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   Table of Contents - Current issue
Coverpage
May-June 2019
Volume 9 | Issue 3
Page Nos. 211-310

Online since Friday, June 7, 2019

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REVIEW ARTICLE  

Efficacy of resin infiltrate in noncavitated proximal carious lesions: A systematic review and meta-analysis Highly accessed article p. 211
Afra Hassan Elrashid, Basmah Sulaiman Alshaiji, Sara Abdulwahab Saleh, Khadijah Ahmed Zada, Mohammad Abdul Baseer
DOI:10.4103/jispcd.JISPCD_26_19  
Objectives: Resin infiltration is a minimally invasive technique for treating noncavitated proximal caries. It slows/stops the carious lesion progression rate by creating a diffusion barrier inside the porous enamel lesion body. The aim was to evaluate the efficacy of resin infiltration on noncavitated proximal carious lesions in primary and permanent teeth. Materials and Methods: The records were obtained using electronic and other sources. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to ensure transparent reporting. Eligible studies were randomized controlled trials evaluating the efficacy of resin infiltration for noncavitated proximal carious lesions by comparing it with control/placebo. Each included study was assessed concerning the “risk of bias” using the Cochrane Collaboration's “risk-of-bias” assessment tool. High risk-of-bias studies were excluded from the meta-analyses due to selective reporting matters. The statistics were performed by RevMan software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) utilizing the random effect model. The GRADE approach was implemented for assessing the quality of evidence. Results: From 106 studies identified, 17 were assessed for eligibility. After “risk-of-bias” assessment, two meta-analyses were conducted to eliminate the limitation of the significant heterogeneity between trials inspecting primary teeth (n = 2) and permanent teeth (n = 3). I2 = 0% indicates the absence of statistical heterogeneity. The risk of carious lesions' progression with resin infiltration was significantly lower in primary (risk ratio [RR]; 95% confidence interval [CI]: 0.48; 0.30–0.75, P = 0.001) and in permanent teeth (RR; 95% CI: 0.19; 0.11–0.33, P < 0.00001) compared to that of control/placebo. The GRADE approach revealed high quality of evidence. Conclusion: The available evidence conveys high confidence that proximal resin infiltration has superior efficacy in slowing/arresting the carious lesions' progression rate in comparison to conventional management modalities.
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ORIGINAL ARTICLES Top

HIV-related discrimination among senior dental students in Jeddah p. 219
Ehab Alshouibi, Faten Alaqil
DOI:10.4103/jispcd.JISPCD_420_18  
Aims and Objectives: Advances in the medical management of HIV infection have increased life expectancy and reduced the mortality rate of infected individuals. As a result, dental and medical health-care workers have a higher chance to meet HIV-positive patients in their clinics. People living with HIV and AIDS (PLWHA) are frequently experiencing discrimination. That negative attitude toward HIV remains quite common among health-care professionals. The purpose of this study was to assess students' attitudes toward PLWHA. Materials and Methods: The present study was a cross-sectional survey to assess the attitudes of senior dental students toward HIV/AIDS in Jeddah, Saudi Arabia. Data were collected using an online self-administered questionnaire. Data analysis was done using the statistical package of social sciences. Descriptive statistics including means, standard deviations, frequencies, and percentages were calculated and used to present the data. A binary logistic regression model was constructed to estimate the effect of different predictors on the level of HIV-related discrimination. Results: A total of 400 individuals took part in the study. Bivariate analysis of HIV discrimination in relation to other variables showed that those reluctant to treat HIV patients, the majority (82%) showed a negative tendency toward HIV/AIDS patients, while 75% who were willing to treat them exhibited more positive attitudes, which was statistically significant (P < 0.0001). The discrimination was high, almost 87%, among those who feared accidental exposure to HIV patients; however, 73% of those who did not experience fear, felt nondiscriminative, which was also statistically significant (P < 0.0001). Conclusions: Stigmatizing views toward PLWHA exist among senior dental students in Jeddah. The most significant predictors of discrimination included fear of accidental exposure, reluctance to provide treatment to these patients, and self-protective concerns.
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Effectiveness of an oral health promotion program for the elderly in Khiri Mat district, Sukhothai province: A randomized control trial p. 225
Eakpong Keyong, Songchai Thitasomakul, Sukanya Tianviwat
DOI:10.4103/jispcd.JISPCD_27_19  
Objectives: Oral disease is one of the most common health problems among the elderly, which impacts the quality of life. Applying the Health Belief Model (HBM) in oral health promotion is expected to improve the effectiveness of prevention and promotion that restricts oral health problems. The aim of the present study was to determine the effectiveness of an oral health promotion program on oral health behavior and oral status among the elderly in Khiri Mat, Thailand. Materials and Methods: A prospective randomized control trial was carried out among 162 elderly people for 6 months. They were interviewed to gather oral health behaviors and perception information, followed by an oral health examination. The experimental group received oral health education based on the HBM theory and tooth brushing practice in a small group of 4–5 persons, and then they were remotivated to support behavior change at 1 and 3 months. The control group received traditional oral health activity. All the elderly were followed up at 6 months. Data were analyzed using the t-test, Mann–Whitney test, Chi-square, and logistic regression. Results: The elderly in the experimental group had significantly higher oral health perception, lower plaque scores, lower gingival inflammation, and lower clinical attachment loss than those in the control group (P < 0.05). Conclusion: This oral health promotion program improved oral health perception, behavior, and oral health status of the elderly.
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Oral health status among children with Down syndrome in Dubai, United Arab Emirates p. 232
Batool Ghaith, Manal Al Halabi, Amar Hassan Khamis, Mawlood Kowash
DOI:10.4103/jispcd.JISPCD_396_18  
Objectives: The purpose of this study was to assess the oral health status in Down syndrome (DS) children in Dubai, United Arab Emirates. Materials and Methods: A total of 106 DS children (mean age = 9.3 ± 2.8) and 125 healthy children (mean age = 11.7 ± 4.4) were recruited from both special needs centers and private/public schools in Dubai. A dental examination for decayed-missing-filled teeth (DMFT) in deciduous dentition/DMFT in permanent dentition indices, simplified oral hygiene index, calculus index (CI), were carried out. In addition, occlusal, dentofacial, soft-tissue abnormalities, and erosion were assessed. Statistical analysis was conducted using SPSS for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA). Results: The mean number of DMFT in DS children was significantly higher than that in healthy children. DS children in the primary dentition group had higher restorative index and Met Need Index scores than the control group. On the other hand, CI was found to be significantly higher among children with DS compared to healthy controls (P < 0.004). DS children had a significantly higher proportion of open bite and other occlusal problems. Class III molar angle malocclusion was significantly higher in DS (66%) compared to controls (11.2%). Erosion was significantly higher among DS children compared to healthy control (34% vs. 15.3%). Conclusions: DS children in Dubai had higher caries rate compared to healthy children. DS group received more restorations and dental treatment compared to the control group. More to add, DS children had significantly more calculus, erosion, and malocclusion problems.
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The densitometric analysis of protein pattern in cleft lip and palate patients p. 240
Regina Purnama Dewi Iskandar, Annise Proboningrat, Amaq Fadholly, Ida Bagus Narmada, Chairul Anwar Nidom, Sri Agus Sudjarwo
DOI:10.4103/jispcd.JISPCD_388_18  
Objectives: Cleft lip and palate (CLP) belongs to the congenital anomaly that is clinically seen as cleft in lip, alveolar bone, palate, and nasal septum. The patients suffer from esthetic and various functional defects. CLP is resulted from impaired palatogenesis during the embryonic phase. The etiology of CLP is influenced by genetic, environmental, and combination of both. According to the literature, CLP is highly associated with defect in interferon regulatory factor 6 (IRF6) and poliovirus receptor-like (PVRL1) genes. The present study aimed to investigate the total protein profile and to identify protein IRF6 and PVRL1 in plasma of CLP patients. Materials and Methods: Dot-Blot analysis was performed to identify protein target of IRF6 and PVRL1. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis was performed in gel concentration 12% using plasma of CLP patients, their parents, and control population. The gels were stained by Coomassie blue afterward. Gels were analyzed through ImageLab 5.2.1 software. Results: The intensity of major bands in CLP patients was darker than control group, but remains similar to the parents group. The target protein IRF6 and PVRL1 were positively identified through Dot-Blot. Retardation factor value was significantly different in major bands of CLP patients compared to control group. Conclusion: There pattern of protein profile in CLP patients was different compared to non-CLP.
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Shaping ability of 2Shape and WaveOne Gold files using cone-beam computed tomography p. 245
Shalini Singh, Nitin Mirdha, PH Shilpa, Rahul V. C. Tiwari, Muqthadir Siddiqui Mohammad Abdul, Shan Sainudeen
DOI:10.4103/jispcd.JISPCD_411_18  
Aim and Objective: The aim of this study is to evaluate the apical transportation, centering ability, and volume of removed dentin of WaveOne Gold (WOG) and 2Shape with the use of cone-beam computed tomography. Materials and Methods: Freshly extracted mandibular teeth with sample size of thirty were carefully chosen and instrumented using the 2Shape and WOG rotary files. Preoperative and postinstrumentation cone-beam computed tomographic scans were done to accomplish mesial and distal dentin walls' measurements and volume of removed dentin calculations, apical transportation, and centering ratio. Statistical analysis was performed and confirmed by independent t-test. Statistical significance was set at 5%. Results: When shaping ability of 2Shape and WOG was evaluated, it was reported that there was no statistically significant differences noted among the groups in relation to the total volume of removed dentin, apical transportation, and centering ratio. Conclusion: It can be concluded that 2Shape and WOG preserved the original canal anatomy well and did not eliminate excess dentin during shaping and cleaning. Rotary nickel–titanium files which work on the principle of rotary movement attained an outcome analogous to that of the rotary files working on reciprocating motion in relation to alteration in angle.
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“Comparative evaluation of the effect of three polishing agents on staining characteristics of provisional restorative material:” An in vitro study p. 250
Seema Sathe, Sneha Karva, Anjali Borle, Mithilesh Dhamande, Tanvi Jaiswal, Sharayu Nimonkar
DOI:10.4103/jispcd.JISPCD_431_18  
Aim: The present study aimed to evaluate the effect of three various polishing agents on provisional restorative material on immersion in a staining solutions. Objectives: The objective of the study is (1) To evaluate the effect of pumice on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (2) To evaluate the effect of aluminum oxide paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (3) To evaluate the effect of diamond paste on staining characteristics of provisional restorative material before and after immersion in chlorhexidine. (4) To compare and assess the outcome of three polishing agents on staining characteristics of provisional restorative material. Materials and Methods: Sixty samples (10 mm × 2 mm) were fabricated of bis-acryl composites (Protemp™ 4) by utilizing a metal mold. The samples were grouped into three groups (n = 20), and various polishing agents were used, including pumice, aluminum oxide paste, and diamond polishing paste. The samples that were not exposed to any polishing agent served as the control group. The samples were kept in a water bath for a day at 37°C and were stained with chlorhexidine mouthwash. The color of all specimens was measured with a spectrophotometer before and after polishing, and color changes (ΔE) were calculated. Results: By using one-way ANOVA, significant difference was found in mean color change in three polishing materials (F = 4.44, P = 0.016). By using Tukey test, statistically significant difference was found among pumice and aluminum oxide paste (P = 0.027), among pumice and diamond paste (P = 0.041) and no significant difference was found among aluminum oxide paste and diamond paste (P = 0.985). Conclusion: Pumice exhibited less staining which was statistically significant when compared with aluminum oxide paste and diamond paste. Hence, it can be considered the most efficient polishing agent.
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Evaluation of styloid process and its anatomical variations: A digital panoramic study with systematic review p. 256
Koduri Sridevi, N Mahesh, B Krishnaveni, A D N Deepika, V Thejasri, B H David Leninson
DOI:10.4103/jispcd.JISPCD_8_19  
Aims and Objectives: To evaluate the styloid process (SP) and its anatomical variations on digital panoramic radiographs from the database and also to synthesize the current evidence of literature on SP and anatomical variations along with the systematic review of the relevant studies after making the necessary exclusions. Materials and Methods: A total of 500 panoramic radiographs from the database were examined and evaluated for the length of SP using OmniVue software and for the calcification patterns which were categorized into three types as described by Langlais. The obtained values were analyzed using t-test and Chi-square tests with a significance level of 0.005 and SPSS version 20.0 software. Results and Conclusion: The mean length of the SP in females was found to be 3.7 cm on the right side and 3.8 cm on the left side. The mean length of the SP in males was found to be 3.4 cm on the right side and 3.3 cm on the left side with significant difference between the genders with the P values of 0.0002 and 0.0001, respectively. The length of the SP was significantly longer in females than in males. Type I was the most common SP and was more prevalent in females. The results of the present study along with the wide range of reported incidence of anatomical variations in the form of elongation from the literature extracted through the systematic review suggests the need to reevaluate the range of the normal length of the SP.
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An in vivo study to compare anti microbial activity of triantibiotic paste, 2% chlorhexidine gel, and calcium hydroxide on microorganisms in the root canal of immature teeth Highly accessed article p. 263
Sumit Sabharwal, Shresth Kumar Bhagat, Kumar Shresth Gami, Abhishek Siddhartha, Kulwant Rai, Yuvika Ahluwalia
DOI:10.4103/jispcd.JISPCD_400_18  
Aims and Objectives: Intracanal medication plays an important role in disinfecting the root canal from various microorganisms. There are various intracanal medication frequently used by practitioners based on the efficacy of the same, therefore to compare antimicrobial activity of a triple antibiotic paste with chlorhexidine gel and calcium hydroxide against microorganisms in the root canal used as irrigating solution. Materials and Methods: The present study was conducted on 88 single rooted (central and lateral incisors), asymptomatic, nonvital, and necrotic teeth. Individuals included were between the ages of 12–15 years with no systemic complications. Overall, 88 teeth were divided randomly into four groups on the basis of treatment they were given, with each group having 22 teeth. Each group was assigned to one intervention group namely 2% chlorhexidine gel group, calcium hydroxide group, triantibiotic paste group, and the normal saline group. Triantibiotic paste was prepared from ciprofloxacin Hydrochloride 500 mg+ Metronidazole 400 mg+ Tetracycline 500 mg. Two samples were collected from individual tooth to assess the change in the extent of total colony forming units. Results: Mean log10 bacterial count among the triantibiotic paste was 5.222 preirrigation which was decreased to 0.653. Maximum percentage of log10 bacterial count was decreased among triantibiotic paste group of 87.20% while control group of normal saline has recorded a decrease of 54.65% in bacterial count. Among all the four groups, there was a decrease of 73.51% of bacterial count. Conclusion: From the above results, it was concluded that triantibiotic paste demonstrated the highest efficacy against bacterial pathogen when used as irrigating solution.
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Awareness of specialties of dentistry among medical trainees and teaching faculty of medical college in the central West India p. 269
Arun P Nagrik, Bhawana A Bhagat, Sushil B Yemle, Sainath Maidapwad
DOI:10.4103/jispcd.JISPCD_297_18  
Objective: The purpose of this study was, to assess and create awareness of specialties of dentistry among medical trainees and teaching faculty. Materials and Methods: Printed and validated questionnaires were given personally to a total sample of 180 patients, including 60 interns, 40 postgraduate (PG) trainees and 80 teaching staff of Government Medical College. Their responses were collected and the results were tabulated using Micro-Soft Excel 2010. Data obtained was analyzed using the GraphPad Prism 7 statistical software. To compare the responses between the study groups a Pearson's Chi-square test was used. Results: About 96.11% of the sample replied that they are not aware of the different specialties of dentistry and 89.44% of the sample refers their patients to the general dentist without knowing the specialty. About 70% of the interns marked orthodontics as a specialty dealing with fractures of the jaw, whereas 82.5% of the PGs and 95% of the faculty advised referral of the fracture mandible case to the Oral and Maxillofacial Surgeon. Percentage of correct response for interns, PGS and staff, was 53.33%, 78.75%, and 92.34%, respectively (P ≤ 0.05). Conclusion: A large number of interns are not aware of the differences among the branches in Dentistry, specifically between orthodontics, oral-maxillofacial surgery, community dentistry, and Pedodontics. Many medical doctors have misbelief that all of their dental-related issues can be solved by the general dental practitioner. It is the present need to spread the awareness among the medical trainees and doctors about different subspecialties of dentistry to ensure proper referral practices of the dental patients they come across.
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Prevalence and perception of shisha smoking among university students: A cross-sectional study p. 275
Muzammil , Dhafer S Al Asmari, Abdullah Saleh Al Rethaiaa, Abdullah Saleh Al Mutairi, Tareq Hamoud Al Rashidi, Hussam Azioy Al Rasheedi, Saad Amer Al Rasheedi
DOI:10.4103/jispcd.JISPCD_407_18  
Aims and Objectives: Understanding perceptions and factors behind the rise in the prevalence of shisha smoking is important for the development of prevention strategies and policies. The aim of this descriptive study was to assess the prevalence and perception of shisha smoking among university students. Materials and Methods: The anonymous, self-structured 12-item questionnaire was administered to 450 male university students, with an overall response rate of 82.44% (n = 371). Prevalence, knowledge, and other associated factors regarding shisha smoking were compared between dental and other specialty students using SPSS software for descriptive statistical analysis. Results: Among 371 university students, 40.43% (n = 150) were nonsmokers, 32.88% (n = 122) were shisha smokers, 12.94% (n = 48) were cigarette smokers, and 13.75% (n = 51) smoked both shisha and cigarette. The overall prevalence of shisha smoking (46.63%, n = 173) was higher than that of cigarette smoking (26.68%, n = 99). The percentage of those knowledgeable about the ill effects of shisha smoking was 44.2% with lesser knowledge among shisha smokers than cigarette smokers. There was no statistically significant difference in the mean total knowledge score between dental (5.65 ± 2.08) and other specialty (5.21 ± 2.3) students. Conclusions: A high prevalence of shisha use among university students is reported in this study as well as a general lack of understanding of the dangers involved with this behavior. Study authors recommend the development of policies targeted at preventing further rise in the prevalence of shisha smoking through the implementation of preventive strategies such as incorporating this topic into the school syllabus and encouraging research on shisha smoking.
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Principle of Lag-Screw fixation in mandibular trauma p. 282
Eswar Rao, Sayani Naveen, Ram Chandra Rao, Kiran Kollabathula, Madhurima Srirambhatla, Sruthi Gandham
DOI:10.4103/jispcd.JISPCD_64_19  
Aims and Objectives: The aim of the study is to assess the effectiveness of lag screw fixation in mandibular fractures with respect to parameters such as stability of the occlusion, functional stability, infection rates, neurosensory deficit, ease of technique, and maximum interincisal opening. Materials and Methods: Our study was carried out on 13 patients with mandibular fractures. Selected cases were treated with lag screw technique and 2.7 mm titanium screws were used. Postoperative complications such as wound dehiscence, infection, neurosensory disturbance, nonunion, malocclusion, postoperative mouth opening, and occlusal discrepancies were assessed. Results: All the patients were male, aged between 17 and 50 years. The cause of the injury was road traffic accidents in all, except for two assaults. Our study of 13 cases of fractured mandible included five symphyses, five parasymphyses, two angle, and one body fracture cases. Our observation with open reduction and rigid internal fixation with 1–2 lag screws revealed close approximation of fractured fragments in all the cases, except in three patients who had mild discrepancy of occlusion. Conclusion: Lag screw technique provides good interfragmentary compression and restoration of premorbid anatomic alignment of fracture fragments. In displaced mandibular fractures, especially in oblique fractures, the use of lag screw has proven to be ideal. The complications were found to be low. It was concluded that the lag screw provided excellent stability and occlusion.
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Assessment of the anterior loop of the mandibular canal using cone-beam computed tomography in Eastern India: A record-based study p. 290
Smriti Sinha, Srinivas Kandula, NC Sangamesh, Purnendu Rout, Silpiranjan Mishra, Atul Anand Bajoria
DOI:10.4103/jispcd.JISPCD_83_19  
Objective: The aim of this study was to assess the presence and course of the anterior loop (AL) in an Odisha sample population using cone-beam computed tomography (CBCT) and to accurately identify and analyze the length, height, and diameter of AL in male and females. Materials and Methods: CBCT images from 1000 patients obtained for various clinical indications were randomly selected and evaluated to determine the presence, length, height, and diameter of the AL. The various parameters were then compared based on gender, age, and the side of the mandible. The data were analyzed using the Chi-square test, independent t-test, multiple post hoc procedure, and one-way ANOVA test. Results: An AL was identified in 9.7% of the cases, and its mean length ranged from 1.8 to 4.8 mm. The loop had a greater mean length and was significantly more prevalent in males. The diameter ranged from 1 to 4 mm and height ranged from 7.8 to 15.1 mm. The AL was most commonly found in the middle-aged patients (39–48 years) which attributed to around 27.83%. Conclusion: In this study, a lower prevalence of the AL of the mandibular canal was found. Being an anatomical variation, an exact evaluation of the AL must be established using the imaging techniques prior to any surgical procedure.
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The dental hygienists in Sweden and Portugal: A comparative study p. 296
Annsofi Johannsen, Sebastian Malmqvist, Sandra Graça, Victor Assunção, Teresa Albuquerque, Henrique Luis
DOI:10.4103/jispcd.JISPCD_1_19  
Aims and Objectives: The aim of the present study was to identify the dental hygienists (DHs)' working areas and compare these findings between Sweden and Portugal. Materials and Methods: A web-based questionnaire was sent by E-mail to all 2943 members of the Swedish DH Association and 381 members of the Portuguese DH Association. The questionnaire contained questions about; number of years of work, which patient groups they worked with, if they had got sufficient knowledge from the education and what different tasks they worked with. Independent sample t-test, relative risk, and logistic regression analysis were used as statistical methods. Results: The response rate for Sweden was 31% (n = 923) and the corresponding figure for Portugal was 53.5% (n = 204). The most common tasks for the DHs, in both countries, were to diagnose and treat patients with periodontitis and to diagnose and perform caries prevention. In Portugal, 86.5% worked with orthodontic patients compared to 32.3% in Sweden (P = 0.001). The logistic regression analysis showed that there was a 25% (P = 0.02) higher probability that Swedish DHs took more X-rays and 38% (P = 0.042) probability that they had more communications skills compared to the Portuguese DHs. Conclusion: The DH profession in Sweden and Portugal was overall quite similar. Despite a few local differences, both the academic education and scope of practice corresponded well between the countries. The few discrepancies could be explained by differences in legislations in each country.
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CASE REPORT Top

Endocrown restoration on postendodontics treatment on lower first molar p. 303
Irmaleny , Zuleika , Sholeh Ardjanggi, Andi Ainul Mardiyah, Dian Agustin Wahjuningrum
DOI:10.4103/jispcd.JISPCD_399_18  
Restoration is one of the most important things in the field of dentistry, in restoration, there are two main things that must be considered, that was esthetic factors and functional factors. A tooth after endodontics treatment require more complex restoration than normal tooth, because lot of factors needed to be observed first, one of which is tissue residue, root canal anatomy, and even the economics condition of the patient. Post, cores, and crowns themselves have several contra indications in their use, therefore a dentist must be able to have other alternatives in the choice of restoration. Endocrown is an alternative that can be used by a dentist in performing postendodontics restoration.
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