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   Table of Contents - Current issue
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September-October 2020
Volume 17 | Issue 5
Page Nos. 319-408

Online since Monday, September 7, 2020

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ORIGINAL ARTICLES  

An in vitro evaluation of the compressive strength and shear bond strength of resin-modified glass-ionomer cement containing purified powder of Salvia officinalis Highly accessed article p. 319
Maryam Forouzanmehr, Mehrdad Barekatain, Mohammad Ali Shahtalebi
DOI:10.4103/1735-3327.294325  
Background: In this study, the effect of adding purified powder of Salvia officinalis on the mechanical properties and bonding ability of resin-modified glass ionomer (RMGI) cement is investigated. Materials and Methods: In this in vitro study Purified powder of S. officinalis with particles smaller than 50 μ, in weight percentages of 0.5%, 0.75%, 1%, and 1.25%, was added to RMGI powder (GC Fuji II LC, GC USA). Fifty samples in five groups of control and percentages that considered, from the powder of GI combined with liquid, according to the manufacturer instructions and prepared samples with 4 mm × 6 mm dimensions and placing in distilled water in an incubator with temperature 37°C for 24 h. Fifty sound extracted upper premolars were collected and divided into five groups. The dentinal cross-sections on the occlusal surfaces of teeth were prepared and assessed under a stereomicroscope with ×16. Then, samples with 2 × 4 dimensions from RMGI was prepared on dentin surface and keeping in moisture environment in an incubator with temperature 37°C for 24 h. Compressive strength and shear bond strength test done with a universal testing machine at the rate of 0.5 mm/min. For the assessment of mode of failure, stereomicroscope with a digital camera and ×20 was used, and photographs from bonding surface were taken. After collecting data, the ANOVA test was used for comparing shear bond strength between groups and Kruskal–Wallis test was used for comparing compressive strength. The Chi-square test was used for comparing the mode of failure between groups. The significance level for all tests was considered 5%. Results: According to the statistical analysis, compressive strength (P = 0.486) and shear bond strength (P = 0.076) were not significantly different between the five groups. The distribution of mode of failure was not significantly different between groups (P = 0.663). Conclusion: The addition of purified powder of S. officinalis to RMGI powder does not affect compressive strength and shear bond strength of RMGI cement.
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Effects of different stretching extents, morphologies, and brands on initial force and force decay of orthodontic elastomeric chains: An in vitro study p. 326
Seyed Mohammad Mousavi, Sara Mahboobi, Vahid Rakhshan
DOI:10.4103/1735-3327.294331  
Background: Elastomeric chains are of clinical importance to orthodontics. Therefore, their behavior should be assessed under different conditions. Some of their critical aspects remain unstudied (including effects of different elongations and chain forms on their force properties). Therefore, we aimed to assess these factors. Materials and Methods: This in vitro study was performed on 540 observations: first, 90 chains (10 specimens per subgroup of three brands [American Orthodontics, Ortho Technology (OT), and G&H], each from three chain types [closed, short, and long]) were stretched for three extents (40%, 60%, and 100%) and their forces were measured using a universal testing machine. Afterward, 270 new chains of the same brands/types were stretched for the same extents by installing them onto pairs of pins with different interpin distances. Plates holding pins/chains were incubated in artificial saliva at 37°C for 4 weeks. Afterward, their forces were measured and analyzed using partial correlation coefficient, three-way analysis of variance (ANOVA), Tukey, Student's t, and Mann–Whitney tests (α = 0.001). Results: Forces degraded significantly from an overall mean of 3.97 ± 0.97 N to 1.29 ± 0.39 N after 4 weeks (all P = 0.000, t-test/Mann–Whitney). ANOVA showed highly significant differences among brands, types, and elongations, in terms of “initial force, force decay, and residual force” (all P = 0.000). Almost all post hoc pairwise comparisons were significant (Tukey P = 0.000). There was a strong positive correlation between elongation extent and force loss (r = 0.846, P = 0.000). Conclusion: OT might be the most preferable brand. Closed chains might usually show better results, especially in OT chains. Instead of using chains half of the size of the space (to elongate for 100%), longer chains should be used to stretch for lesser extents.
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Association of temporomandibular joint morphology in patients with and without temporomandibular joint dysfunction: A cone-beam computed tomography based study p. 338
Anuridhi Choudhary, Upasana Sethi Ahuja, Akshay Rathore, Nidhi Puri, Manu Dhillon, Akansha Budakoti
DOI:10.4103/1735-3327.294334  
Background: The etiology of temporomandibular disorders (TMDs) is complex and associated with multiple predisposing and initiating factors. Articular eminence morphology and steep eminence inclination have been postulated as the etiological factors, but there has been no clear evidence of association of morphology of the temporomandibular joints (TMJ) complex as a probable predisposing factor in the pathogenesis of TMDs. Materials and Methods: This was a cross-sectional, case–control study, and cone-beam computed tomography scans, and the evaluation was performed for 60 joints in 30 patients with symptomatic TMDs and for 40 healthy joints of 20 age-matched patients. One-way ANOVA, post hoc, unpaired t-test, Chi-square, and intra-class correlation coefficient test were used to determine the correlation between the TMJ articular eminence inclination, height, condylar bone changes, condyle, and fossa shapes with symptomatic TMDs. The P < 0.05 were considered statistically significant. Results: There was a statistically significant difference of articular eminence inclination and height with a steeper eminence inclination in the control group (P = 0.044*, and 0.035*). The condylar bone changes were found to be significantly more in the TMJ disorder group (P = 0.001*). There was no significant association of condyle and fossa shapes (P = 0.482 and 0.689) and of articular eminence inclination and height with condylar bone changes (P = 0.695, 0.498, 0.192, and 0.823) and condyle shapes (P = 0.389, 0.521, 0.260, and 0.387). The eminence inclination was not associated with fossa shapes (P = 0.471 and 0.086), but eminence height was associated with fossa shapes in the TMJ disorder group (P = 0.043* and 0.111). Conclusion: The results depicted that there was no significant association between TMJ complex anatomy and TMJ disorders in the present study population.
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A spectroscopic assessment of interaction between 4% articaine hydrochloride with adrenaline and various endodontic irrigants p. 347
Kristam Lakshmi Shivaraj, Balasubramanian Saravana Karthikeyan, Nandini Suresh, Velmurugan Natanasabapathy
DOI:10.4103/1735-3327.294332  
Background: Interaction between 2% lidocaine HCl (with and without adrenaline) and sodium hypochlorite (NaOCl) resulted in a toxic precipitate formation. The aim of this in vitro study was to assess the interaction between 4% articaine hydrochloride with adrenaline (AHa) and commonly used endodontic irrigants 3% NaOCl, 2% chlorhexidine (CHX), and 17% ethylenediaminetetraacetic acid (EDTA) using spectroscopic analyses. Materials and Methods: In this in vitro study, 3% NaOCl, 2% CHX, and 17% EDTA were mixed with 4% AHa individually. 1.7 ml of 4% AHa from the cartridge was mixed with 1.7 ml of each test irrigants. The solutions were subjected to a preliminary ultraviolet spectroscopic (UVS) analysis to assess forpotential interactions (if any). If the interaction was detected, the test solutions were further subjected to nuclear magnetic resonance (NMR) analysis for characterization. The precipitate formed (if any) was then subjected to NMR analysis. Results: UVS analysis revealed a bathochromic shift when 3% NaOCl and 2% CHX were mixed with 4% AHa, respectively. This shift was not observed when EDTA was mixed with 4% AHa. 1H and 13C NMR spectra confirmed the interaction between 3% NaOCl with 4% AHa, which resulted in a precipitate formation, methyl 3-amino-4-methylthiophene-2-carboxylate (MAMC). The analysis of 1H NMR spectra showed peaks at 7.1 ppm, 2.21 ppm, and 9.93 ppm, respectively, which corresponds to aromatic ring protons. A peak at 3.8 ppm was assigned to methyl proton of methyl ester. The characteristic appearance of peaks at 14.82 and 51.16 ppm corresponds to aliphatic carbons. The five peaks occurring at 126, 134.5, 139.2, 156.5, and 162.9 ppm correspond to the aromatic carbon atoms present in the thiophene unit. NMR spectra revealed no interaction between 2% CHX and 4% AHa. 1H and 13C NMR spectra confirmed that 3% NaOCl interacted with 4% AHa, leading to the formation of a precipitate MAMC. Conclusion: 3% NaOCl interacted with 4% AHa leading to the formation of a precipitate MAMC which is reported to exhibit the least toxicity. Until the precipitate is studied further, it would be advisable to avoid the immediate use of NaOCl following administration of intrapulpal anesthetic solution with articaine hydrochloride (with adrenaline).
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Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial p. 354
Mohammadreza Badiee, Nima Jafari, Sayedali Fatemi, Nazila Ameli, Shahin Kasraei, Asghar Ebadifar
DOI:10.4103/1735-3327.294328  
Background: Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions. Materials and Methods: In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05. Results: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste. Conclusion: The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.
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Oral health status, self-perceived dental needs, and barriers to utilization of dental services among people with psychiatric disorders reporting to a tertiary care center in Haryana p. 360
Girish M Sogi, Sami Ahmed Khan, Manish Bathla, Jasneet Sudan
DOI:10.4103/1735-3327.294324  
Background: Patients with psychiatric disorders can be vulnerable to oral diseases due to the adverse effects of medications and disease per se. The aim of this study is to assess oral health status, self-perceived dental needs, and barriers to utilization of dental services along with evaluation of intervention urgency among psychiatric patients. Materials and Methods: In this cross-sectional study, 165 individuals were examined at the psychiatric outpatient department of a tertiary care center. Clinical examination [dentition status and community periodontal index (CPI) modified] was done according to the World Health Organization Basic Oral Health Surveys, 2013. Other information was collected by direct interview and all the data were recorded on a prestructured, validated pro forma. Data were analyzed using SPSS Software. The statistical significance was determined by analysis of variance (ANOVA) and level of significance was set at P < 0.05. Results: Although decayed, missing, and filled teeth (DMFT) and CPI-modified scores increased with increase in duration of illness, the difference was not statistically significant. Evaluation of self-reported attributes revealed that the majority of the individuals had reported dental pain (34.6%) as their dental problem, 39.6% visit dentist only when there is a dental problem, and 41.7% did not felt any need to visit dentist. The ANOVA of DMFT in relation to duration of illness (P > 0.062) and CPI-modified scores (P > 0.078) were not statistically significant. Although when intervention urgency was evaluated, 70.3% needed prompt treatment depending on their oral health assessment. Conclusion: The findings of this study suggest that oral health concerns of this marginalized section of the population are unrecognized and should be given prominence by psychiatrists.
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Quantitative evaluation of remineralizing potential of three agents on artificially demineralized human enamel using scanning electron microscopy imaging and energy-dispersive analytical X-ray element analysis: An in vitro study p. 366
Nitin Khanduri, Deepak Kurup, Malay Mitra
DOI:10.4103/1735-3327.294329  
Background: The aim of this study is to quantitatively evaluate the remineralization potential of three remineralizing systems as follows: fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and CPP-ACP with fluoride, under scanning electron microscope with energy-dispersive X-ray analysis. Materials and Methods: In this in vitro study A total of 40 enamel specimens were prepared from the buccal or lingual surfaces of human premolars extracted for orthodontic reason. Specimens were then placed in demineralizing solution for 96 h, to produce artificial caries-like lesion. Calcium and phosphate weight percentage of demineralized specimens was measured. Specimens were divided into four groups as follows: (a) control, (b) CPP-ACP, (c) CPP-ACP with fluoride, and (d) fluoride varnish. Except for the control group, the entire specimens were subjected to remineralization using respective remineralizing agents of their groups. The prepared specimens were assessed for calcium and phosphate weight percentage using scanning electron microscopy-energy dispersive X-ray spectroscopy. One way analysis of variance (ANOVA), followed by Tukey's test, was performed with the help of critical difference (CD) or least significant difference at 5% and 1% level of significance. P ≤ 0.05 was taken to be statistically significant and P < 0.001 as statistically highly significant. Results: The mean weight percentage of calcium and phosphorus of specimens treated with CPP-amorphous calcium phosphate nanocomplexes plus fluoride (ACPF) was significantly higher than other groups. Conclusion: All the groups showed statistically significant remineralization. However, because of added benefit of fluoride, CPP-ACPF showed statistically significant amount of remineralization than CPP-ACP.
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Height and dental caries among 13-year-old adolescents in India: A sociobehavioral life course approach p. 373
Shilpi Singh, N Vijayakumar
DOI:10.4103/1735-3327.294330  
Background: The aim of the study was to assess the relationship between height and dental caries among 13-year-old adolescents in schools of Bangalore, India. Materials and Methods: A cross-sectional study was undertaken on 1900 schoolchildren aged 13 years from both government and private schools of Bangalore using stratified random sampling. Demographic data; family-related factors; and general and oral health-related factors such as frequency of sugar consumption, dietary habits, oral hygiene practices, and dental attendance were interviewed using both open-ended and close-ended questions. Anthropometric measurements for height and weight were performed. Clinical examination was done and caries was recorded using the decayed, missing, and filled teeth (DMFT) index (WHO criteria, 1997). Data were analyzed using SPSS version 21.0, and descriptive statistics including percentages, mean, and frequencies were performed. Student's t-test and ANOVA were applied to find the significant differences between mean DMFT among groups. Categorical data were analyzed by Chi-square test for differences between groups. Pearson correlation coefficient was used to find the correlation among dental caries and height and body mass index (BMI).P value was set at a statistical significance level of 0.05. Results: The prevalence of dental caries among the study population was 36.3% which was higher among girls as compared to boys. Dental caries was found to be significantly associated with socioeconomic status, family structure, birth order, use of oral hygiene aids, mouthrinsing, last dental visit, weight, and BMI. Height and BMI showed a strong negative correlation with dental caries. Conclusion: The present study showed a significant negative correlation between height and dental caries. However, since both caries and height are a dynamic phenomenon, hence a longitudinal study exploring the possible relationship should be considered.
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Fenestration and dehiscence in the alveolar bone of anterior maxillary and mandibular teeth in cone-beam computed tomography of an Iranian population p. 380
Zahra Dalili Kajan, Seyed Ebrahim Seyed Monir, Negar Khosravifard, Delara Jahri
DOI:10.4103/1735-3327.294327  
Background: The presence of dentoalveolar lesions such as fenestration and dehiscence has great clinical importance. This study was designed to determine the incidence of bony fenestrations and dehiscences associated with the anterior teeth by using cone-beam computed tomography images. Materials and Methods: A total of 216 images (1189 teeth) were included in this cross-sectional study. The presence of fenestration and dehiscence at the buccal and lingual/palatal surfaces and also their relative levels on the roots of the teeth were determined. McNemar's, Chi-square, and Cochran's Q tests were used for data analysis. A value of P < 0.05 was considered to be statistically significant. Results: The incidence of fenestration and dehiscence was 17.6% and 3.9%, respectively with the maxillary fenestrations being more prevalent (P < 0.0001). No significant differences were observed in the incidence of dehiscences between the jaws (P = 0.824) and among the tooth types (P = 0.689). The lesions were more frequent at the buccal surfaces (80%–92.5%). About 85.9% of the fenestrations occurred in the apical root thirds, whereas dehiscences had the highest prevalence in the cervical thirds. Fenestration and dehiscence incidences were significantly higher in females (P < 0.05). There was no significant difference among the age groups regarding these lesions. Conclusion: Fenestration and dehiscence were observed more on the buccal surfaces and also in the apical and cervical root thirds, respectively. Age had no significant influence on the occurrence of these lesions in contrast to the sex.
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Risk factors for anterior open bite: A case–control study p. 388
Suellen de Lima Mendes, Isabella Lima Arrais Ribeiro, Ricardo Dias de Castro, Vitor Marques Filgueiras, Tânia Braga Ramos, Rosa Helena Wanderley Lacerda
DOI:10.4103/1735-3327.294335  
Background: Anterior open bite (AOB) is noteworthy because it is a complex dysplasia, and clinical studies on this malocclusion are usually epidemiological studies or experimental models with small samples and no control group, which renders the data on AOB incomplete and therefore inconclusive. The objective this study was to assess the risk factors involved in developing AOB. Materials and Methods: A case–control study was provided with a total of 96 lateral cephalometric radiographs of male and female patients aged between 8 and 14 years were used, regardless of facial type. The dependent variable was the presence or absence of AOB, which divided the participants into case and control groups, respectively; these groups were matched for gender and age. The case and control groups data were analyzed by descriptive and inferential analysis by binary logistic regression using at the 5% significance level Results: The occurrence of AOB was associated with the presence of deleterious oral habits (P = 0.014; Chi-square test) and was approximately three times (odds ratio = 3.04) more likely to occur in participants with AOB. No significant association between the presence of mouth breathing and the occurrence of AOB was found (P = 0.151; Chi-square test). The odds associated with tongue interposition were 10.51 times higher than those of participants with no such deglutition. The odds associated with the dolichofacial pattern were 5.74 times those of participants with a nondolichofacial pattern. Conclusion: Tongue interposition and dolichocephalic facial pattern were risk factors for developing AOB.
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Can oral health-related quality of life be worsened by dental appointments? p. 395
Afolabi Oyapero, Augustine I Edomwonyi, Abiola Adetokunbo Adeniyi, Olubukola Olamide Olatosi
DOI:10.4103/1735-3327.294326  
Background: Constraints in dental access and limitations associated with service delivery necessitate the use of an appointment system in patient care. This research aimed to identify association between treatment appointments and oral health-related quality of life (OHRQOL) in dental patients at the Lagos State University Teaching Hospital. Materials and Methods: This was a descriptive study that surveyed 412 individuals. Socio-demographic, clinical history, and OHRQOL data was collected using a structured interviewer administered questionnaire. Visual analog scale (VAS) was used to assess inconvenience while the oral health impact profile-14 was used for OHRQOL assessment at baseline and at review. Data entry and analysis was done using SPSS while ANOVA and Chi-square tests were used to determined significant association. P < 0.05 was considered significant. Results: Most (175; 45.2%) dental appointments were within a month although 59 (15.2%) individuals had to wait for more than 6 months. Using VAS, 87 (22.5%) individuals were moderately inconvenienced while 68 (17.6%) were extremely inconvenienced. At baseline, the most commonly reported oral health quality of life impacts were within the dimensions “physical pain” and “psychological discomfort.” At review, there was increase in OHRQOL scores in the subdomains of pain (2.27 ± 1.80), self-consciousness (1.67 ± 1.15), discomfort on chewing (1.61 ± 1.13), and pronouncing words (1.49 ± 2.21). The highest mean impact score (2.27 ± 1.80) was observed in the subdomain of painful aching in the mouth. Conclusion: Dental appointments appear to result in worse OHRQOL. Since the appointment systems in public oral health facilities may have a direct bearing on OHRQOL of patients, quality control standards on dental appointments should be established and enforced.
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CASE REPORT Top

Biological posts and crown: An esthetic recovery of smile p. 404
Shilpi Tiwari, MS Adarsha, Ashwini Santosh, Chethana S Murthy
DOI:10.4103/1735-3327.294333  
Anterior teeth fracture is a common form of dental trauma that mainly affects children and adolescents. Maxillary incisors are the most commonly affected teeth. Loss of coronal tooth structure might affect esthetics and function. In recent decades, dentistry has shown many scientific and technological advances in restorative materials. However, no synthetic restorative material can replicate the natural tooth structure. Hence, the use of natural tooth as a restorative material has been suggested in literature and is termed as a biological restoration. The present case report represents the successful use of biological post and crown and was adequate with respect to adhesion, function, and esthetics with the follow-up period of 1 year. Hence, it may be concluded that the biological restoration, if feasible, is a cost-effective way to restore a damaged tooth with acceptable esthetics and tooth functions in the stomatognathic system.
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