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   Table of Contents - Current issue
Coverpage
November-December 2018
Volume 15 | Issue 6
Page Nos. 379-452

Online since Tuesday, November 13, 2018

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REVIEW ARTICLE  

Effect of Camellia sinensis plant on decreasing the level of halitosis: A systematic review Highly accessed article p. 379
Bahareh Tahani, Roya Sabzian
DOI:10.4103/1735-3327.245226  
Tea is the second most consumed beverage. Polyphenolic catechins of green tea have a number of beneficial effects in oral cavity. This study aims to evaluate the clinical effects of green tea on halitosis through a systematic review of available literature. All available randomized, clinical trials – with a relevant subject that met the inclusion criteria – were included by searching PubMed, Cochrane, ProQuest, and Google Scholar, and Scopus databases. To score the selected articles, 27 items of CONSORT 2010 checklist were considered. Each article was reviewed by all the authors. Searching the PubMed database yielded 42 articles, 2 of which met the inclusion criteria. None of the 12 articles were obtained through Cochrane library, and 85 articles retrieved from ProQuest database met the inclusion criteria. Three hundred and five articles were obtained from Google Scholar, three of which fulfilled the inclusion criteria. Two articles were omitted because they were duplicated, and the rest were excluded. Searching the Scopus database yielded 270 articles, 2 of which met the inclusion criteria, but they were also duplicated. Finally, two studies were selected according to the inclusion criteria of the study. In both of the included articles, the early effect of green tea use was statistically significant in comparison with baseline. One of the studies showed the long-term effect of green tea mouthwash. Green tea can reduce halitosis through rinsing and antimicrobial effect.
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ORIGINAL ARTICLES Top

Comparison of the permeability rate of nanoparticle calcium hydroxide and conventional calcium hydroxide using a fluorescence microscope p. 385
Babak Farzaneh, Sina Azadnia, Reza Fekrazad
DOI:10.4103/1735-3327.245236  
Background: The permeability feature of conventional calcium hydroxide (CH) and nanoparticle CH (NCH) was compared to show the desired effects of this new material and in case of confirmation of its other properties; CH can be used as a safe alternative. Materials and Methods: This in vitro was carried out in two phases: First phase: measurement and comparison of the permeability rate of conventional CH and NCH in the dentinal tubules employing a fluorescence microscope were carried out. Second phase: measurement and comparison of the permeability rate of NCH and conventional CH in L929 fibroblast cells using a fluorescence microscope were carried out. Kruskal–Wallis analysis was used for overall comparisons. A series of Mann–Whitney U tests were used for pair-wise comparisons (P < 0.05). Results: Based on the results of Kruskal–Wallis test, in all three regions of the cervical third, middle third, and apical third of the root, mean values of the percentage difference of the fluorescence and color change in NCH were more than the conventional CH, and the difference was statistically significant (P < 0.001). the percentage of fluorescence color change in drug with the concentration of 1 g/cc was more than the one with the concentration of 0.1 g/cc and the difference was statistically significant (P < 0.001). Conclusion: The nanoparticle drug compared with the conventional drug has a more penetration depth in all regions of the root of the dentinal tubules.
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A cross-sectional evaluation of children preference for dentist attire and syringe type in reduction of dental anxiety p. 391
Prashant Babaji, Pavni Chauhan, Vishwajiit Rampratap Churasia, Tamanpreet Kaur, Smita Singh, Melvin Augustine
DOI:10.4103/1735-3327.245228  
Background: Fear of a dental child is most commonly associated with dentist attire and usage of syringe. The objective of the study was to evaluate the preference of dentist's attire and kind of syringe (conventional or camouflage) among different age groups of children. Materials and Methods: In this cross-sectional study A total of 750 children aged 4–14 years were included in the study. All the participants were subdivided into five major groups according to their age, i.e., 4–5 years, 6–7 years, 8–9 years, 10–11 years, and 12–14 years. A set of six photographs which included dentists in white-colored apron, pink-colored apron, green-colored apron, blue-colored apron, and gown with cartoon character and dentists without apron (formal attire) along with: (a) camouflage syringe and (b) conventional syringe were provided to every child and was asked to give his/her preference looking at the six set of pictures. The preference of each child was thus recorded. Children's anxiety level during injections and dentist attire was assessed and recorded using two anxiety scales, i.e. the Modified Child Dental Anxiety Scale faces version and Facial Image Scale.SPSS statistical software and Chi-square test were used. (P < 0.05). Results: A majority of 35.3% participants in the 4–5-years age group preferred aprons with cartoon character, while 65.3% in the 12–14-years age group selected white apron as the preferred choice. Regarding preference of the syringe type, it was observed that 82% of the younger age preferred camouflage syringe and 75% of the older age preferred conventional syringe. On comparison of both the scales, no significant differences were found. About 82% children in the older age group were reported to be nonanxious with white attire and only 14% were anxious with the conventional syringe type. Conclusion: Younger children have a greater preference of colorful attire of dentist and camouflage syringe over the conventional one when compared to older children.
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Antimicrobial assay of combination surfactant irrigant regimen on vancomycin-resistant Enterococcus faecalis. An in vitro direct contact test p. 397
Manikandan Ravinanthanan, Mithra N Hegde, Veena A Shetty, Suchetha Kumari
DOI:10.4103/1735-3327.245231  
Background: Vancomycin-resistant enterococci (VRE) are on the rise globally in primary intraradicular infections and resistant to most intracanal irrigants and medicaments. The aim of this study was to evaluate the efficacy of irrigants and identify a cost-effective regimen to eradicate VRE. Materials and Methods: In this in vitro study irrigants were categorized as primary and surfactant groups with individual concentrations consisting of 10 samples each. Primary irrigants; sodium hypochlorite (NaOCl), chlorhexidine (CHX), and iodine potassium iodide (IKI) were prepared in concentrations of 5%, 2.5%, 2%, and 1%. Surfactants cetrimide (CTR) and sodium dodecyl sulfate (SDS) were prepared in concentrations of 0.25%, 0.5%, 1%, and 2%. Biopure MTAD was chosen as the control group. ATCC 51299 (VRE) was evaluated for antimicrobial susceptibility to the above irrigants by direct contact test for 5 min. The effect of each test irrigant was determined by calculating the percentage kill of viable bacteria by spectrophotometer. Statistical analysis was done by means of a one-way ANOVA and Mann–Whitney U-test (P < 0.05 consider significant). Results: About 2.5% and 5% CHX were significant over mixture of tetracycline, acid and detergent (MTAD) (P < 0.05). 5% CHX could achieve 100% elimination while 2.5% CHX and 5% IKI had 99.90%. 2% CHX and 2.5% IKI had 99% effective kill percentage. All concentrations of NaOCl were ineffective (90%) as compared to MTAD (95%). CTR (0.5%, 1% and 2%) and SDS (2%) were significant (P < 0.05) over MTAD. Combination surfactant regimens of 2% CHX +0.5% CTR and 2% CHX +1% SDS achieved 99.90% eradication potential and were significant (P < 0.05) over MTAD. Conclusion: Surfactant regimens were highly effective and superior to MTAD. CTR and SDS by their organic solvent property enhanced the antibacterial action of CHX.
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Effect of different finishing/polishing procedures on surface roughness of Ormocer-based and different resin composites p. 404
Marco Colombo, Lodovico Vialba, Riccardo Beltrami, Ricaldone Federico, Marco Chiesa, Claudio Poggio
DOI:10.4103/1735-3327.245232  
Background: The aim of this study was to evaluate and compare the surface roughness of six esthetic restorative materials (Gradia Direct Anterior, GC Corporation, Tokyo, Japan; Filtek Supreme XTE, 3M ESPE, St. Paul, MN, USA; Ceram.X Universal, Dentsply DeTrey, Konstanz, Germany; Essentia enamel, GC Corporation, Tokyo, Japan; Admira Fusion, Voco, Cuxhaven, Germany; and Estelite, Tokuyama Dental corporation, Taitou-ku, Tokyo, Japan) achieved using three different finishing and polishing techniques. Materials and Methods: In this in vitro study Forty specimens of each material (6 mm in diameter, 2 mm high) were created and divided into four groups, one per each finishing and polishing procedure and a control group, only cured and not polished. All specimen preparation and finishing and polishing procedures were performed by the same investigator, to reduce variability, following strictly the manufacturer's instructions. Specimens were analyzed using a profilometer to measure the mean surface roughness (Ra, μm), and microscopy images were taken during the measurements through the microscope of the profilometer. Two-way ANOVA test was applied to determine significant differences with respect to material, finishing/polishing technique, and interaction between both variables. Post hoc comparison was done using Tukey's honestly significant difference test. Significance for statistical tests was predetermined at P < 0.05. Results: Finishing and polishing procedure using tungsten carbide burs provided the best values in terms of surface roughness. All materials of this study treated with this method have provided superimposable values, and no material can be considered more performing than the others. Similar values were also found in the control group. Conclusion: This study demonstrated that the finishing technique with carbide burs produced an excellent surface smoothness, even if the best surface smoothness is achieved curing the restorative material under a polyester matrix.
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Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial p. 411
Sedigheh Mozafar, Majid Bargrizan, Mojtaba Vahid Golpayegani, Shahnaz Shayeghi, Rahil Ahmadi
DOI:10.4103/1735-3327.245235  
Background: This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. Materials and Methods: In this randomized, cross-over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included.Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross-over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients' anxiety and parents' satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon' s signed rank test and Paired t-tests with a P value set at 0.05. Results: Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. Conclusion: Both of the drug combinations resulted in acceptable, efficient, and safe sedation outcomes.
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Biomechanical and radiological assessment of immediate implants for alveolar ridge preservation p. 420
Ali Al Qabbani, Sausan Al Kawas, Hamid Enezei, Noor Hayati A. Razak, Saad Wahby Al Bayatti, A Rani Samsudin, Suzina A. B. Hamid
DOI:10.4103/1735-3327.245233  
Background: The aim of this study was to evaluate the stability of immediate implant placement for alveolar bone augmentation and preservation with bovine bone graft following atraumatic tooth extraction. Materials and Methods: This was a prospective interventional study with convenient sampling (n = 10). Thirty patients aged between 18 and 40 years, who needed noncomplicated tooth extraction of mandibular premolar tooth, were sequentially divided equally into three groups. In Group I, simple extraction was done and the empty extraction socket left to heal conventionally. In Group II, extraction sockets were filled with lyophilized bovine granules only. In Group III, immediate implants were placed into extraction sockets, and the buccal gap was also filled with bovine granules. All groups were subjected to cone beam computed tomography scan for radiological evaluation. Assessment of biomechanical stability (radiofrequency analysis [RFA] was performed at 9 months postoperative for Group III to assess the degree of secondary stability of the implants using Osstell. Repeated measure analysis of variance (ANOVA) test was applied when comparing within each group at three different time intervals, whereas one-way ANOVA was applied followed by post hoc-tukey test when comparing between groups. P < 0.05 was considered statistically significant. Results: Radiological assessment reveals a significant difference of bone resorption in alveolar dimension within Group I; 1.49 mm (P = 0.002), and 0.82 mm (P = 0.005), respectively, between day 0 and 3 months. Comparison between Group I and III showed a highly significant difference of bone resorption in ridge width at 3 months 2.56 mm (P = 0.001) and at 9 months interval 3.2 mm (P < 0.001). High RFA values demonstrating an excellent biomechanical stability were observed in Group III at 9 months postoperatively. Conclusion: The insertion of immediate implants in extraction sockets with bovine bone augmentation of the buccal gap was able to preserve a greater amount of alveolar ridge volume.
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Assessing the quality of dental services using SERVQUAL model p. 430
Nooredin Dopeykar, Mohammadkarim Bahadori, Parisa Mehdizadeh, Ramin Ravangard, Mahmood Salesi, Seyed Mojtaba Hosseini
DOI:10.4103/1735-3327.245230  
Background: The measurement of service quality had an important role in managing service provided, diagnosing the problem, and assessing service performance. Patient satisfaction is one of the key indicators of quality in health-care organizations. This study aimed to measure the service quality gap of patients' perceptions and expectations in five dimensions at a military Specialized Dental Clinic in Iran using SERVQUAL tool. Materials and Methods: This was a cross-sectional and descriptive-analytical study conducted at a Specialized Dental Clinic affiliated to the Armed Forces of Islamic Republic of Iran in Tehran in 2013. All 385 patients referring to the studied clinic during two working shifts of morning and evening in one month, August, were selected. The required data were collected using the modified SERVQUAL questionnaire. The collected data were analyzed using SPSS 20.0 through statistical tests including Mann–Whitney and Kruskal–Wallis tests. P < 0.05 was considered statistically significant. Results: The results showed that the quality of services provided to patients was significantly lower than their expectations and the quality gaps were statistically significant in all studied dimensions (P < 0.001). Furthermore, the highest and lowest quality gap was related to empathy (−1.16) and reliability (−0.61), respectively. Conclusion: According to the results, the managers of this clinic should take steps toward improving the quality of services in all dimensions, especially responsiveness and empathy, through planning properly, prioritizing services, and reviewing processes with regard to the patients' expectations.
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Stress analysis of mandibular implant overdentures retained with one, two, or four ball attachments: A finite element study p. 437
Mohamed M El-Zawahry, Eman M Ibraheem, Mohammad Zakaria Nassani, Sahar A Ghorab, Mohamed I El-Anwar
DOI:10.4103/1735-3327.245234  
Background: The aim of this study is to compare stress patterns induced by ball attachments when used to retain mandibular overdentures supported by one, two, or four dental implants. Materials and Methods: In this finite element study, three 3D models were prepared to simulate mandibular implant overdentures retained by one or two or four ball attachments of 3.5 mm diameter with collar height 1.6 mm. The geometric solid models were created by commercial engineering computer-aided design package then transferred to ANSYS as set of standard ACIS text files. Vertical load of 100 N was applied on the central fossa of the right molar. Stresses were evaluated at the areas of implant and attachment components, mucosa underlying overdentures, and cortical and cancellous bone adjacent to implants. Results: The results of this study showed that the Von Mises stresses generated by the application of vertical loading varied according to the number of implants used to support the overdenture. Maximum Von Mises stress on cortical bone ranged between 1.15 and 1.77 MPa in all-studied cases. Mucosa was squeezed under the one implant model. Flexibility of the overdenture material played a significant role in distributing the load stress and deformation of all underlying structure.Caps deformation was the highest when using two implants. Conclusion: With increasing the number of implants, stresses and deformations of overdenture are reduced, but implants receive greater stresses and deformations. Using two implants in the canine region showed the best results when compared with using one or four implants, except for the caps.
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CASE REPORTS Top

Dental implant-retained auricular prosthesis p. 444
Farzad Yeganeh, Abbas Haghighat, Maryam Amini-Pozveh
DOI:10.4103/1735-3327.245227  
Absence or loss of facial structures causes functional deficits and enormous psychological distress, so rehabilitation is necessary. However, facial prostheses have some difficulties due to mobile underlying tissues and retention. We used dental implant instead of conventional maxillofacial implant and safe on four prosthetic systems which is used in over dentures for retention of auricular prosthesis.
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Rehabilitations of a single element with one-piece implants with electrowelded needles: A different approach p. 447
Marco Pasqualini, Franco Rossi, Luca Dal Carlo, Giorgio Comola
DOI:10.4103/1735-3327.245229  
To ensure single dental implant stability, there are some approaches. The stabilization of a single-piece implant by welding it to a titanium needle allows immediate loading and promotes the final osseointegration. The aim of this case report study was an evaluation of long-term clinical outcomes of immediate loading in cases with bone atrophy in the canine region by welding single implant to a titanium needle. In two cases with maxillary atrophic anterior bone, single-piece titanium implants were used. As support structure, a Scialom-type stabilization titanium needle was used (diameter 1.2 mm and suitable length to obtain a bicortical positioning). These two elements were joined together using a Mondani intraoral welder. The implants immediately loaded by temporary restorations. The cases were followed for 24 years, and clinical outcomes were assessed. The use of this method, in the cases with maxillary atrophic anterior bone, allows immediate loading with a fixed acrylic prosthesis at the end of the surgical session. Clinical outcome was successful for 24 years. This approach is a successful method that allows immediate loading in atrophic bone.
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