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   Table of Contents - Current issue
Coverpage
September-October 2017
Volume 7 | Issue 5
Page Nos. 223-300

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REVIEW ARTICLES  

A systematic review of the consequences of early extraction of first permanent first molar in different mixed dentition stages p. 223
Thamer Alkhadra
DOI:10.4103/jispcd.JISPCD_222_17  
Aims and Objectives: The aim of this study was to consider the available evidence regarding early extraction of permanent first molars (PFMs) in different mixed dentition stages that affect the integrity of occlusion and the implications for treatment planning. Materials and Methods: Electronic database, including PubMed and Science Direct, searches were conducted for available evidence. Key terms used in the search were “extraction,” “ first permanent molar,” and “mixed dentition.” Results: The initial search identified 56 studies to be related to the review. Although a significant number of published articles had dealt with early extraction of PFM, only three studies had fulfilled the final selection criteria to be considered for this systematic review. Conclusion: Future active appliance treatment is important after extraction of PFMs with poor prognosis. If such therapy is not needed, consideration should be given to extraction at the ideal developmental age to achieve spontaneous space closure. Each case should be assessed for the need of balancing or compensating extractions to preserve the dental midline and prevent overeruption.
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Platelet-rich fibrin: A paradigm in periodontal therapy – A systematic review p. 227
Umesh Pratap Verma, Rakesh Kumar Yadav, Manisha Dixit, Abhaya Gupta
DOI:10.4103/jispcd.JISPCD_429_16  
Periodontal tissue regeneration has always been a challenge for the periodontists owing to its structural complexity. Although with tissue engineering as a growing multidisciplinary field, this aim has partially been fulfilled. In recent years, platelet-rich fibrin (PRF) has gained wide attention for its utilization as a biocompatible regenerative material not only in dental but also in medical fields. The following systematic review has gathered all the currently available in vitro, animal, and clinical studies utilizing PubMed electronic database from January 2006 to August 2016 highlighting PRF for soft and hard tissue regeneration and/or wound healing. Although results are encouraging but require further validation from clinical studies to justify the potential role of PRF in periodontal regeneration so that this relatively inexpensive autologous biomaterial can be utilized at a wider scale.
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A systematic review and meta-analysis of school children's caries studies in gulf cooperation council states p. 234
Wafa Alayyan, Manal Al Halabi, Iyad Hussein, Amar Khamis, Mawlood Kowash
DOI:10.4103/jispcd.JISPCD_237_17  
Objectives: The aim of the present study was to evaluate the prevalence and severity of dental caries school children in the Gulf Cooperation Council (GCC) area, to help the development of systematic approaches for preventive oral care programs in the GCC states and to provide sound information for oral health promotion and public health care. Materials and Methods: A comprehensive search to identify both published and unpublished articles concerning relevant studies of dental caries in children aged 6–16 years for their permanent teeth published from 1992 to 2016 with no language and time limit was performed. The search strategies employed electronic databases and incorporated both dental subject headings and free-text term. Results: The overall mean decayed, missing and filled teeth in the permanent teeth was 2.57, and the prevalence was 64.7% in the GCC area. Conclusions: Most of the studies were conducted in the Kingdom of Saudi Arabia. The results may not be a true reflection, and other countries in GCC are urged to study the prevalence and severity of caries in their children population.
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ORIGINAL ARTICLES Top

Comparison between antibacterial effect of chlorhexidine 0.2% and different concentrations of cyperus rotundus extract: An in vitro study p. 242
Roza Haghgoo, Majid Mehran, Hamideh Farajian Zadeh, Elaheh Afshari, Nafiseh Farajian Zadeh
DOI:10.4103/jispcd.JISPCD_157_17  
Aims and Objectives: Modern methods of caries prevention concentrated on natural ingredients usage such as probiotics and polyphenols that are safer for young children with Streptococcus mutans inhibitory properties. The purpose of this study was to compare antibacterial effects of different concentration of Cyperus rotundus extract and chlorhexidine (CHX) 0.2% mouthwash on S. mutans and Lactobacillus acidophilus. Materials and Methods: In this in vitro study, the antibacterial effectiveness of the C. rotundus extract and CHX was compared with minimum inhibitory concentration (MIC) test in tube, minimum bactericidal concentration (MBC) test in solid medium, and disc diffusion for measurement of inhibition zone. Data were analyzed using one-way ANOVA, one sample t-test, and independent sample t-test statistical methods by SPSS. 24 software (SPSS Inc., Chicago, USA). Results: MIC and MBC values of the C. rotundus extract were obtained 225 and 450 mg/ml, respectively, for S. mutans and 108 and 225 mg/ml for L. acidophilus, which are more than CHX (0.5, 1 res.). The inhibition zone increased in a dose-dependent manner but lower than CHX. Conclusion: The C. rotundus extract had antibacterial effects (bactericide and bacteriostatic) on S. mutans and L. acidophillus. Although this effect was lower than CHX. With regard to adverse effect of CHX, this extract can be a potential antibacterial agent.
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The effect of chlorhexidine mixed with mineral trioxide aggregate on bacterial leakage of apical plug in simulated immature teeth using human fresh saliva p. 247
Gholamhossein Ramezani, Sohrab Tour Savadkouhi, Sahar Sayahpour
DOI:10.4103/jispcd.JISPCD_198_17  
Objectives: Apexification is a challenging treatment in necrotic open apices teeth and bacterial leakage is the main reason for the treatment failure. The aim of this study is to compare the effect of mixing mineral trioxide aggregate (MTA) with chlorhexidine (CHX) on microbial leakage in apexification treatment of simulated immature teeth. Materials and Methods: In this experimental study, 44 intact central incisors were selected based on inclusion criteria. The coronal and 2 mm of apical part of the specimens were removed till all root segments were 12 mm long. The apical parts of the teeth were prepared using Profile #40/0.06 (Dentsply Maillefer, Ballaigues, Switzerland) in the apical to coronal direction to simulate open apices. The specimens were separated into experimental groups (n = 40) and control groups (n = 4). Group 1 delivered a 5 mm apical plug by MTA/H2O and group 2 delivered an apical plug by MTA/CHX 0.12%. The positive control group had no apical barrier; on the other hand, the negative control group had an apical barrier and two layers of nail varnish on entire root surface. The microbial leakage assessment was done by a dual-chamber apparatus using fresh human saliva after 10-week follow-up. The turbidity of the lower chamber containing the Brain Heart Infusion (BHI) solution was analyzed based on the McFarland (0.5) standard which utilizes spectrophotometry results. Data analyses were done using Chi-square, Kaplan–Meier, and log-rank tests. Results: MTA/CHX group had lower microbial leakage percentage (P = 0.001) and longer time of leakage (P = 0.002) in compared with MTA/H2O group and the difference was statistically meaningful. Conclusion: Based on the results of this study, MTA/CHX mixture can reduce the amount of bacterial leakage.
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Effect of fluoride concentration in drinking water on intelligence quotient of 12–14-year-old children in Mathura District: A cross-sectional study Highly accessed article p. 252
Priyanka Razdan, Basavaraj Patthi, Jishnu Krishna Kumar, Nikhil Agnihotri, Prajakta Chaudhari, Monika Prasad
DOI:10.4103/jispcd.JISPCD_201_17  
Aims: The aim was to assess and correlate the influence of the concentration of fluoride in ingested water on the intelligence quotient (IQ) of 12–14-year-old youngsters in Mathura district. Materials and Methods: A total of 219 children were selected, 75 from low F area, 75 medium F area, and 69 from high F area. The concentration of fluoride in the routinely ingested water was estimated using “Ion Selective Electrode method”; then, Raven's Test was utilized to estimate the IQ of the study participants. Independent t-test, Tukey's post hoc, Chi-square an analysis of variance tests were used to associate the mean and proportion IQ scores in high-, medium-, and low-fluoride regions along with inter-group significant differences (P ≤ 0.05). Results: The comparison of IQ score showed that 35 (46.7%) participants from the high fluoride and 10 (13.3%) participants from the medium-fluoride areas had below average IQ. Further, it was noted that the lowest mean marks were obtained by the children in the high-fluoride region (13.9467) followed by those in medium (18.9467) and uppermost in least noted fluoride area (38.6087). However, gender-based intergroup comparison did not produce a significant relation with fluoride (P ≥ 0.05). Conclusion: Concentration of Fluoride in the ingested water was significantly associated with the IQ of children. It has also coined the proportional variability in mental output in accordance to the ingested fluoride level. As two sides of a coin, fluoride cannot be utterly blamed for a lower intelligence in a population; it puts forward a fact that intelligence is a multifactorial variable with a strategic role played by genetics and nutrition to develop cognitive and psychosomatic activities in an individual.
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Evaluation of the impact of oral health education on oral hygiene knowledge and plaque control of school-going children in the city of Amritsar p. 259
Gunmeen Sadana, Teena Gupta, Neha Aggarwal, Hashmit Kaur Rai, Ankita Bhargava, Satinder Walia
DOI:10.4103/jispcd.JISPCD_251_17  
Aims and Objectives: The present study aims to evaluate the impact of oral health education on oral hygiene knowledge and plaque control of school-going children in the city of Amritsar. Materials and Methods: The study was carried out for 6 weeks and included four groups of schoolchildren of 10–12 years of age. Children were randomly selected and assigned into one of the four groups – Group I (verbal communication), Group II (verbal communication and self-educational pamphlets), Group III (audiovisual aids and verbal communication), and Group IV (control group). Oral health education was assessed by getting a questionnaire filled by children and plaque scores was recorded using Silness and Loe plaque index before and after the study. The data were then compared and analyzed using SPSS 16 software manufactured by IBM. Results: Differences in knowledge gain after the dental health education were statistically significant between all the groups, except between Group II and Group III in which the difference was not found to be significant. Group III showed the highest decrease in plaque score followed by Group II. There was a significant difference in reduction in plaque scores between all the groups, except between the Groups II and III. Conclusion: Both methods, i.e., pamphlets and audiovisual aids when used along with oral lectures, are equally effective in improving the knowledge and plaque scores in children.
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Comparison of the clinical biological width with the published standard histologic mean values p. 264
Fatme Mouchref Hamasni, Fady El Hajj
DOI:10.4103/jispcd.JISPCD_261_17  
Aims and Objectives: Biologic width (BW) as defined by Cohen is the part of the supracrestal gingival tissues that occupy the space between the base of the gingival crevice and the alveolar crest; it includes the junctional epithelium and the connective tissue element. Interactions between dental crowns and the marginal periodontal tissues analyzed in many review papers concluded that the recognition of the BW, in terms of crown margin placement, is beneficial for periodontal health. Therefore, knowledge of the dimensions of the sum of the junctional epithelium and connective tissue attachment as well as the sulcus depth (SD) is of clinical relevance. The aim of the study is to compare the average SD and BW clinically measured around teeth with the standard application of a mean value of 0.69 mm and 2.04 mm, respectively, found by Gargiulo et al.in a histological study on cadavers. Materials and Methods: Forty-two healthy patients with age ranging from 20 to 50 years presented to the Multidisciplinary Department at the Lebanese University. A total of 504 tooth sites of 126 teeth were selected and measured by two periodontists. All measurements were done on teeth requiring infiltration anesthesia for surgical, restorative, or endodontic procedures on neighboring tooth/teeth, which eliminate any ethical concerns. The SD and the distance from gingival margin to bone crest at four sites per tooth; mesial, midbuccal, distal, and midlingual/palatal were measured. Clinical, BW was calculated by subtracting SD from the distance between gingival margin to bone crest. Statistical Analysis: Friedman's ANOVA test, independent samples t-tests, and one-sample t-tests were applied. The IBM® SPSS® statistics 20.0 statistical package was used to carry out all statistical analyses. Results: The BW is statistically significantly lower than the value stated by Gargiulo et al. (2.04 mm) with a mean value of 1.13 mm, whereas the SD is statistically significantly greater than the value stated by Gargiulo et al. (0.69 mm) with a mean value of 1.96 mm. Conclusion: It can be concluded that there is a need to create a patient/site-specific distance from the proposed margin of the restoration to the bone crest when restoring subgingivally fractured or carious teeth. This leads to more stable and healthy tissues when performing crown lengthening procedures. Therefore, using the term clinical, BW is more reliable and it should be used to reestablish stability and integrity of periodontal tissues around restored teeth.
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Relationship between the remaining dentin thickness and coronal pulp status of decayed primary molars p. 272
Roula Berbari, Hussein Fayyad-Kazan, Mohamad Ezzedine, Mohammad Fayyad-Kazan, Daniel Bandon, Elia Sfeir
DOI:10.4103/jispcd.JISPCD_267_17  
Aims and Objectives: The aim of this study was to assess the correlation between the remaining dentin thickness (RDT) in deep decayed primary molars and the inflammatory status and bacterial composition of the corresponding coronal pulp. We hypothesized that RDT could be used as a reference for clinicians in assigning the indication for pulpotomy. Materials and Methods: Pulpotomies were conducted on the cameral pulp of 48 primary molars. Microorganisms, such as Lactobacillus sp., Streptococcus sp., and Prevotella sp., were identified and quantified and levels of tumor necrosis factor-alpha (TNF-α) and interlukin-6 (IL-6) were assessed. The correlation between the pre-operative RDT based on radiographic images and inflammatory-microbial profiles in vitro was evaluated using Spearman's rho correlation coefficient. All data analysis was performed using a statistical software program (SPSS 20.0, SPSS Inc., Chicago, IL, USA). Results: Immunological and microbiological studies revealed elevated levels of TNF-α and IL-6 cytokines, and Lactobacillus sp., Streptococcus sp. and Prevotella sp. in the cameral pulp with an RDT measuring up to 1.1 mm. No significant relationship could be established between RDT, inflammatory status and microbial content of the pulps. Conclusion: The RDT remains a key clinical factor that needs to be assessed when establishing the indication for pulpotomy. Additional parameters that can improve this therapy should be investigated in the future.
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How much do Italian patients in supportive periodontal therapy know about the role of smoking in oral health and what is their lifestyle? p. 279
Roberto Pippi, Maria Vita, Roberto Alvaro, Carlo Di Paolo
DOI:10.4103/jispcd.JISPCD_75_17  
Objective: The level of awareness of patients receiving supportive periodontal therapy (SPT) concerning the role of smoking as a risk factor for oral health was investigated. Materials and Methods: A questionnaire was administered to 158 patients previously treated for periodontitis in four periodontally oriented private dental offices in Rome. The generalized linear model was used to test the simultaneous effect of questions posed to all patients. Fisher's exact test was used to verify significant associations among qualitative variables. Results: Only 53.79% of the total sample referred having been informed by the dentist/hygienist about smoking as an oral health risk factor. About 40% of patients did not know that oral cancer exists and only 36.08% of them reported being informed about it by their own dentist/hygienist. Females are significantly less frequent among ex-smokers than among smokers. Nonsmokers were on periodontal supportive therapy for a longer period than smokers. Patients who started smoking later found harder to quit smoking than those who started earlier. Conclusion: Awareness of patients in SPT about health risks related to smoking does not assume a change in their harmful behavior. Among oral health professionals, there is not yet a widespread awareness of the importance of their role in increasing patient's motivation to quit.
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Apical extrusion of intracanal bacteria with single file and multifile rotary instrumentation systems p. 292
Eshaghali Saberi, Shahram Shahraki Zahedani, Sediqe Ebrahimipour
DOI:10.4103/jispcd.JISPCD_199_17  
Aims and Objectives: Instrumentation techniques may cause extrusion of microorganisms and their products into the periapical region resulting inflammation and treatment failure. The aim of this ex vivo study was comparing the apical bacterial extrusion in canals prepared with single file versus multiple file rotary systems. Materials and Methods: Ninety-two human single-rooted mandibular first premolars were used. Endodontic access cavities were prepared, and root canals were contaminated with an Enterococcus faecalis (E. faecalis) suspension. The samples were incubated at 37°C for 30 days; the contaminated teeth were divided into four groups of 20 specimens each (1: Reciproc, 2: Mtwo, 3: Neoniti A1, 4: Safesider). Six teeth were not infected and each were prepared with one of the above instruments were considered as negative and six teeth which had been previously infected, were used as positive control groups. Extruded bacteria from the apical foramen during instrumentation were collected into vials containing 0.9% NaCl. The microbial samples were taken from the vials and incubated in brain heart agar medium for 24 h. The resulting bacterial titer, in colony-forming units per mL, was determined. The data entered into SPSS 18 software and were analyzed by Kruskal–Wallis and Mann–Whitney U-tests at 0.05 significance level. Results: Mtwo multifile system showed significantly less bacterial extrusion than Safesider (P = 0.015) and Neoniti A1 (P = 0.042) but did not show significant difference with Reciproc system (P = 0.25). Conclusions: All instrumentation systems extruded bacteria beyond the apical foramen. However, this study showed that Mtwo multifile rotary system extruded fewer bacteria.
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CASE REPORT Top

Endodontic management of a maxillary first molar with seven root canal systems evaluated using cone-beam computed tomography scanning p. 297
Vijay Reddy Venumuddala, Sridhar Moturi, SV Satish, B Kalyan Chakravarthy, Sudhakar Malapati
DOI:10.4103/jispcd.JISPCD_297_17  
Permanent maxillary first molar morphology has been studied widely. Usually, it has three roots with three canals and the frequent deviation being incidence of a second mesiobuccal canal, thus showing a multifaceted root canal anatomy. Other variations comprise four and five roots and abnormal root canal morphology within individual roots. Many case reports with five and six root canals or a C-shaped canal configuration have been reported in the past. This varying number of root canals poses a challenge for endodontist in detecting and treating by root canal treatment. This problem can be avoided using techniques such as using the dental operating microscope and cone-beam computed tomography (CBCT). We report a change in canal morphology case of maxillary first molar having seven root canals, its evaluation, and management using latest equipment such as CBCT.
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