inclusion and exclusion criteria were selected. An acrylic stent with two points marked at 3 mm and 6 mm from the soft tissue summit of the alveolar ridge was fabricated. Linear measurements at these points were estimated with three techniques viz. RM on the diagnostic cast, CBCT, and direct surgical in situ measurements after flap reflection. Results: Considering direct in situ surgical measurements as the gold standard with an accuracy of 100%, the accuracy for CBCT and RM on the diagnostic cast was 95.5% and 87.4%, respectively, for the maxillary arch. Whereas the accuracy for CBCT and RM on the diagnostic cast was 88.6% and 92.2%, respectively, for mandibular arch. Conclusion: The three approaches discussed are reliable for the assessment of ridge dimensions in the horizontal direction. Ridge mapping on the diagnostic cast is a simple, precise, noninvasive technique without any radiographic exposure. Clinical significance: Ridge mapping on a diagnostic cast along with two-dimensional (2D) radiography can be used as a valuable chairside diagnostic tool in the treatment planning prior to dental implant placement in the cases of a regular alveolar ridge and even mucosal lining. This clinical technique provides zero radiation exposure and is also cost-effective.



Goyal Shrishtee Manoj, Narayan Kulkarni, Atri Naik, Binal Naik

Construction of an In Vivo Debonding Device and Comparison of Bracket Failure Rate and Debonding Force for Indirect Orthodontic Bonding

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:9] [Pages No:193 - 201]

Keywords: Adhesive remnant index, Bracket failure, Dual-cure adhesive resin, Indirect bonding, In vivo bond strength, In vivo debonding device

   DOI: 10.5005/jp-journals-10024-3310  |  Open Access |  How to cite  | 


Aim: A major limitation of indirect bonding is incomplete penetration of the curing light through transfer trays, leading to inadequate curing of light-cure adhesive resin, causing bracket bond failure. Dual-cure adhesive resin is both light and chemically cured, which reduces the requirement of light for curing of the composite. Comparative evaluation of bracket failure rate and bond strength between dual-cure composite and light-cure composite for indirect orthodontic bonding of brackets. Materials and methods: A split-mouth randomized clinical study was carried out in 51 patients (30 females and 21 males). Indirect orthodontic bonding using Erkogum as adhesive to attach the bracket to cast and glue gun material was utilized to form a transfer tray. Conventional light-cure and dual-cure adhesive resins were compared with regard to their bracket failure rate, adhesive remnant index score, and in vivo clinical bond strength. Results: Kolmogorov-Smirnov test was employed to test the normality of data. Mann–Whitney U test and Chi-square test were performed for the quantitative variables and it was observed that both the groups showed similar results for the parameters being measured. The mandibular arch showed more bracket failure, the dual-cure composite group showed more bracket failure, however, the adhesive remnant index (ARI) score for both the groups was similar. No statistically significant difference was seen concerning the clinical bond strength between the two adhesive resins. Conclusion: Dual-cure adhesive system can be used for indirect bonding in orthodontics. The mandibular arch had a higher bond failure in the second premolar region. The sequence of bond failure was concordant among both the adhesive groups. However, dual-cure adhesive invariably showed more bracket failure. The highest bond strength was observed for the maxillary canine brackets in the light-cure group, and mandibular canine brackets in the dual-cure group. Whereas, the weakest bond strength in the light-cure group was observed for the mandibular second premolar brackets and for maxillary second premolar brackets in the dual-cure group. There was no significant difference between the in vivo clinical bond strength between the two adhesive systems. On debonding, majority of the adhesive was observed to be on the tooth surface. Clinical significance: This study signifies that both light-cure and dual-cure resins can be used for indirect bonding procedures but light-cure composite resin shows a lower bracket failure rate as compared to dual-cure composite resin.



Ranganathan Ajay, Vikraman Rakshagan, Arul Queenalice, Sengottaiyan Vinothkumar, Chandramohan Ravivarman, Paulpandian Saravanadinesh

Effect of Triazine Comonomer Substitution on the Structure and Glass Transition Temperature of Monomethacrylate-based Resin Polymer: An In Vitro Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:6] [Pages No:202 - 207]

Keywords: Antimicrobial, Copolymer, Denture base, Glass transition temperature, Triazine

   DOI: 10.5005/jp-journals-10024-3260  |  Open Access |  How to cite  | 


Aim and objectives: The present research aimed to characterize and deduce the structure of a novel denture base copolymer containing antimicrobial triazine comonomer by nuclear magnetic resonance (NMR) and energy-dispersive X-ray (EDX) spectroscopies. Also, it aimed to evaluate the glass transition temperature (Tg) with the addition of TATA at different concentrations. Materials and methods: The trial groups G10 and G20 were thermo-polymerized with triazine comonomer, whereas the control group G0 was polymerized without the triazine. NMR and EDX spectroscopies assessed copolymerization along with deducing elemental composition in mass %. The surface topographies were observed through field-emission scanning electron microscopy (FESEM). The Tg of the resultant copolymer was examined by differential scanning calorimetry. Pertinent statistical tests with relevant multiple comparison tests were exercised to compare the mean Tg of the groups. Results: The configuration of a new copolymer containing triazine comonomer was manifested with additional protons and carbon atoms. Nitrogen was detected in the EDX spectroscopy of the trial groups. The Tg of the new copolymer was higher than the G0. The triazine comonomer in the copolymer at 20% concentration exhibited the highest Tg. Conclusion: The triazine comonomer substitution produced a novel denture base copolymer with enhanced Tg. Clinical significance: The novel denture base copolymer may possess enhanced biomechanical properties due to the TATA's cross-linking capability. Nevertheless, the antimicrobial property of the triazine comonomer incorporated in the denture base composition might be beneficial in inhibiting the microbial colonization on the denture's surface.



Ritesh Rambharos Kalaskar, Hemraj Badhe, Nupur Suresh Ninawe, Anuradha Vinayak Khade, Shruti Balasubramanian, Henpu Kamki

Comparative Evaluation of Ozonoid Olive Oil and Calcium Hydroxide as an Indirect Pulp Capping Agent in Primary Mandibular Second Molar: A Randomized Controlled Trial

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:7] [Pages No:208 - 214]

Keywords: Calcium hydroxide, Indirect pulp capping, Ozonoid olive oil, Primary molars, Split-mouth randomized controlled trial

   DOI: 10.5005/jp-journals-10024-3307  |  Open Access |  How to cite  | 


Aim: The aim of this study was to evaluate clinical and radiographical success of ozonoid olive oil as an indirect pulp capping (IPC) agent in primary mandibular second molar when compared to calcium hydroxide and to evaluate the antimicrobial efficacy of ozonoid olive oil on Streptococcus mutans and Lactobacilli. Materials and methods: A split-mouth randomized controlled trial was conducted on 30 primary mandibular second molars in 15 children of age 5–9 years with deep dentinal carious lesion. Teeth were randomly allocated to two groups of 15 each. After achieving local anesthesia and rubber dam isolation, an IPC procedure was performed using ozonoid olive oil in group I and calcium hydroxide in group II. Teeth were evaluated clinically and radiographically at 6 and 12 months of follow-up for success or failure of IPC. The bacterial counts of S. mutans and Lactobacilli were measured before and after application of ozonoid olive oil for 60 seconds on dentinal tissue in group I and recorded as colony-forming units per mL (CFU/mL). Results: There were no statistically significant differences found between the materials used for IPC (p >0.05). About 93.33% and 100% clinical and radiographical success rates were seen in group I and group II, respectively. Statistically significant differences were observed for bacterial reduction after the application of ozonoid olive oil (p <0.05) for both the microorganisms. Conclusion: The results of this study showed that the success of IPC is independent of capping material. Ozonoid olive oil, an antimicrobial agent, can also be used for IPC. The success of the IPC procedure depends on a reduction in the bacterial count and sealing of the tooth with hermetic restoration. More clinical studies with a larger sample size and longer follow-up duration are required for understanding the efficacy of this material. Clinical significance: Ozonoid olive oil can be used as an IPC agent in primary molars and also for a bacterial reduction in dentinal caries.



Mansi Nautiyal, KS Jyothi, Seshagiri Muttagi, NT Pallavi, Avita UH D Almeida, Chintan P Shah, Nishtha Singh

Effect of Hypochlorites on the Compressive Strength and Surface Hardness of Type V Dental Stone: An In Vitro Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:6] [Pages No:215 - 220]

Keywords: Compressive strength, Dental stone, Disinfection, Hypochlorite, Surface hardness

   DOI: 10.5005/jp-journals-10024-3248  |  Open Access |  How to cite  | 


Aim: The study aimed to evaluate the compressive strength and surface hardness of a type V dental stone after hypochlorite disinfection. Materials and methods: Two types of specimens were made according to the American Dental Association (ADA) specification no. 25 for each wet compressive strength, dry compressive strength, and surface hardness. The specimens were split into three groups with 30 samples each according to the type of disinfection. All specimens were immersed in their respective disinfecting solutions for 30 minutes at room temperature and after removal, they were left to dry for 24 hours at room temperature. Total five cycles of immersion and drying were followed. A compressive strength test was done using a universal testing machine. Wet compressive strength was tested one hour after the last cycle and dry compressive strength was tested 7 days after the last cycle. Surface hardness was measured after 48 hours using Vickers hardness test. The results were statistically analyzed. Results: There was a statistical difference between the calcium hypochlorite and sodium hypochlorite groups for both dry and wet compressive strength. The mean wet compressive strength of calcium hypochlorite was higher when compared to the sodium hypochlorite group and it was statistically significant (p = 0.042). The results were similar and statistically significant (p = 0.003) for dry compressive strength. When the mean surface hardness of the sodium hypochlorite (As) group was compared to calcium hypochlorite the results were highly significant (p = 0.0001) with the mean surface hardness of the calcium hypochlorite group more than the sodium hypochlorite group. Conclusion: Calcium hypochlorite used as a disinfectant showed better compressive strength and surface hardness when compared to sodium hypochlorite as a disinfectant. Clinical significance: Dental casts poured in the contaminated impressions which might not be disinfected at all or properly. They also come in contact with the prosthesis that might be tried inside the patient's mouth and sent to a lab for corrections without disinfecting the cast causing cross-contamination between patients, dentists, and laboratory personnel. However, immersion disinfection with sodium or calcium hypochlorite might affect important properties of the cast. Any negative effect on the mechanical or physical properties of the cast will affect the final outcome of the prosthesis.



Shivangi Trivedi, Abhishek Bansal, Navneet Kukreja, Aparna Trivedi, Swati Chhabra, Rikki Deswal, Parwan Gill, Archana Jain

Evaluation of Fracture Resistance of Reattached Fractured Tooth Fragment Stored in Different Storage Media: An In Vitro Study

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:5] [Pages No:221 - 225]

Keywords: Coconut water, Fractured teeth, Hanks balanced salt solution, Milk, Propolis, Reattachment, Storage media

   DOI: 10.5005/jp-journals-10024-3235  |  Open Access |  How to cite  | 


Aim: To evaluate the fracture resistance of coronal fractured tooth fragments stored in five different storage media when reattached with nanohybrid flowable composite. Materials and methods: The crown portion of 50 extracted human permanent maxillary central incisors were divided into three equal parts (incisal third, middle third and cervical third) and then marked incisal third were cut with the diamond disk. These were divided into five equal groups according to the type of storage media used i.e. dry storage, fresh tender coconut water, HBSS, milk, and propolis for 2 hours. Coronal fractured part with their respective apical parts were then reattached with flowable composite (G-aenial Universal Flo, GC India), then after thermocycling process samples were subjected to universal testing machine for testing fracture resistance. The collected data were subjected to statistical analysis using one way ANOVA and Post-hoc Tukey test. Results: The obtained results revealed that large amount of force is required to fracture the reattached teeth which were stored in milk and fresh tender coconut water as compared to those which were stored in dry environment, HBSS and propolis. Conclusion: In this study, maximum fracture resistance was seen in teeth stored in milk and fresh tender coconut water. Therefore, these two were considered as better storage media. Clinical significance: Due to increased interest towards the use of tooth colored restoration, recently, fractured teeth reattachment treatment procedure gaining attention by preserving life like translucency of treated tooth.



Edoardo Bianco, Ruggero Tagliabue, Luca Mirabelli, Marcello Maddalone

Assessment of Electromyographic Changes in a Patient with Masseter Hypertrophy and Muscle Pain after Botulinum Injections: A Case Report and 5 Months Follow-up

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:6] [Pages No:226 - 231]

Keywords: Botulinum toxin, Dental esthetics, Masseter, Occlusion, Orofacial pain, Sleep bruxism

   DOI: 10.5005/jp-journals-10024-3296  |  Open Access |  How to cite  | 


Aim: To determine if botulinum injections in masseters could be an option to avoid surgery and prolonged treatment with occlusal splints and/or drugs to care for both painful bruxism and cosmetic improvement in a patient with a square jaw, bruxism, and orofacial pain. Background: Masseter muscle hypertrophy (MMH) is a benign, unilateral, or bilateral, painless enlargement in the lower face. It presents as a symmetrical or asymmetrical increase in the masseter muscle. Masseter muscle hypertrophy (MMH) sometimes can be related to bruxism symptoms like muscle and/or temporomandibular joint (TMJ) pain. Case description: A 38-year-old woman complained of bilateral pain at palpation in the masseter body. She also complained about esthetics because of the prominent masseter muscle in the face and square face shape. A diagnosis of bruxism-related myalgia was performed, and treatment with botulinum injections into the masseter muscles was opted for. An oral electromyography was performed to detect the electrical muscular activity of masseter muscles over time. Conclusion: After a drastic reduction in the mean electrical activity immediately after the botulinum injections, a progressive increase in strength over time was noted, testifying about the decrease in the effect of botulinum over time. The pain disappeared for 5 months after the injections of botulinum. The reduction of the masseter muscle mass led to a softening of the face shape. Clinical significance: This case report shows that treatment with botulinum can lead, in the short term, to a reduction in orofacial pain due to a decrease in muscle electrical activity.



Lashika V Tambe, Madhura M Tandale, Radhika Chhibber, David T Wu

Treatment of Multiple Gingival Recessions Using Modified Tunnel Technique with V-reverse Sutures: A Report of Three Cases

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:5] [Pages No:232 - 236]

Keywords: Autogenous connective tissue graft, Gingival recessions, Modified tunnel technique

   DOI: 10.5005/jp-journals-10024-3301  |  Open Access |  How to cite  | 


Aim: The clinical case series presents a minimally invasive modified tunnel procedure with autogenous connective tissue graft (CTG) using a V-reverse sutures to treat multiple gingival recessions. Background: In periodontal and peri-implant plastic procedures, proper graft and flap stabilization are crucial in the outcomes. The coronally advanced flap allows for better access with the possibility of suturing the graft to the de-epithelialized papillae of the periosteum; there is little evidence with using the V-reverse sutures technique in stabilizing the graft and the flap when performing tunnel techniques (TUN). The following case series presents a minimally invasive modified tunnel procedure with autogenous CTG using V-reverse sutures to treat gingival recessions. Case description: Three patients with Miller Class I maxillary buccal gingival recessions defects were selected for this study. All subjects were treated with the minimally invasive modified tunnel technique with autogenous subepithelial CTG. V-reverse sutures technique was performed to further improve the stability of the graft at the recipient site. Clinical parameters, including mean recession depth and root coverage esthetic score (RES), were recorded at baseline, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1-year postoperative follow-up visits. Conclusion: At the 1-year follow-up, complete root coverage was achieved in multiple gingival recessions defect sites. In conclusion, this technique represents an alternative treatment for Miller Class I gingival recessions defects with clinical and esthetically satisfactory outcomes. Clinical significance: Combining the advantages of V-reverse sutures and CTG in the treatment of gingival recessions is feasible and noninvasive.



Salwa A El-Negoly, Mohammed E Grawish

Socket-shield Technique vs Conventional Immediate Implant Placement for Esthetic Rehabilitation: A Systematic Review and Meta-analysis

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:8] [Pages No:237 - 244]

Keywords: Anterior teeth, Conventional immediate implant technique, Pink esthetic score, Socket-shield technique, Systematic review and meta-analysis

   DOI: 10.5005/jp-journals-10024-3302  |  Open Access |  How to cite  | 


Aim: The present systematic review and meta-analysis (SR/MA) aimed to test the null hypothesis that there is no difference between socket-shield technique (SST) and conventional immediate implant placement (CIIP) as an esthetic rehabilitation option for permanent human anterior teeth, against the alternative one of a difference. Background: Socket-shield technique is considered as a highly promising procedure that has the potential to prevent resorption of anterior alveolar ridges, maintains white and pink esthetics, and provides a solution for esthetically critical cases. Controlled randomized clinical trials (RCT) and nonrandomized ones had been identified by searching the following databases: Google Scholar, Scopus, and PubMed. Literature search was determined from January 2010 up to June 2020. Hand searches were also accomplished for relevant abstracts, books, and reference lists. The eligibility criteria included prospective observational controlled RCTs and non-RCTs. Populations: patients with endodontically treated/nonrestorable permanent mature anterior teeth indicated for extraction. Interventions: the sockets were subjected to immediate implant placement using SST. Controls: implants placed with SST compared with those of CIIP. Outcome: the pink esthetic score measured for esthetic rehabilitation. To assess article quality, the Cochrane risk-of-bias tool was used by two independent authors. The data across quantitative studies were analyzed using comprehensive MA software. Review results: The initial search found out 172 references through the search strategy and three additional ones were recognized through hand searching. After being filtered, 101 references were screened and recorded. After the inclusion and exclusion criteria were applied, only seven unduplicated prospective controlled RCTs and non-RCTs were involved in the quantitative MA. At the 6-month evaluation period, the total standard difference in mean was 1.07 and I2 test value measuring heterogeneity was 77.182, whereas at the 12-month period, the total standard difference in mean was 1.43 and I2 test value measuring heterogeneity was 64.914. Conclusion: SST had a positive effect on the esthetic rehabilitation for anterior teeth better than CIIP. However, this conclusion was dependent on a very few well-conducted prospective RCT and non-RCT. Further RCTs with longer observational time, proper methodology, and of larger sample size are still required to adequately answer the question of the present SR. Clinical significance: There is limited knowledge about the appropriateness of SST in the field of implant dentistry, specifically for esthetic consideration. This SR/MA confirmed the positive effect of the SST over CIIP for esthetic rehabilitation for anterior teeth. Systematic review registration: PROSPERO, identifier CRD42020194086.



Mohammed A Jafer, Ruba MA Salem, Fatimah B Hakami, Raghad E Ageeli, Tamador A Alhazmi

Techniques for Extraction Socket Regeneration for Alveolar Ridge Preservation

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:6] [Pages No:245 - 250]

Keywords: Alveolar ridge preservation, Autologous platelet concentrates, Barrier membranes, Bone grafts, Growth factors, Immediate implantation, Socket preservation, Tissue engineering, Tooth bone grafts

   DOI: 10.5005/jp-journals-10024-3247  |  Open Access |  How to cite  | 


Background: Alveolar bone undergoes volumetric changes after extraction due to physiologic bone remodeling. The amount of alveolar bone available during prosthodontic treatment can affect the esthetic outcome of the treatment and make implant placement challenging. Socket preservation techniques are advocated postextraction to maintain the bone's vertical and horizontal alveolar bone dimensions and prevent its atrophy. Aim: This review is oriented toward a clinician, describing the different materials and techniques in practice today for socket preservation. Review results: A variety of methods have been studied as a means to stop alveolar ridge resorption. While immediate implant placement was recommended as a socket preservation technique, clinical trials have not demonstrated favorable results. The main techniques favored by clinicians today involve bone grafts, bone substitutes, barrier membranes, and combinations thereof. As with periodontal defects, these materials show favorable outcomes in alveolar bone regeneration and ridge preservation. Tooth bone grafts, both autogenous and allogenous, have been recommended recently for ridge preservation as they are chemically similar to bone and can induce osteogenesis. The use of autologous platelet concentrates has yielded contradictory results in studies. Cutting-edge approaches entail using growth factors and tissue engineering concepts. While these strategies are still in the development stages, it has peerless potential in preserving and regenerating alveolar bone. Conclusion: Alveolar ridge resorption is an unavoidable physiological process after extraction and leads to severe bone deficiencies, affecting esthetics. These changes in alveolar ridge dimensions make implant placement difficult and affect the longevity of the implant. Clinical intervention can prevent alveolar bone resorption and preserve the ridge. Bone grafts and substitutes including concentrates remain the best choices in ride preservation. The use of growth factors and tissue engineering concepts requires further clinical trials before widespread use in clinical practice.



Ranjith Mari, Anjali R Nath, Maya Rajan Peter, Rajesh Vyloppillil, Biju Balakrishnan, Reshma Suresh

Periodontal Approaches to Esthetic Dentistry: A Review on Current Trends

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:17] [Pages No:251 - 267]

Keywords: Esthetics, Mucogingival surgery, Periodontal plastic surgery

   DOI: 10.5005/jp-journals-10024-3304  |  Open Access |  How to cite  | 


Aim: The present review is to discuss the current trends in periodontal approaches for improving the esthetics in dentistry. Background: Esthetics is an essential component of today's dental care. A growing awareness of esthetics has fueled an increase in esthetic demand in dentistry in recent years. The ultimate goal in modern dentistry is to attain “white and pink esthetics” in the esthetically important zone. Review results: Current evidence-based periodontal approaches for improving esthetic dentistry are discussed. The periodontal management of esthetics is mainly focused on proper assessment of the case scenario including the associated mucogingival deformities and selection of a proper technique for the correction of the same. Clinical significance: There is drastic increase in esthetic demand for the dental procedures in recent years. With the evolution of innovative techniques, clinicians can fulfill the patient's esthetic demands. Thus it is important to be updated in this field about the current innovative approaches. Conclusion: Newer procedures are being developed all the time and are gradually being integrated into periodontal practice. The practitioner should be mindful that novel approaches are sometimes presented without appropriate clinical research. Our ongoing progress toward better therapeutic approaches should be guided by critical analysis of freshly offered methodologies.



Vanishri C Haragannavar, Afrah Yousef, Neethi Gujjar, Suman Kashyap

Nanopore Sequencing Technology in Oral Oncology: A Comprehensive Insight

[Year:2022] [Month:February] [Volume:23] [Number:2] [Pages:8] [Pages No:268 - 275]

Keywords: Epigenetics, Genomics, Nanopore sequencing, Oral cancer, Third-generation sequencing

   DOI: 10.5005/jp-journals-10024-3240  |  Open Access |  How to cite  | 


Aim: To review the principles and application of Nanopore Sequencing Technology (NPST) in oral cancer. Background: Oral cancer is a disease caused by aberrations in the genes. Substantial research at the genomic level is still required for in-depth understanding of the molecular mechanism in oral cancer. The advent of the novel nanopore sequencing technique has the potential to detect the alterations at the genomic level. This review highlights nanopore sequencing, its advantages and disadvantages, and how research supports its application in the field of oral oncology. Materials and methods: Web-based search via PubMed database, internet sources using keywords “nanopore sequencing, third-generation sequencing, next generation sequencing, cancer, oral squamous cell carcinoma, genetic, epigenetic, oncogenic viruses” was performed in this review. Original research, reviews, and short discussions published from 2008 to 2020 were included. The findings are discussed with emphasis on common gene mutations, epigenetic alterations, and oncogenic viruses in oral cancer. A brief mention regarding translational nanopore sequencing research in oral cancer and future perspectives is also discussed. Results: The results obtained reveal that cost-effectiveness and rapid turnaround time make nanopore sequencing an enticing platform to resolve the ambiguity of genomes, epigenomes, and transcriptomes. Conclusion: The findings will encourage researchers to further adopt NPST in their studies and give an overview of the latest findings of oral squamous cell carcinoma (OSCC) management. To highlight the importance of NPST application in OSCC studies, this paper not only discusses the use of NPST in identifying the behavior of malignancy but also implies the need for further research using this technique. Clinical significance: The review suggests that nanopore sequencing can be utilized for diagnosis and achieving personalized treatment in each oral cancer patient.


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