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Vajrabhaya L, Sappayatosok K, Kulthanaamondhita P, Korsuwannawong S, Sirikururat P. Desensitizing Efficacy of a Herbal Toothpaste: A Clinical Study. World J Dent 2019; 10 (6):408-412.
Aim: This double-blinded randomized parallel-group comparison study aimed to investigate the efficacy of an herbal desensitizing toothpaste (test group) compared to a 5% potassium nitrate toothpaste (control group) and a base toothpaste (benchmark group), with respect to dentine hypersensitivity. Materials and methods: Ninety healthy participants were arbitrarily allotted into three groups. All subjects received instructions on oral hygiene using a toothbrush with these toothpastes for a 4-week period. The subjects were evaluated at baseline, week 2, and week 4. During the visits, two hypersensitive teeth were assessed using two validated stimulus tests: a tactile test and an airblast test. Data on the percentage of positive responses to the tactile stimulus and visual analog scale (VAS) scores for air stimulation were analyzed. Results: The mean airblast VAS score and percentage of positive responses to the tactile stimulus after using the test and control toothpastes were significantly reduced compared with the benchmark. At week 4, the airblast VAS score and percentage of positive responses to the tactile stimulus decreased significantly in the test and control groups (p < 0.01), whereas the scores in the benchmark group decreased slightly. Conclusion: After 4 weeks of use, the herbal desensitizing toothpaste significantly diminished dentine hypersensitivity to the same extent as did the synthetic desensitizing toothpaste. Clinical significance: An herbal desensitizing toothpaste can reduce dentine hypersensitivity, supporting its usefulness in clinical practice.
Sunila B Sangappa,
Thomas V Chacko,
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Sangappa SB, Chacko TV, Bhandary S. Ensuring Student Competence in Essential Dental Consultation Communication Skills for Patient Care: Developing, Validating and Piloting a Comprehensive Checklist. World J Dent 2019; 10 (6):413-421.
Aim: Ability to communicate effectively as a core competency for dental practitioners is deemed important for a patient-centered practice. This study aims to pilot the process of developing and using a comprehensive checklist for ensuring student competence in essential dental consultation communication for patient care.
Materials and methods: A total of 87 third-year dental undergraduate students’ videotaped patient interviews were independently rated by six raters to evaluate the psychometric properties of the developed Dental Consultation Communication Assessment Checklist (DCCAC). Students were given training in basic consultation communication skills and patient interview techniques according to the developed DCCAC. Improvement in communication was assessed in pre-intervention and post-intervention using the checklist for giving feedback on performance of real patient examination.
Results: The majority of faculty (84%) and patients (93%) gave positive feedback (satisfaction) on the process and 87% of the students’ feedback indicated they would use their learning regarding communication skills in the future (transfer to practice). This comprehensive tool was found to be highly reliable with internal consistency reliability (Cronbach\'s alpha) of 0.987. Construct validity of the tool was examined through principal components analysis with varimax rotation. Based on the principal component analysis, new extracted domains demonstrated very high internal consistency (Cronbach\'s alpha range = 0.975–1.00).
Conclusion: The product arising from the development and psychometric testing of DCCAC for undergraduate dental students has the potential to be used as a valid tool to assess clinical competence during a patient interview and provide specific and formative feedback/self-reflection for consciously improving performance during the next patient encounters. Self-reflection during formative years will also make them reflective practitioners engaging in continuing professional development (CPD) in the future.
Clinical significance: The DCCAC developed by us would ensure that dental graduates will be competent in dental consultation communication and use the habit of self-reflection to engage in CPD to improve the quality of patient-centered care.
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Loganathan K, Mohan J, Kamaraj B, Jaganathan S, Sengodan S, Varghese A. Comparison of New Flap Design with Conventional Flap Designs on Postoperative Pain and Swelling Following Mandibular Third Molar Removal. World J Dent 2019; 10 (6):422-427.
Aim: To evaluate a new flap design that is a modification of an envelope flap in reducing the postoperative complications and to compare it with the conventional flaps such as a bayonet flap and an envelope flap for the surgical removal of impacted mandibular third molars. Materials and methods: A prospective randomized control clinical study was conducted on 90 medically healthy patients who came with impacted mandibular third molars. The patients were randomly divided into group I, group II, and group III of 30 patients each. All three group patients underwent surgical removal of impacted mandibular third molars wherein for group I patients, a bayonet flap was raised, for group II a modified envelope flap (new flap design), and for group III an envelope flap was raised. Postoperative pain and swelling at day 1, 3, and 7 were assessed and compared. Data were analyzed with ANOVA, using SPSS software version 20. Results: The group II proved more successful in reducing the postsurgical sequelae of impacted third molar removal. Postoperative analysis showed increased amount of pain and swelling in groups I and III as compared to group II. Conclusion: The new design flap that is a modification of an envelope flap is more superior to other two conventional techniques. Clinical significance: The new flap design is useful in reducing postoperative pain and swelling, which is the most common sequel of surgical removal of the impacted third molar and is easy to practice.
Aim: The aim of the present study was to compare and assess film thickness and temperature of different luting cements. Materials and methods: A total of 45 samples (15 glass slabs with respective cements in each group) were prepared. Group I: zinc phosphate, group II: resin-modified glass-ionomer cement (RMGIC), group III: glass ionomer cement type I. This study was conducted as per the American Dental Association (ADA) specification no. 8 guidelines. Two glass slabs of 2 cm width and 5 cm length were used. The complete assembly of glass slabs was placed in a water bath at 25°C ± 2°C and 35°C ± 2°C temperature. One glass slab was placed on top of the other glass slab and a metallurgical microscope with a magnification of 10× was used to measure the space between the two glass slabs. Results: The lowest film thickness (22.180 ± 0.68) was reported for RMGIC, followed by the glass ionomer cement type I group (26.844 ± 0.24) and then the zinc phosphate group (27.650 ± 0.32). ANOVA analysis indicated statistically significant intergroup differences between different luting cements’ film thickness at 25°C ± 2°C temperature. At 35°C ± 2°C temperature, the lowest film thickness (26.262 ± 0.16) was reported for RMGIC, immediately followed by the glass ionomer cement type I group (27.713 ± 0.01) and then the zinc phosphate group (28.103 ± 0.10). However, the film thicknesses of different luting cements at 35°C ± 2°C temperature were not found to be statistically significant. Conclusion: After considering the limitations of this study, it can be concluded that the resin-modified glass ionomer cement demonstrates the lowest film thickness when compared to the glass ionomer cement and zinc phosphate. This suggests that a temperature of 25°C ± 2°C is preferred for mixing the cement when it has to be used for the luting purpose. Clinical significance: The selection of the luting cement is a critical part in restorative dentistry. This study evaluated the effect of temperature on film thicknesses of different luting cements, which helps in the clinical selection of dental cements.
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Dsouza TS, Radhakrishna V, Dsouza N, Kumari S. In Vitro Cytotoxic Evaluation of Mineral Trioxide Aggregate with Silver and Titanium Dioxide Nanoparticles. World J Dent 2019; 10 (6):432-434.
Aim: The aim of the study was to evaluate the cytotoxicity of mineral trioxide aggregate (MTA) when mixed with either silver or titanium dioxide (TiO2) nanoparticles on human lymphocytes. Materials and methods: Human lymphocytes were exposed to white MTA or MTA in combination with silver or TiO2 nanoparticles. The cytotoxicity was assessed using the MTT assay for freshly mixed pellets, at 24 hours, at 48 hours, and at 72 hours time periods. The results were statistically analyzed. Results: There was no significant difference in the experimental groups with regard to cell viability. The addition of nanoparticles to MTA showed similar cell viability compared with MTA alone. Conclusion: Mineral trioxide aggregate mixed with silver or TiO2 nanoparticles showed similar biocompatibility to MTA alone. Clinical significance: The cytotoxicity exhibited by silver or TiO2 nanoparticles when mixed with MTA showed no significant difference and therefore, they can be used as a suitable additive to improve the antimicrobial efficacy of MTA.
Ramdas M Nirmal,
Thuckanickenpalayam R Yoithapprabhunath
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Indrapriyadharshini K, Sekar B, Saranyan R, Nirmal RM, Murugesan A, Yoithapprabhunath TR. Immunohistochemical Expression of Epidermal Growth Factor Receptor among Metastatic and Nonmetastatic Oral Squamous Cell Carcinomas. World J Dent 2019; 10 (6):435-439.
Aim: To evaluate and correlate the epidermal growth factor receptor (EGFR) expression in oral squamous cell carcinomas (OSCC) patients with metastasis and without metastasis. Materials and methods: The study comprised of 40 samples, 20 cases of metastatic and 20 nonmetastatic OSCC. All the cases were immunostained for EGFR antibody. Epidermal growth factor receptor stained sections were evaluated for staining intensity and distribution. The differences between the groups were statistically analyzed using Chi-square test. Results: Immunoexpression of EGFR in OSCC was 100% among the study groups, where metastatic group showed an increased positive expression comparing to nonmetastatic OSCC that show statistically significance among the study groups. Conclusion: Expression of EGFR can be used as reliable biomarker for prognosis which can be employed in the prediction of the survival of the patient with OSCC. Clinical significance: Since we are in the theragnostic era, evaluating and quantifying the expression of EGFR in OSCC patient will definitely pave a way in targeted drug therapy and personalized medicine for the diseased.
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Mohmmed SA, Mahdee AF. Assessment of the Effect of Three Agitation Techniques on the Removal Efficacy of Sodium Hypochlorite for the Organic Films. World J Dent 2019; 10 (6):440-444.
Aim: Root canal irrigation is an essential step in the root canal treatment. The aim of this study was to compare the efficacy of three agitation methods [manual-dynamic irrigation gutta-percha (GP), EndoActivator, and passive ultrasonic irrigation (PUI)] for 2.5% NaOCl irrigation solution in debriding two organic films (collagen and hydrogel) from simulated root canal walls. Materials and methods: Twenty-four Endo-Vu blocks were used to create half root canals using Profile instruments. The working length was 0.5 mm short of the canal end. The canal was enlarged to 30/06. The canals were allocated into two experimental groups (n = 12): group I (collagen film models), group II (hydrogel layer models). Each group was subdivided into three equal subgroups (n = 4): manual-dynamic irrigation (GP), EndoActivator sonic irrigation, and PUI. Each half canal was then covered with a flat glass slide, before quantifying the collagen or hydrogel film by using the Image-Pro Plus 4.5 and ipWin4 software. The data were analyzed using the generalized linear mixed model. Results: The duration of irrigation had a significant influence on surface area coverage with the residual film (hydrogel, collagen). Exposure of the organic film to PUI irrigation was significantly associated with more film removal than GP irrigation (p = 0.0001). Exposure of the organic film to EndoActivator irrigation was significantly associated with more film removal than GP irrigation (p < 0.001). Conclusion: The protocol of EndoActivator agitation of the NaOCl irrigant is more effective in simulant biofilm removal than gutta-percha pumping but less effective than passive ultrasonic agitation. Clinical significance: The findings from this study make several contributions to enhance our understanding of the use of passive agitation of NaOCl, when compared to sonic and manual agitation as a final irrigation protocol, in the removal of the biofilm from the apical, middle, and coronal thirds of the root canal.
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Dash S, Dash BP, Mohanty P, Dash S, Meher J, Bhushan V. Role of Orthopantomogram as an Ancillary to Lateral Cephalogram in Diagnosis of Vertical Malocclusions: A Comparative Study. World J Dent 2019; 10 (6):445-448.
Aim: Vertical malocclusion is an important and commonly seen anomaly of the craniofacial complex. The aim of the present study was to evaluate and compare the efficiency of the orthopantomogram (OPG) over the lateral cephalogram. Materials and methods: A total of 60 radiographs were collected from patients. Independent reference planes were set up in the maxilla and the mandible. The inclusion criteria of the study involved subjects in the age group of 20–25 years, class I skeletal and dental relationship with an overjet, and overbite in the range of 2–4 mm with an orthognathic profile. Exclusion criteria involved crowding, asymmetry, or spacing along with no history of prior orthodontic or surgical treatment. Mean values were evaluated using the z test. The statistical analysis was performed by using the Statistical Package for the Social Sciences. Results: Significant values were obtained for effective length of ramus, effective length of corpus, effective height of corpus, interocclusal distance, panoramic alternative of gonial angle (PGOA), panoramic alternative condylar inclination (PCOI), panoramic alternative of mandibular plane angle (PMPA), and maxillary occlusal angle. Conclusion: On completion of our study, we can conclude that the OPG can be used in the assessment of vertical malocclusion quantitatively. Clinical significance: Less radiation exposure and easy availability of OPGs will be useful clinically.
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Sugiatno E, Herminajeng E, Sosroseno W. Synergism of Prostaglandin E2 and Nitric Oxide on Human Osteoblast Proliferation Induced by Hydroxyapatite. World J Dent 2019; 10 (6):449-453.
Aim: To assess whether osteoblast proliferation induced by hydroxyapatite (Ha) may be regulated by prostaglandin E2 (PGE2) and nitric oxide (NO) in a synergic fashion. Materials and methods: Human osteoblasts (HOS cell line) were cultured onto Ha with or without nimesulide, a cyclooxygenase-2 (COX-2), and/or L-NIO, an endothelial nitric oxide synthase (eNOS) inhibitor. The cells pretreated with nimesulide and/or L-NIO were cultured onto Ha added with PGE2 and/or S-nitroso acetyl penicillamine (SNAP), a NO donor. The Ha-plated cell cultures were also added with anti-PGE2 and/or carboxy PTIO, a NO scavenger. The cell proliferation was assessed colorimetrically from the 3-day cultures. The levels of PGE2 and NO were determined from the culture supernatants. Results: Hydroxyapatite-induced cell proliferation was partially inhibited by nimesulide or L-NIO but fully by both inhibitors. The production of PGE2 from the same cell cultures was inhibited fully by nimesulide but partially by L-NIO. In contrast, NO production was inhibited only by L-NIO. Partial suppression of Ha-stimulated cell proliferation by nimesulide or L-NIO was abolished by PGE2 or NO, respectively. The combination of PGE2 and NO donor could abrogate fully nimesulide—but partially L-NIO-mediated suppression of Ha-induced cell proliferation. Anti-PGE2 or carboxy PTIO partially inhibited but combination of both scavengers fully suppressed the Ha-induced cell proliferation. Conclusion: Osteoblast proliferation induced by Ha may be regulated by a synergic function of PGE2 and NO in an autocrine fashion. Clinical significance: The successful or failing Ha-based dental implantation may be determined by the synergic regulatory functions of the host PGE2 and NO at the implanted sites.
Kocherlakota S Dwijendra,
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Pranitha V, Singh T, Dwijendra KS, Nagarjuna G, Sultana Z, Anusha K. Comparison of Pain Perception and Latency with Alkalinization of 2% Lidocaine Using 8.4% Sodium Bicarbonate: A Randomized Controlled Study. World J Dent 2019; 10 (6):454-456.
Aims: Local anesthesia (LA) administration is a prerequisite for pain reduction but ironically becomes a source of pain and anxiety in children. The purpose of the study was to compare the latency and pain perception of alkalinized and nonalkalinized LA with adrenaline (1:80,000) by using 8.4% sodium bicarbonate. Materials and methods: After obtaining the ethical clearance, 40 participants fulfilling the inclusion criteria were included and divided into two groups, namely, those who received alkalinized LA on the first appointment and those who received nonalkalinized LA 1 week later in the second appointment. Pain reaction on deposition of solution was quantified by visual analog scale (VAS). Results: Statistical analysis was done using SPSS 25, Chi-square test for pain perception. An independent samples t test was used to measure the latency time period. The mean latency time in alkalinized group was 118.9 seconds, while that for the nonalkalinized group was found to be 132.3 seconds, with a mean difference of 13.4 seconds between the two groups (p = 0.43). Conclusion: Alkalinization hastens the onset of analgesia and reduces pain on injecting, making the alkalinized local anesthetic apt for cases with localized infection. Clinical significance: Successful dental treatment outcomes demand efficient pain management which otherwise may lead to avoidance of dental care in children.
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Francis T, Sakkir N, Joshi SB. Effectiveness of a Novel Calcium-enriched Mixture Root Cement to Decelerate Replacement Resorption in Replanted Teeth: A Case Report. World J Dent 2019; 10 (6):457-460.
Aim: To assess the effectiveness of calcium-enriched mixture (CEM cement) to decelerate replacement resorption in replanted teeth. Background: A high prevalence of traumatic injuries in the orofacial region have been reported in school children. External replacement resorption (ERR) is the most common complication of replanting an avulsed tooth. Ankylosed teeth were lost in the first few years after ERR was initiated in young patients. Fixed replacement using dental implants or bridges is best delayed until skeletal growth is completed in young patients. With the gamut of biosilicate cements available, operators can now attempt to salvage these young permanent teeth diagnosed with ERR until the age when skeletal growth is complete. Case description: In this case report, a novel biosilicate cement, CEM cement, was used to retard the progress of ERR and to preserve the affected teeth until the suitable age for receiving implants or bridges. In this 15-year-old patient, the resorptive process was regressed using CEM cement and the tooth remained functional till 22 years of age. The teeth were then extracted and implant treatment was initiated. Conclusion: Currently there is no suitable protocol for the management of these cases. Newer biosilicate cements such as CEM cement help decelerate the resorptive progress and can be considered as a suitable protocol in intervening ERR. Clinical significance: Losing an anterior tooth after ERR has functional, esthetic, phonetic, and psychological impacts on children and adolescents. Down regulating the resorptive process is critical and paramount in preserving esthetics and function until the time extraction and replacement can be done safely.
K Kranthi Raja,
Kiran P Singbal
Aim: This case report aims to describe nonsurgical endodontic treatment in a second mandibular premolar (tooth #45) with type II dens evaginatus using a new bioceramic material (OrthoMTA). Background: A 13-year-old boy reported recurrent swelling related to mandibular premolars (#44 and #45) with discharging sinus in the periapical area. Case description: Orthograde obturation with OrthoMTA was done after thorough disinfection using activated sodium hypochlorite (NaOCl) and calcium hydroxide (Ca(OH)2) medicament. Conclusion: A 1-year post-obturation follow-up, using clinical and radiographic examination [cone-beam computed tomography (CBCT)] showed good apical sealing. Clinical significance: The synergistic effect of the chemomechanical preparation and intracanal medicament, followed by the filling of OrthoMTA helped, in the successful management of this case.
Introduction: Hemisection refers to the surgical separation of multirooted teeth when the decay or resorption is restricted to one root, followed by removal of the affected root with preservation of the healthy root with its crown portion and its usage as abutment for subsequent prosthetic restoration. Aim: The aim of this case report was to raise awareness among dentists that preservation of tooth structure in the form of hemisection may be considered an alternative treatment modality in cases of multirooted teeth with extensive caries restricted to one of the roots. Case description: This describes the hemisection procedure of right mandibular second molar performed in a 35-year-old female referred for extraction. Intraoral examination and intraoral periapical (IOPA) radiography revealed extensive decay of tooth 47, restricted to the distal root, with satisfactory condition of the mesial root and its crown portion to be preserved by hemisection and used as abutment for a fixed prosthetic restoration. 6 weeks after the successful hemisection, a three-unit metal-porcelain fixed denture was performed, using the retained mesial root of mandibular second molar (47) and the mandibular second premolar (45) as abutments and replacing the missing mandibular first molar (46). Conclusion: Preservation of tooth structure by performing hemisection in carious multirooted teeth in cases when caries is restricted to one of the roots should be considered a valuable alternative treatment instead of extraction; therefore, it should be discussed with patients as one of the treatment options whenever suitable and possible to perform. Clinical significance: The rationale of hemisection in our case is that it enabled the preservation of tooth structure by supplying an abutment for construction of a three-unit fixed partial denture, thus providing the patient the opportunity to maintain occlusal function with reduced financial cost over dental implants.
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Salam TA, Varghese S, Shenoy RP. Prevalence and Clinical Parameters of Cervical Abrasion as a Function of Population, Age, Gender, and Toothbrushing Habits: A Systematic Review. World J Dent 2019; 10 (6):470-480.
Aim: To determine specific differences in prevalence and etiology of cervical abrasion (CA) related to age, gender, and population and to recommend optimal management protocols. Background: Cervical abrasion is a part of a spectrum of regressive changes in teeth called noncarious cervical lesions (NCCLs). These are physiological or pathological alterations as a function of time, related to physical and/or chemical factors. There are multiple variables involved in the pathogenesis and management of these lesions. There may be age-, gender-, and population-based differences in prevalence and clinical parameters of CA. Results: Our review selected 24 studies from an initial 3,876 titles. We found significant differences in prevalence of CA in relation to age, toothbrushing frequency, brush type, and brushing technique. There were definite conclusion regarding type of teeth affected and appropriate management to enhance quality of life of the patients. Data on CA are inconsistent and need standardization. Conclusion: Cervical abrasion varies in prevalence across countries. However, it exhibits definite age-related increase. There is no gender predilection. The frequency of toothbrushing, type of brush, brushing technique, and use of dentifrice influences the prevalence. Certain teeth are more susceptible to abrasion than others. Resin-modified glass ionomers were reported to be better for treating this condition. Clinical significance: There is no standardized methodology to diagnose the presence and clinical severity of dental abrasion. This affects data on prevalence, habits, and management. Standardized protocol and tools may be developed for the same, and would improve outcomes particularly in vulnerable groups like geriatric populations, which are mainly affected by this condition.