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REVIEW ARTICLES
Outcomes of vital pulp therapy in permanent teeth with different medicaments based on review of the literature
Najmeh Akhlaghi, Abbasali Khademi Khademi
September-October 2015, 12(5):406-417
DOI:10.4103/1735-3327.166187  PMID:26604953
Vital pulp therapy (VPT) is a biologic and conservative treatment modality to preserve the vitality and function of the coronal or remaining radicular pulp tissue in vital permanent teeth. A search was conducted via the Cochrane database, PubMed, MEDLINE, and Ovid for any articles with the criteria for "pulp-capping," or "pulp-capping materials" and "VPT outcomes" from 1978 to mid 2014. All articles were evaluated and the valid papers were selected. The outcomes of various VPT techniques, including indirect pulp treatment, direct pulp treatment, partial pulpotomy, and complete pulpotomy in vital permanent teeth were extracted. Although various studies have different research approach, most studies noted a favorable treatment outcome. Mineral trioxide aggregate (MTA) appears to be more effective than calcium hydroxide (Ca(OH) 2 ) for maintaining long-term pulp vitality after indirect and direct pulp-capping. However, it seems that the success rate for partial pulpotomy and pulpotomy with Ca(OH) 2 is similar to MTA.
  6,671 1,694 14
ORIGINAL ARTICLES
Diagnostic efficacy of color Doppler ultrasound in evaluation of cervical lymphadenopathy
Deepankar Misra, Sapna Panjwani, Shalu Rai, Akansha Misra, Mukul Prabhat, Prashant Gupta, Subrata K Talukder
May-June 2016, 13(3):217-224
DOI:10.4103/1735-3327.182180  PMID:27274341
Background: To evaluate the efficacy of color Doppler ultrasound (CDUS) in differentiating benign and malignant cervical lymph nodes by detecting differences in blood flow patterns. Materials and Methods: In this cross-sectional prospective study, 25 untreated patients with clinical evidence of cervical lymphadenopathy were evaluated. CDUS was performed for 80 cervical lymph nodes. The gray scale parameters of the lymph node and intranodal perfusion sites were the key CDUS features used to differentiate between reactive and metastatic lymph nodes. Histopathological confirmations were obtained and compared with the results of CDUS. Results: Initially, 53 cervical lymph nodes were evaluated by clinical examination. Twenty-seven additional lymph nodes (53 + 27 = 80) were discovered by CDUS evaluation. Gray scale parameters for lymph nodes such as size of lymph node, shape of lymph node, and presence or absence of hilum revealed highly significant results (P < 0.0001). Color Doppler flow signals revealed that central/hilar flow was characteristic for benign nodes whereas peripheral/mixed flow was characteristic for malignant nodes, the findings were highly significant (P < 0.0001). Gray scale and color Doppler features are used to differentiate benign and malignant nodes. Conclusion: Within the limitations of this study, CDUS evaluation was found to be highly significant with a high sensitivity and specificity over clinical evaluation CDUS examination provides a prospect to reduce the need for biopsy/fine needle aspiration cytology in reactive nodes.
  7,927 404 1
REVIEW ARTICLE
Interforaminal hemorrhage during anterior mandibular implant placement: An overview
Chandan Kumar Kusum, Pranav V Mody, Indrajeet , Deviprasad Nooji, Suhas K Rao, Bhushan Ganesh Wankhade
July-August 2015, 12(4):291-300
DOI:10.4103/1735-3327.161422  PMID:26288617
Implant surgery in mandibular anterior region may turn from an easy minor surgery into a complicated one for the surgeon, due to inadequate knowledge of the anatomy of the surgical area and/or ignorance toward the required surgical protocol. Hence, the purpose of this article is to present an overview on the: (a) Incidence of massive bleeding and its consequences after implant placement in mandibular anterior region. (b) Its etiology, the precautionary measures to be taken to avoid such an incidence in clinical practice and management of such a hemorrhage if at all happens. An inclusion criterion for selection of article was defined, and an electronic Medline search through different database using different keywords and manual search in journals and books was executed. Relevant articles were selected based upon inclusion criteria to form the valid protocols for implant surgery in the anterior mandible. Further, from the selected articles, 21 articles describing case reports were summarized separately in a table to alert the dental surgeons about the morbidity they could come across while operating in this region. If all the required adequate measures for diagnosis and treatment planning are taken and appropriate surgical protocol is followed, mandibular anterior region is no doubt a preferable area for implant placement.
  6,935 704 4
Cyclosporine A: Novel concepts in its role in drug-induced gingival overgrowth
Deepa Ponnaiyan, Visakan Jegadeesan
November-December 2015, 12(6):499-506
DOI:10.4103/1735-3327.170546  PMID:26759584
Cyclosporine is a selective immunosuppressant that has a variety of applications in medical practice. Like phenytoin and the calcium channel blockers, the drug is associated with gingival overgrowth. This review considers the pharmacokinetics, pharmacodynamics, and unwanted effects of cyclosporine, in particular the action of the drug on the gingival tissues. In addition, elucidates the current concepts in mechanisms of cyclosporine-induced gingival overgrowth. Clinical and cell culture studies suggest that the mechanism of gingival overgrowth is a result of the interaction between the drug and its metabolites with susceptible gingival fibroblasts. Plaque-induced gingival inflammation appears to enhance this interaction. However, understanding of the pathogenesis of gingival overgrowth is incomplete at best. Hence, it would be pertinent to identify and explore possible risk factors relating to both prevalence and severity of drug-induced gingival overgrowth. Newer molecular approaches are needed to clearly establish the pathogenesis of gingival overgrowth and to provide novel information for the design of future preventive and therapeutic modalities.
  4,113 742 10
ORIGINAL ARTICLES
Oral health knowledge, behaviour and practices among school children in Qatar
Mohammed Sultan Al-Darwish
July-August 2016, 13(4):342-353
DOI:10.4103/1735-3327.187885  PMID:27605993
Background: The aim of this study was to assess the oral health knowledge behaviour and practices among school children in Qatar. Materials and Methods: A cross-sectional study was carried out in Qatar from October 2011 to April 2012. A total of 2200 school children aged 12–14 years were approached from 16 schools of different areas. The information about oral health knowledge and sources of information was obtained through a self-administrated questionnaire. Data analyses were performed. Results: The overall response rate was (96%). Only (25.8%) of children reported a high level of oral health knowledge. After each meal, tooth brushing was observed by a very low percentage of children (3.7%). About 44.6% of children recognized dental floss as a cleaning device for between the teeth. A large number of children (32.5%) thought incorrectly that one must visit the dentist only in case of pain. A great majority was not aware of cariogenic potential of soft drinks (39%) and sweetened milk (97.8%). Less than half (38.9%) of children actually had heard about fluoride. Only (16.8%) correctly answered the question about sign of tooth decay. Slightly, less than half (48.4%) could not define the meaning of plaque. Parents were the most popular (69.1%), source of oral health information for the children. Conclusion: The oral health knowledge in Qatar is below the satisfactory level. Parents were the most popular source of oral health knowledge for the children followed by dentists, school teachers, and media.
  4,091 552 3
Three-dimensional accuracy of different impression techniques for dental implants
Mohammadreza Nakhaei, Azam S Madani, Azizollah Moraditalab, Hamidreza Rajati Haghi
September-October 2015, 12(5):431-437
DOI:10.4103/1735-3327.166190  PMID:26604956
Background: Accurate impression making is an essential prerequisite for achieving a passive fit between the implant and the superstructure. The aim of this in vitro study was to compare the three-dimensional accuracy of open-tray and three closed-tray impression techniques. Materials and Methods: Three acrylic resin mandibular master models with four parallel implants were used: Biohorizons (BIO), Straumann tissue-level (STL), and Straumann bone-level (SBL). Forty-two putty/wash polyvinyl siloxane impressions of the models were made using open-tray and closed-tray techniques. Closed-tray impressions were made using snap-on (STL model), transfer coping (TC) (BIO model) and TC plus plastic cap (TC-Cap) (SBL model). The impressions were poured with type IV stone, and the positional accuracy of the implant analog heads in each dimension (x, y and z axes), and the linear displacement (ΔR) were evaluated using a coordinate measuring machine. Data were analyzed using ANOVA and post-hoc Tukey tests (α = 0.05). Results: The ΔR values of the snap-on technique were significantly lower than those of TC and TC-Cap techniques (P < 0.001). No significant differences were found between closed and open impression techniques for STL in Δx, Δy, Δz and ΔR values (P = 0.444, P = 0.181, P = 0.835 and P = 0.911, respectively). Conclusion: Considering the limitations of this study, the snap-on implant-level impression technique resulted in more three-dimensional accuracy than TC and TC-Cap, but it was similar to the open-tray technique.
  3,756 582 5
Effectiveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions
Farzin Heravi, Farzaneh Ahrari, Behrad Tanbakuchi
March-April 2018, 15(2):95-103
DOI:10.4103/1735-3327.226532  
Background: This clinical trial investigated the effectiveness of two remineralizing creams on regression of white spot lesions (WSLs) after orthodontic therapy. Materials and Methods: The study included patients with WSLs on their upper anterior teeth who recently completed orthodontic treatment at the Department of Orthodontics of Mashhad Dental School and two private offices. The participants were randomly assigned into three groups by treatment: (1) a 12-week regimen of a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); (2) a 12-week regimen of a cream containing hydroxyapatite and fluoride (Remin Pro); and (3) usual home care (control). Thirty-nine patients participated and three withdrew. The main outcomes including area, mineral content, and color of WSLs were measured at enrolment and 4, 8, and 12 weeks later, respectively. Blinding was applied for outcome assessment only. The data were analyzed by analysis of variance and repeated measures analysis at the statistical significance of P < 0.05. Results: Over a 3-month period, the application of both MI Paste Plus and Remin Pro caused significantly greater reduction in area and significantly higher increase in mineral content of WSLs compared to the control group (P < 0.05). The appearance of WSLs improved significantly in both experimental groups (P < 0.05), but not in the control group. No side effect was observed throughout the experiment. Conclusion: The application of either MI Paste Plus or Remin Pro was effective in reducing the area, increasing the mineral content and improving the appearance of demineralized enamel, indicating that these products could be recommended for managing postorthodontic WSLs.
  3,714 341 3
Comparison of microleakage from stainless steel crowns margins used with different restorative materials: An in vitro study
Mahtab Memarpour, Reza Derafshi, Mahshid Razavi
January-February 2016, 13(1):7-12
DOI:10.4103/1735-3327.174689  PMID:26962309
Background: Obtaining optimal marginal adaption with prefabricated stainless steel crowns (SSCs) is difficult, especially after removing dental caries or defects in cervical areas. This situation requires the use of an SSC after tooth reconstruction. This study evaluated microleakage and material loss with five restorative materials at SSC margins. Materials and Methods: One hundred and twenty primary molar teeth were randomly divided into six groups (n = 20). Class V cavities were prepared on the buccal surfaces of the teeth in groups 1-5. Cavities were restored with amalgam, resin-based composite, glass ionomer (GI), zinc phosphate, or reinforced zinc oxide eugenol (Zonalin). Group 6 without cavity preparation was used as a control. Restorations with SSCs were prepared according to standard methods. Then, SSCs were fitted so that the crown margins overlaid the restorative materials and cemented with GI. After thermocycling, the specimens were placed in 0.5% fuchsin and sectioned. The proportions of mircoleakage and material loss were evaluated with a digital microscope. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney tests. Results: The groups differed significantly (P < 0.001). Amalgam and GI showed the least microleakage. Amalgam restorations had significantly less microleakage than the other materials (P < 0.05). Microleakage was greatest with resin-based composite, followed by Zonalin. Material loss was greater in samples restored with Zonalin and zinc phosphate. Conclusion: When SSC margins overlaid the restoration materials, cavity restoration with amalgam or GI before SSC placement led to less microleakage and material loss. Regarding microleakage and material loss, resin-based composite, zinc phosphate, and Zonalin were not suitable options.
  3,325 719 2
Accuracy of different impression materials in parallel and nonparallel implants
Mahroo Vojdani, Kianoosh Torabi, Elham Ansarifard
July-August 2015, 12(4):315-322
DOI:10.4103/1735-3327.161429  PMID:26288620
Background: A precise impression is mandatory to obtain passive fit in implant-supported prostheses. The aim of this study was to compare the accuracy of three impression materials in both parallel and nonparallel implant positions. Materials and Methods: In this experimental study, two partial dentate maxillary acrylic models with four implant analogues in canines and lateral incisors areas were used. One model was simulating the parallel condition and the other nonparallel one, in which implants were tilted 30° bucally and 20° in either mesial or distal directions. Thirty stone casts were made from each model using polyether (Impregum), additional silicone (Monopren) and vinyl siloxanether (Identium), with open tray technique. The distortion values in three-dimensions (X, Y and Z-axis) were measured by coordinate measuring machine. Two-way analysis of variance (ANOVA), one-way ANOVA and Tukey tests were used for data analysis (α = 0.05). Results: Under parallel condition, all the materials showed comparable, accurate casts (P = 0.74). In the presence of angulated implants, while Monopren showed more accurate results compared to Impregum (P = 0.01), Identium yielded almost similar results to those produced by Impregum (P = 0.27) and Monopren (P = 0.26). Conclusion: Within the limitations of this study, in parallel conditions, the type of impression material cannot affect the accuracy of the implant impressions; however, in nonparallel conditions, polyvinyl siloxane is shown to be a better choice, followed by vinyl siloxanether and polyether respectively.
  3,317 564 8
REVIEW ARTICLES
The antioxidant master glutathione and periodontal health
Vivek Kumar Bains, Rhythm Bains
September-October 2015, 12(5):389-405
DOI:10.4103/1735-3327.166169  PMID:26604952
Glutathione, considered to be the master antioxidant (AO), is the most-important redox regulator that controls inflammatory processes, and thus damage to the periodontium. Periodontitis patients have reduced total AO capacity in whole saliva, and lower concentrations of reduced glutathione (GSH) in serum and gingival crevicular fluid, and periodontal therapy restores the redox balance. Therapeutic considerations for the adjunctive use of glutathione in management of periodontitis, in limiting the tissue damage associated with oxidative stress, and enhancing wound healing cannot be underestimated, but need to be evaluated further through multi-centered randomized controlled trials.
  3,330 516 8
ORIGINAL ARTICLES
A finite element study of teeth restored with post and core: Effect of design, material, and ferrule
Viram Upadhyaya, Akshay Bhargava, Hari Parkash, B Chittaranjan, Vivek Kumar
May-June 2016, 13(3):233-238
DOI:10.4103/1735-3327.182182  PMID:27274343
Background: Different postdesigns and materials are available; however, no consensus exists regarding superiority for stress distribution. The aim of this study was to evaluate the effect of design and material of post with or without ferrule on stress distribution using finite element analysis. Materials and Methods: A total of 12 three-dimensional (3D) axisymmetric models of postretained central incisors were made: Six with ferrule design and six without it. Three of these six models had tapered posts, and three had parallel posts. The materials tested were titanium post with a composite resin core, nickel chromium cast post and core, and fiber reinforced composite (FRC) post with a composite resin core. The stress analysis was done using ANSYS software. The load of 100 N at an angle of 45΀ was applied 2 mm cervical to incisal edge on the palatal surface and results were analyzed using 3D von Mises criteria. Results: The highest amount of stress was in the cervical region. Overall, the stress in the tapered postsystem was more than the parallel one. FRC post and composite resin core recorded minimal stresses within the post but the stresses transmitted to cervical dentin were more as compared to other systems. Minimal stresses in cervical dentine were observed where the remaining coronal dentin was strengthen by ferrule. Conclusion: A rigid material with high modulus of elasticity for post and core system creates most uniform stress distribution pattern. Ferrule provides uniform distribution of stresses and decreases the cervical stresses.
  3,241 562 4
Fracture resistance of three different posts in restoration of severely damaged primary anterior teeth: An in vitro study
Bahman Seraj, Sara Ghadimi, Zohreh Estaki, Mostafa Fatemi
July-August 2015, 12(4):372-378
DOI:10.4103/1735-3327.161461  PMID:26286271
Background: Restoration of anterior primary teeth with severe caries lesion is a big challenge. The aim of this study was to compare the fracture resistance of three types of post, including composite resin, customized quartz fiber and prefabricated glass fiber in restoration of severely damaged primary anterior teeth. Materials and Methods: Sixty extracted human primary maxillary incisors were randomly divided into three groups: Group 1: Customized quartz fiber post, Group 2: Composite post and Group 3: Prefabricated glass fiber post. Due to the effect of bonded area on the fracture resistance, the bonded surface of each sample was measured 1 mm above cementoenamel junction. An increasing force was subjected with a crosshead speed of 0.5 mm/min by a universal testing machine until fracture occurred, and the failure mode was assessed afterwards. Data were analyzed using One-way analysis of variance and Kruskal-Wallis tests. The level of significance was considered at P < 0.05. Results: The mean fracture resistance values of three groups were 343.28 N, 278.70 N and 284.76 N, respectively. Although customized quartz fiber post showed the greatest fracture resistance, statistical analysis revealed no significant difference between groups (P = 0.21). The mean fracture strength values of three groups were 12.82 N/mm–2 , 11.93 N/mm–2 and 11.31 N/mm–2 , respectively; however, the differences were not statistically significant (P = 0.72). Favorable failure mode was more frequent in all groups (P = 0.12). Conclusion: Within the limitations of this study, it can be concluded that all three types of studied posts can be successfully used to restore badly destructed primary anterior teeth.
  3,256 506 2
Botox as an adjunct to lip repositioning for the management of excessive gingival display in the presence of hypermobility of upper lip and vertical maxillary excess
Lobna Abdel Aziz Aly, Nelly Ibrahim Hammouda
November-December 2016, 13(6):478-483
DOI:10.4103/1735-3327.197039  PMID:28182056
Background: Excessive gingival display (GD) is a frequent finding that can occur because of various intraoral or extraoral etiologies. This work describes the use of a mucosal repositioned flap for the management of a gummy smile associated with vertical maxillary excess (VME) and hypermobility of the upper lip followed by injection of Botox. Materials and Methods: Seven female patients in the age range of 17–25 years presented with a gummy smile. At full smile, the average GD ranged from 6 to 8 mm. A clinical examination revealed hypermobility of the upper lip. A cephalometric analysis pointed to the presence of VME. The mucosal repositioned flap surgery was conducted followed by injection with botulinum toxin type A (Botox) 2 weeks postsurgically. Results: After 4 weeks, results were definitely observed with a decrease from 8 mm gingival exposure to 3 mm, which was considered as normal GD for an adult during smiling. Conclusion: For patients desiring a less invasive alternative to orthognathic surgery, the mucosal repositioned flap is a viable alternative. Moreover, Botox is a useful adjunct to enhance the esthetics and improve patient satisfaction where surgery alone may prove inadequately in moderate VME.
  3,112 460 2
A comparative evaluation of Morinda citrifolia, green tea polyphenols, and Triphala with 5% sodium hypochlorite as an endodontic irrigant against Enterococcus faecalis: An in vitro study
AR Divia, Mali G Nair, Jolly Mary Varughese, Shobha Kurien
March-April 2018, 15(2):117-122
DOI:10.4103/1735-3327.226526  
Background: Endodontic infections require effective removal of microorganisms from the root canal system for long-term prognosis. Sodium hypochlorite (NaOCl) is the most effective irrigant currently, but potential complications due to its toxicity warrant search for newer alternatives. In this study, the antimicrobial efficacy of Morinda citrifolia (MC), green tea polyphenols and Triphala was compared with 5% NaOCl against Enterococcus faecalis. Materials and Methods: In this in vitro study sixty extracted human premolar teeth were infected with E. faecalis, a Group D Streptococci for 48 h. At the end of 48 h, the vital bacterial population was assessed by counting the number of colony-forming units (CFUs) on blood agar plate. Samples were divided into five groups; Group I (distilled water), Group II (NaOCl), Group III (MC), Group IV (Triphala), and Group V (green tea polyphenols). The samples were irrigated with individual test agents and CFUs were recorded. Kruskal–Wallis test was performed as the parametric test to compare different groups. Student's t-test was used to compare mean values between groups before and after treatment with test agents (P < 0.001). Results: NaOCl was the most effective irrigant the elimination of E. faecalis reinforcing its role as the best irrigant available currently and a gold standard for comparison of the experimental groups. Its antibacterial effect was comparable to Triphala. Among the experimental groups, MC showed the minimum antibacterial effect. Conclusion: The use of herbal alternatives as a root canal irrigant might prove to be advantageous considering the several undesirable characteristics of NaOCl.
  3,288 213 2
REVIEW ARTICLE
The cold ceramic material
Jalil Modaresi, Hamid Reza Hemati
March-April 2018, 15(2):85-88
DOI:10.4103/1735-3327.226522  
The purpose of this paper was to review the composition, sealing ability, biocompatibility and various physical properties of cold ceramic (CC) material that potentially used as a root filling material. The review of the articles was performed by electronic and manual searching methods regarding the properties of CC from November 2000 to May 2016. The results revealed that there were many published reports carried out on the properties of CC. Only one article had extensively studied the composition of CC, five studies had investigated the sealing ability of CC, three articles had studied the biocompatibility, and some studies had investigated the radiopacity, setting time, pH value, and solubility of CC. It was concluded that CC material had good potential for endodontic use. Furthermore, clinical studies are needed in these areas.
  3,193 277 -
ORIGINAL ARTICLES
Effects of artifact removal on cone-beam computed tomography images
Hooriyeh Bashizade Fakhar, Raheleh Emami, Kave Moloudi, Farzaneh Mosavat
March-April 2018, 15(2):89-94
DOI:10.4103/1735-3327.226531  
Background: Dental implants and metal fillings may cause artifacts in cone-beam computed tomography (CBCT) images and reduce image quality and anatomic accuracy. The purposes of this study are a subjective evaluation of anatomic landmarks and linear bone measurements after applying artifact removal (low–medium) option on CBCT images. Materials and Methods: In this cross-sectional study, thirty CBCT images from thirty qualified patients were selected in a private radiology center. Low and medium artifact removal was applied to images. Three radiologists assessed the visibility of the mandibular canal, mental foramen, and lamina dura in images. Crestal width and bone length were also measured in three groups of images and was compared by exact McNemar test. ICC test (two-way random model, absolute agreement types) was calculated for comparison of linear bone measurements in three images groups. P ≤ 0.05 was considered statistically significant. Results: Percent agreement of determining mental foramen (outline and location), mandibular canal (outline and location), and lamina dura between three groups of images were 100%, 100%, 83.3%, 96.7%, and 56.6%, respectively. The results of exact McNemar test revealed that medium artifact removal group had a statistical difference in lamina dura observation with none and low artifact removal groups (P < 0.001). Intraclass correlation coefficient showed no statistical differences in crestal width and bone length between groups (P < 0.001). Conclusion: Applying artifact removal does not affect the visibility of large anatomical structures and linear bone measurements, but delicate structures such as lamina dura may become less clear after artifact removal.
  3,186 273 -
The effect of two remineralizing agents and natural saliva on bleached enamel hardness
Haleh Heshmat, Maryam Hoorizad Ganjkar, Yasaman Miri, Mohamad Javad Kharrazi Fard
January-February 2016, 13(1):52-57
DOI:10.4103/1735-3327.174713  PMID:26962316
Background: In order to compensate the adverse consequences of bleaching agents, the use of fluoride-containing remineralizing agents has been suggested by many researchers. The aim of this study was to compare the effect of applying two remineralizing materials on bleached enamel hardness and in comparison to natural saliva. Materials and Methods: In this experimental study, 30 enamel samples of sound human permanent molars were prepared for this study. Microhardness (MH) of all specimens was measured and 35% hydrogen peroxide was applied 3 times to the specimens. After completion of the bleaching process, MH of samples was measured and then enamel specimens were divided into three groups each of 10, specimens of groups 1 and 2 were subjected to daily application of hydroxyl apatite (Remin Pro) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) (MI Paste Plus) pastes, respectively, for 15 days. In group 3, the specimens were stored in the operators' natural saliva at room temperature in this period of time. Final MH of all groups was measured. The data were analyzed using repeated measures ANOVA (α = 0.05). Results: The hardness significantly decreased in all groups following bleaching. Application of either Remin Pro, CPP-ACPF or natural saliva increased the hardness significantly. The hardness of the three test groups after 15 days were statistically similar to each other. Conclusion: The hardness of enamel increases eventually after exposure to either MI Paste Plus, Remin Pro or natural saliva.
  2,662 792 7
REVIEW ARTICLE
Prevalence of orthodontic treatment need in permanent dentition of Iranian population: A systematic review and meta-analysis of observational studies
Faezeh Eslamipour, Zohreh Afshari, Arash Najimi
January-February 2018, 15(1):1-10
DOI:10.4103/1735-3327.223616  
Background: Malocclusion is a common oral health problem and can affect the psychosocial well-being in the long term. Therefore, in the recent decades, demand for orthodontic treatment to correct malocclusion has greatly increased worldwide. This systematic review and meta-analysis was undertaken to assess existing evidence on the prevalence of orthodontic treatment need in Iran. Materials and Methods: National and international databases were searched for articles on the prevalence of orthodontic treatment need using index of orthodontic treatment need (IOTN) and dental aesthetic index (DAI). The required data were completed by hand-searching. After applying the inclusion and exclusion criteria, the quality of articles was checked by a professional checklist. Data extraction and meta-analysis were performed. A random effects model was employed, and publication bias was checked. Results: From a total of 443 articles that reported orthodontic treatment need in Iran, 24 articles were included in the meta-analysis process. Meta-analysis was performed on components of IOTN and DAI. The pooled prevalence of orthodontic treatment need based on Dental Health Component and Aesthetic Component of IOTN and DAI was 23.8% (19.5%–28.7%), 4.8% (3.3%–7%), and 16.1% (12.3%-20.8%). The results were found to be heterogeneous (P < 0.05). Conclusion: The results of this study revealed that orthodontic treatment need was not high in the Iranian population. Considering the differing prevalence of orthodontic treatment need based on normative index and self-perceived index, it is essential to improve the people's awareness of malocclusion and its side effects on their oral and general health.
  3,160 267 1
ORIGINAL ARTICLES
Clinical evaluation of Class II and Class III gingival recession defects of maxillary posterior teeth treated with pedicled buccal fat pad: A pilot study
D Deepa, KV Arun Kumar
January-February 2018, 15(1):11-16
DOI:10.4103/1735-3327.223613  
Background: Buccal fat pad (BFP) is a specialized vascular tissue adequately present in buccal space and is close to the maxillary posterior quadrant. The aim of this clinical study was to evaluate the utility of pedicled BFP (PBFP) in the treatment of Class II and III gingival recession. Materials and Methods: Ten systemically healthy patients with age ranging from 35 to 55 years with Class II and Class III gingival recession in the maxillary molars were selected. Before the surgical phase, patients were enrolled in a strict maintenance program including oral hygiene instructions and scaling and root planing. A horizontal incision of 1–1.5 cm was made in the buccal sulcus of the maxillary molar region; buccinator muscle was separated bluntly to expose the BFP. The fat was then teased out from its bed and spread to cover defects adequately. It was then secured and sutured without tension. Clinical parameters such as probing depth, recession width, recession length (RL), and width of keratinized gingiva were recorded at baseline and at 6 months postoperatively, and weekly assessment was done at 1 week, 2 weeks, 3 weeks, and after 4 weeks for observations during the postoperative healing. Results: Treated recession defects healed successfully without any significant postoperative complications. Decreased gingival recession horizontal width values from 4.65 ± 0.4327 to 0.94 ± 1.350 and RL from 6.4 ± 1.075 to 0.7 ± 0.6750 were observed postoperatively (P < 0.05). Percentage of root coverage average was 89.3%. There was a statistically significant decrease in the width and depth of recession. Conclusion: Pedicled buccal fat showed promising results as the treatment modality in the management of Class II and Class III gingival recession of maxillary posterior teeth.
  3,138 280 -
Viscosity of endodontic irrigants: Influence of temperature
Claudio Poggio, Matteo Ceci, Riccardo Beltrami, Marco Colombo, Alberto Dagna
September-October 2015, 12(5):425-430
DOI:10.4103/1735-3327.166189  PMID:26604955
Background: The aim of this study was to assess the influence of temperature on the viscosity of different endodontic irrigants. Materials and Methods: The measurements of viscosity of 3% hydrogen peroxide, 0.9% sodium chloride, aqueous solution of 0.2% chlorhexidine (CHX) and 0.2% cetrimide, 5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) at different temperatures (22°C, 30°C, 40°C, 50°C and 60°C) were obtained using Mohr balance and Ostwald viscometer. The Shapiro-Wilk test and Mann-Whitney U-tests were used for the statistical analysis. (α = 0.05). Results: No significant differences were recorded at each temperature among 3% hydrogen peroxide, 0.9% sodium chloride and aqueous solution of 0.2% CHX and 0.2% cetrimide. 5% NaOCl and 17% EDTA showed the higher values. Viscosity statistically decreased with increasing temperature. Conclusion: Within the limitations of this study, 5% NaOCl and 17% EDTA are significantly viscous at room temperature and their viscosity reduces with elevating temperature.
  3,091 322 1
Design, formulation, and evaluation of a herbal gel contains melissa, sumac, licorice, rosemary, and geranium for treatment of recurrent labial herpes infections
Abolfazl Aslani, Behzad Zolfaghari, Yeganeh Fereidani
May-June 2018, 15(3):191-200
DOI:10.4103/1735-3327.231865  PMID:29922338
Background: The herpes simplex virus is a human pathogen which can cause skin or mucous membrane infections. Melissa, sumac, licorice, rosemary, and geranium have antimicrobial, antiviral, anti-inflammatory, and local analgesic effect. Shortening recovery period of recurrent herpes labialis and control of viral protein formation are the other effects of these herbs. The aim of this study is design, formulation, and evaluation of the gel containing extracts of these five herbs. Materials and Methods: In this experimental study after photochemical and macroscopic evaluation of these medicinal herbs, the semisolid concentrated extracts were incorporated in gel bases. Mucoadhesive gels were prepared using carbopol 940, sodium carboxymethylcellulose (Na CMC) and hydroxypropyl methylcellulose K4M as bioadhesive polymers. Physicochemical tests, viscosity, mucoadhesive strength measurement, and in vitro drug release study were carried out on formulations F10 (carbopol 940, 0.5% and Na CMC, 3%) and F11 (carbopol 940, 1% and Na CMC, 3%). Results: Polyphenol content of extracts mixture was measured 210.8 ± 13.68 mg GAE/g. pH of formulations was 6.0 ± 0.2. 14 gel formulations were prepared. Physical appearance, homogeneity, and consistency of F10and F11were good. Mucoadhesion and viscosity of F11was more than F10. Study of release profiles in F10and F11formulations showed drug release from F11was slower. Conclusion: The best formulation for treatment and shortening recovery period of recurrent labial herpes infections should exhibit high value of mucoadhesion, show controlled release of drug. F11with the highest viscosity and mucoadhesion and the lowest release rate was considered as the best formulation.
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Microbiological analysis after complete or partial removal of carious dentin using two different techniques in primary teeth: A randomized clinical trial
Deepak Kumar Singhal, Shashidhar Acharya, Arun Singh Thakur
January-February 2016, 13(1):30-37
DOI:10.4103/1735-3327.174695  PMID:26962313
Background: The management of deep carious lesions can be done by various techniques but residual caries dilemma still persists and bacterial reduction in cavities treated by either partial or complete caries removal techniques is debatable. So the objective of the present randomized clinical trial was to compare microbial counts in cavities submitted to complete caries removal and partial caries removal using either hand instruments or burs before and after 3 weeks of restoration. Materials and Methods: Primary molars with acute carious lesions in inner half of dentine and vital pulp were randomly divided into three groups of 14 each: Group A: Partial caries removal using hand instruments atraumatic restorative treatment (ART) only; Group B: Partial caries removal using bur; Group C: Complete caries removal using bur and caries detector dye. Dentine sample obtained after caries removal and 3 weeks after restoration, were subjected to microbial culture and counting (colony-forming units [CFU]/mg of dentine) for total viable bacterial count, Streptococcus spp., mutans streptococci, Lactobacillus spp. Results: Three techniques of caries removal showed significant (P < 0.05) reduction in all microorganisms studied after 3 weeks of evaluation, but there was no statistically significant difference in percentage reduction of microbial count among three groups. Conclusion: Results suggest the use of partial caries removal in a single session as compared to complete caries removal as a part of treatment of deep lesions in deciduous teeth in order to reduce the risk of pulp exposure. Partial caries removal using ART can be preferred for community settings as public health procedure for caries management.
  2,839 543 8
Effect of different cavity conditioners on microleakage of glass ionomer cement with a high viscosity in primary teeth
Romina Mazaheri, Leila Pishevar, Ava Vali Shichani, Sanas Geravandi
July-August 2015, 12(4):337-341
DOI:10.4103/1735-3327.161448  PMID:26288623
Background: Glass ionomer cement is a common material used in pediatric dentistry. The aim of this study was to evaluate the microleakage of high-viscosity glass ionomer restorations in deciduous teeth after conditioning with four different conditioners. Materials and Methods: Fifty intact primary canines were collected. Standard Class V cavities (2 mm × 1.5 mm × 3 mm) were prepared by one operator on all buccal tooth surfaces, including both enamel and dentin. The samples were divided into five groups with different conditioners (no conditioner, 20% acrylic acid, 35% phosphoric acid, 12% citric acid, and 17% ethylenediaminetetraacetic acid [EDTA]). Two-way - ANOVA, Kruskal-Wallis and Mann-Whitney tests were used to compare the means of microleakage between the five groups. The significance level was set at P < 0.05. Results: There was no significant difference between the means of microleakage in incisal (enamel) and gingival (dentin) margins (P = 0.34). Furthermore, there was no significant difference between the means of microleakage in enamel and dentin margins (P = 0.4). There was a significant difference between the means of microleakage in different groups (P = 0.03). Conclusion: Within the limitations of this study, it is suggested that 20% acrylic acid and 17% EDTA be used for cavity conditioning which can result in better chemical and micromechanical adhesion.
  2,905 456 2
Innovative evaluation of local injective gel of curcumin on the orthodontic tooth movement in rats
Sohrab Asefi, Massoud Seifi, Ghazal Hatami Fard, Ali Lotfi
January-February 2018, 15(1):40-49
DOI:10.4103/1735-3327.223618  
Background: Curcumin is the most active compound in turmeric. It can suppress the nuclear factor kappa-light-chain-enhancer of activated B cells pathway and prevent the osteoclastogenesis procedure. This study aimed to be the first to evaluate the effect of curcumin on the rate of orthodontic tooth movement (OTM). Materials and Methods: Forty rats were used as follows in each group: (1) negative control: Did not receive any appliance or injection; (2) positive control: received 0.03 cc normal saline and appliance; (3) gelatin plus curcumin (G): Received 0.03 cc hydrogel and appliance; and (4) chitosan plus curcumin (Ch): Received 0.03 cc hydrogel and appliance. They were anesthetized and closed nickel-titanium coil springs were installed between the first molars and central incisors unilaterally as the orthodontic appliance. After 21 days, the rats were decapitated, and the distance between the first and second molars was measured by a leaf gauge. Howship's lacunae, blood vessels, osteoclast-like cells, and root resorption lacunae were evaluated in the histological analysis. Data were analyzed by one-way ANOVA, Tukey's test, and t-test (P < 0.05 consider significant). Results: No significant difference was found in OTM between groups delivered orthodontic forces. Curcumin inhibited root and bone resorption, osteoclastic recruitment, and angiogenesis significantly. Conclusion: Curcumin had no significant inhibitory effect on OTM. While it had a significant role on decreasing bone or root resorption (P > 0.05).
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Clinical and radiographic assessment of mineral trioxide aggregate and calcium hydroxide as apexification agents in traumatized young permanent anterior teeth: A comparative study
SG Damle, Hiteshwar Bhattal, Dhanashree Damle, Abhishek Dhindsa, Ashish Loomba, Sumit Singla
May-June 2016, 13(3):284-291
DOI:10.4103/1735-3327.182191  PMID:27274351
Background: To evaluate and compare the efficacy of mineral trioxide aggregate (MTA) and traditionally used calcium hydroxide (Ca(OH) 2 ) in inducing root end formation of immature roots of traumatized young permanent anterior teeth. Materials and Methods: The study was carried out on 22 nonvital, immature permanent maxillary incisors. Samples were allotted into two groups - Group I MTA and Group II Ca(OH) 2 Success rate was determined based upon the time duration required for apical barrier formation. The canals were obturated using gutta-percha points in MTA group, after 24 h, whereas in Ca(OH) 2 group, obturation was carried out after radiographic confirmation of the apical barrier. The clinical and radiographic evaluation was carried out at a follow-up periods of 3, 6, and 9 months and statistical analysis was carried out by SPSS version 15.0 statistical analysis software (Chi-square test and fisher exact test). Results: In MTA Group, barrier formation was observed in 90.90% of the patients after 9 months whereas in Ca(OH) 2 Group, the same was observed in 81.81%. The mean time required for barrier formation in MTA group was 4.90 months and 5.33 months in Ca(OH) 2 group. Conclusion: MTA and Ca(OH) 2 , as medicaments for apexification, were comparable in terms of the evaluation parameters. However, MTA was beneficial in terms of immediate obturation of immature roots with wide open apices.
  2,857 486 4