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   Table of Contents - Current issue
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September-October 2020
Volume 10 | Issue 5
Page Nos. 531-679

Online since Monday, September 28, 2020

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REVIEW ARTICLES  

A systematic review to evaluate knowledge, attitude, and practice regarding biomedical waste management among dental teaching institutions and private practitioners in Asian countries p. 531
Priyanka Pandurang Tompe, Neelam Abhay Pande, Bhushan Dattatray Kamble, Usha Manohar Radke, Bhabani Prasad Acharya
DOI:10.4103/jispcd.JISPCD_157_20  
Objective: The objective of this study was to assess knowledge, attitude, and practices among dental teaching institutions and private practitioners in Asian countries. Materials and Methods: Systematic review of observational studies on BMW management was conducted. We searched the following electronic bibliographic databases: PubMed/MEDLINE and Google Scholar. Manual search was carried out for similar topics in the National Medical Library, New Delhi. In addition, the bibliographies were manually searched. There was no disagreement between the two reviewers. This review was reported and conducted in step with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only studies written in English and published until November 2019 were included. This review was registered in International Prospective Register of Systematic Reviews (PROSPERO registration number is CRD42019124900). Results: In this review, of 678 articles, 24 articles met inclusion criteria. Available scientific studies showed that knowledge regarding BMW management guidelines varied from 33% to 100% among dentists. Most of the studies reported that knowledge and practice regarding segregation of BMW was limited. Most of the study subjects were aware of hazardous effects of amalgam and had amalgam separator. Studies done in Chennai and Karnataka, approximately one-third dentists were not following BMW guidelines for sharp management and most of them were disposing of sharps in general waste bins. Conclusion: On the basis of the current evidence and data extracted from the various databases, it can be concluded that knowledge regarding BMW management guidelines among dentists is inadequate and practice regarding the same is poor. Regular training sessions and Continuing Dental Education (CDE) on BMW management guidelines and updates need to be organized for improvement of knowledge and practice regarding BMW among dentists.
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Dental risks and precautions during COVID-19 pandemic: A systematic review Highly accessed article p. 540
Khawlah A Turkistani, Khadijah A Turkistani
DOI:10.4103/jispcd.JISPCD_295_20  
Objective: To provide dentists and dental team with insights concerning risk and precautions during COVID-19 outbreak crisis as it would help in decision making among dental community. Materials and Methods: A comprehensive review of all English and non-English articles was carried out using the available CORD-19 dataset with MEDLINE via PubMed, Cochrane library, Google Scholar and ScienceDirect databases. The study included all articles that matched the search terms. Results: A total of 353 were retrieved, of which 13 articles were reviewed comprehensively. Studies included in this systematic review emphasized on reinforcing strict infection control measures and minimizing human-to-human contact during COVID-19 outbreak. All surfaces in operatory room including waiting area need adequate ventilation and disinfection. Dental patients need to be screened using COVID-19 targeted questions as well as measuring their body temperature. Restricting dental treatments to only emergency cases and rescheduling all routine visits is advised with careful attention to minimize aerosol generation and following highest level of personal protection when treating COVID-19 confirmed cases. Dental offices need to establish a standard protocol of case reporting and referral to other well-prepared facilities. Lastly, online platforms are beneficial tools in providing psychological support to distressed dentists, dental team and dental patients and educating public during COVID-19 crisis. Conclusion: Dental team need to follow strict infection control measures and minimize aerosol generation during COVID-19 outbreak. It is the responsibility of dental care workers to keep themselves informed and ensure safety and control transmission within dental facilities. Further research is required.
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ORIGINAL ARTICLES Top

Kiddie doctors education strategy in improving the knowledge, attitude, and oral hygiene status of elementary school children p. 549
Muri Maftuchan, Ella Nurlaella Hadi
DOI:10.4103/jispcd.JISPCD_116_20  
Objectives: This study aimed to assess the improvement in the knowledge, attitude, and oral hygiene scores of elementary school children after being provided education by kiddie doctors. Materials and Methods: A quasi-experiment design with pretest–posttest control group model was conducted on 143 students belonging ages 8–12 years old in two selected elementary schools. Kiddie doctors educated their peers three times at four-week intervals. Baseline data were collected a week before the education, and the final data were collected a month after the third education session. Data regarding knowledge and attitude were collected using questionnaires filled in by the respondents. The oral hygiene index simplified (OHIS) and patient hygiene performance (PHP) index data were obtained through intra-oral examinations. Data were analyzed using dependent and independent t tests and multiple linear regression analysis. Results: After receiving education, there was a change in the knowledge, attitude, OHIS, and PHP scores (P = 0.005). Kiddie doctors were estimated to decrease the OHIS and PHP scores by 0.312 and 0.579 points, respectively. Conclusions: The education provided by kiddie doctors improved the knowledge, attitude, and oral hygiene status of children. Kiddie doctors could help health workers who are still constrained in routine promotional activities.
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Antibacterial efficacy of calcium hydroxide with iodoform versus calcium hydroxide with camphorated paramonochlorophenol as intrachannel pastes on an Enterococcus faecalis biofilm: A comparative in vitro study p. 555
Marisa Jara, Doris Salcedo-Moncada, Gerardo Ayala, Romel Watanabe, Daniel Alvítez-Temoche, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_177_20  
Objective: The objective of this study was to assess in vitro the antibacterial efficacy of Ca(OH)2 with iodoform versus Ca(OH)2 with camphorated paramonochlorophenol as intrachannel pastes on an Enterococcus faecalis biofilm. Materials and Methods: The diffusion method was used in wells. The strain used was E. faecalis ATCC 29212. Bile esculin agar was inoculated into 60-well plates of 5 mm in diameter. Three groups were formed: Group 1: Calen PMCC (Ca(OH)2 + camphor paramonochlorophenol); Group 2: Metapex (Ca(OH)2 + iodoform); and Group 3: camphor paramonochlorophenol inoculated with E. faecalis as a positive control. The plates were then incubated at 37°C for 24 h. Bacterial inhibition halos were read. Results: Group 1 presented the highest antimicrobial efficacy with a mean of 16.2 ± 0.6 mm, whereas Group 2 only had an antimicrobial effect of 9.7 ± 1.3 mm. Finally, Group 3 only exposed to the positive control (camphor paramonochlorophenol) showed an effect of 14.6 ± 1.0 mm. The inferential analysis showed statistically significant differences between the antimicrobial effect of the three groups (P = 0.001). Conclusion: Ca(OH)2 paste with camphor paramonochlorophenol (Calen PMCC) has a greater antibacterial action on E. faecalis. The iodoform-associated Ca(OH)2 paste (Metapex) showed significantly lower antibacterial action against E. faecalis (P < 0.05).
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Nordic assessment of occupational disorders among dental students and dentists in Saudi Arabia p. 561
Khalid T Aboalshamat
DOI:10.4103/jispcd.JISPCD_142_20  
Objectives: Ergonomics and the avoidance of occupational or work-related musculoskeletal disorders (WRMSDs) are crucial for a future dentist’s career, as studies have linked WRMSDs to some serious complications, including early retirement. This study aimed to investigate the level of knowledge and awareness about ergonomics and the prevalence of WRMSDs among dental students and dentists in Makkah province, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted of 322 dental students and dentists from two universities in Makkah province, Saudi Arabia, using a self-report questionnaire to measure ergonomic awareness and the Nordic Musculoskeletal Questionnaire to measure WRMSDs. Results: Among the respondents, only 4.82% could correctly explain ergonomics, 14.16% had attended a course or workshop on ergonomics, 55.12% were familiar with preventive techniques for WRMSDs, and 37.95% were familiar with remedies/treatment for WRMSDs. Females were significantly more aware of WRMSDs than males. There was 81.33% who had trouble (pain, aches, or discomfort) in one or more parts of their body during the previous 12 months. The most common sites for WRMSDs were the upper back (48.19%), wrists/hands (44.27%), lower back (43.98%), neck (36.45%), and shoulder (33.43%). In most body parts, WRMSDs were more common among males and participants from a governmental university than among females or those from a private university. Conclusion: Both dental students and dentists in Saudi Arabia lacked awareness of ergonomics and experienced high levels of WRMSDs. More educational efforts and attempts are needed to boost dental professionals’ knowledge about musculoskeletal disorders related to dental profession and built the skills to cope with them.
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Implementation of a medical ethics course in undergraduate dental education and assessment of knowledge and attitudes p. 569
Annabelle Tenenbaum, Grégoire Moutel, Maryse Wolikow, Amandine Vial-Dupuy, Sylvie Azogui-Levy
DOI:10.4103/jispcd.JISPCD_364_19  
Objectives: A medical ethics course was launched in 2012 in a French University Dental School. We compared knowledge and attitudes, before and after implementation of that course. The aim of this study was to compare students who received an ethics course (third year) to those who did not have such training, however, most of them did have some clinical traineeship. Materials and Methods: An anonymous questionnaire was sent to the second-, third-, and sixth-year students. It comprised questions with Likert item format answers and clinical vignettes with open responses. The results were analyzed by two approaches: a statistical analysis (chi-square or Fischer exact tests) and a content analysis using a predefined grid. Results: A total of 299 respondents replied (75% students) the questionnaire. The analysis showed a statistically significant association between knowledge of the law and information procedures (P < 0.0001), access to medical files (P = 0.004), and recording consent (P = 0.049). It was also significant between knowledge of the law and the principles of biomedical ethics (P < 0.0001 for autonomy and beneficence). The third-year students could state the principles of medical ethics with their percentage always greater than the sixth-year students. After the third year, the students’ attitudes switched from a social to a medical emphasis, and their point of view regarding patient’s autonomy evolved. Patient’s refusal of care raised potential conflicts between autonomy, professional judgment, information, and consent. Conclusion: Ethics teaching could offer a way to turn positive attitudes into real competencies and should be considered at an early stage.
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Ethanol extract of Schinus molle L. (molle) and Erythroxylum coca Lam (coca): Antibacterial properties at different concentrations against Streptococcus mutans: An in vitro study p. 579
Daniel Loyola, Roman Mendoza, Lucy Chiong, Magnolia Rueda, Daniel Alvítez-Temoche, Walter Gallo, Frank Mayta-Tovalino
DOI:10.4103/jispcd.JISPCD_237_20  
Objective: The aim of this study was to compare in vitro the antibacterial activity of an ethanol extract of Erythroxylum coca Lam (EEE) and Schinus molle L. (EES) at 50% and 75% versus Streptococcus mutans ATCC 25175. Materials and Methods: This was a prospective, comparative, longitudinal experimental study. The ethanol extract of coca and molle leaves was obtained by the vacuum filtration method at concentrations of 50% and 75% and was compared with a positive control (0.12% chlorhexidine). Streptococcus mutans strains were isolated in a culture medium (Mitis Salivarius Agar) ideal for the growth of bacterial colonies. The antibacterial activity of the ethanol extract was carried out following the Kirby–Bauer disk-diffusion method in Mueller–Hinton agar to measure bacterial sensitivity. A value of P < 0.05 was considered statistically significant. Results: Evaluation of the antibacterial effect of EEE and EES at 24 and 48 h showed that a concentration of 75% for both groups had the highest antimicrobial activity against S. mutans (11.2 ± 0.7 mm; 11.6 ± 0.5 mm and 11.3 ± 0.7 mm; 11.8 ± 0.5 mm, respectively). So, the results have shown that the concentration of EEE and EES of 75% has a greater efficacy than the concentration of 50%, but both concentrations are not as effective as chlorhexidine. Conclusion: EEE and EES at concentrations of 50% and 75% present antibacterial activity against S. mutans ATCC 25175.
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Comparative evaluation of the influence of different sports/energy drinks and alcoholic beverages on the surface roughness of three different flowable esthetic restorative materials: An in vitro Analysis p. 585
Naman Vaidya, Pravin Kumar, Karishma Pathak, Sandhya K Punia, Ashish Choudhary, Arun K Patnana
DOI:10.4103/jispcd.JISPCD_246_20  
Objective: This study aimed to evaluate the surface roughness of three flowable esthetic restorative materials after exposure to sports/energy drinks and alcoholic beverages. Materials and Methods: A total of 210 specimens of dimension (2cm diameter and 2 mm thickness) with giomer, compomer, and composite (70 samples with each esthetic material) were made with the help of plastic rings. The prepared samples were tested in six experimental sports/energy drinks (beer, whiskey, vodka, Gatorade, Red Bull, and Sting) and distilled water was considered as the control group. Profilometric analyses of all samples were recorded before immersing into the experimental and control solutions. Then, the samples were stored in the experimental and control group solutions for 5min for 30 days. The profilometric analysis was repeated after 30 days and records were statistically analyzed. Results: Flowable composite showed the minimum surface roughness, whereas the flowable compomer showed the maximum surface roughness in the present test conditions. When the erosive potential of the test solutions was evaluated, surface roughness values were more for sports/energy drinks when compared to that of alcoholic beverages. Conclusion: All the sports/energy drinks and alcoholic beverages evaluated in this study altered the surface roughness of the tested restorative materials. The effects ranged from slight to a markedly negative impact on the surface roughness of the test restorative materials.
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Third molar angulation changes in Class II div I malocclusion subjects treated with extraction of four premolars: A retrospective study p. 591
Keerthan Shashidhar, Chrysl Karishma Castelino, MN Kuttappa, Rohit A Nair, Crystal Runa Soans, Harikrishnan S Nair
DOI:10.4103/jispcd.JISPCD_342_19  
Aim: The aim of this study was to assess the changes in maxillary and mandibular third molar inclinations in individuals with class II div 1 malocclusion, before and after orthodontic treatment with extraction of all four first premolars. Materials and Methods: This retrospective study consisted of the pretreatment and posttreatment records of 30 patients that were obtained from the archives of the department of orthodontics and dentofacial orthopedics in A B Shetty Memorial Institute of Dental Sciences. The maxillary third molar’s relation to the palatal plane and the mandibular third molar’s relation to the mandibular plane were measured. The paired t test was used to calculate pre- and posttreatment changes. A value of P < 0.05 was considered to be statistically significant. Results: The maxillary third molars showed a mean correction of 6.15° (P < 0.001) and the mandibular third molars showed a mean correction of 5.10° (P < 0.001). Conclusion: Maxillary third molars showed more uprighting when compared to the mandibular third molars and that both maxillary and mandibular third molars showed an improvement in their angulations to their respective planes after extraction of the first premolars. However, the results of the study cannot be analyzed to state if the third molars do become fully functional.
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The knowledge and perception of antiplatelet and anticoagulant agents among dentists in northern jordan p. 597
Rasheed K Ibdah, Sukaina I Rawashdeh, Ehab Harahsheh, Abdallah Almegdadi, Abdullah Al.Ksassbeh, Nasr Alrabadi
DOI:10.4103/jispcd.JISPCD_70_20  
Objectives: The aim of this study was to describe the attitude and perception toward antiplatelet/anticoagulant agents in patients with cardiovascular diseases among dentists in the northern district of Jordan and to compare the current practice of Jordanian dentists and the recently published guidelines regarding the management of patients taking antiplatelet/anticoagulant drugs before dental procedures. Materials and Methods: This is a cross-sectional study conducted on dentists and dental interns working at the dental clinics in northern Jordan, including dental clinics at Jordan University of Science and Technology (JUST) and the private sector. The total sample size comprised of 128 subjects (78 dentists from JUST and 50 private practitioners). The participants were interviewed using a preformed questionnaire to assess their knowledge and perceptions regarding the antiplatelets and the anticoagulant agents. Results: Approximately 61.5% of participants from JUST university and 20.0% of those in the private sector were aware of the use of clopidogrel (P < 0.0001). Although the overall awareness regarding other antiplatelets such as prasugrel was very low (8.6%), dentists from JUST (12.8%) showed a significantly higher level of awareness compared to the private practitioners (2.0%) (P = 0.049). More than 70% of the participants from JUST and only 46.0% of the private practitioners were aware of the consequences of interrupting treatment with clopidogrel in patients with coronary stents (P = 0.002). Almost both the participants from JUST (25.78%) and the private sector (24.22%) are consulting the cardiologists with similar frequencies before interrupting the treatment with the antiplatelet/anticoagulant agents. Participants who have clinical PhD qualifications are more aware of the recent clinical guidelines and the newest agents compared to others. Conclusions: The awareness regarding the newest antiplatelet/anticoagulant agents is poor among the dentists in northern Jordan. However, the majority (62.3%) of them realize the consequences of interrupting such treatments in patients with coronary stents. Unfortunately, only a quarter of the dentists are consulting the cardiologists before interrupting the treatment with the antiplatelet agents. Proper education, courses, and workshops should be performed to the dentists to improve their knowledge about this critical issue.
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Influence of parents’ oral health knowledge and attitudes on oral health practices of children (5–12 years) in a rural school in KwaZulu-Natal, South Africa p. 605
Prenisha Nepaul, Ozayr Mahomed
DOI:10.4103/jispcd.JISPCD_273_20  
Context: Oral health knowledge, beliefs, and attitudes of parents have a direct influence on their child’s oral health maintenance, dietary habits, and oral health behaviors. Aim: The aim of this study was to assess the knowledge, and attitude of parents with regard to the oral health practice of their children and its associated factorsMaterial and Methods: A self-administered structured questionnaire was administered to parents or guardians of learners aged 5–12 years at a low socioeconomic rural primary school in the Ugu district, KwaZulu-Natal, South Africa. In addition to demographic variables, knowledge of dental health, use of toothbrush, use of toothpaste, dietary practices, and dental visits; practice with respect to dental care; and attitudes toward oral health were requested. Results: One hundred and forty-four completed survey instruments were received with an 80% (118) representation of mothers. Ninety-five percent of the parents (136) had a positive attitude toward oral health with 86% (124) of the children brushed their tongue and 89% (128) of the children brushed their teeth happily. The mean knowledge score was 70%. Children were significantly more likely to brush their tongues (adjusted odds ratio [AOR]: 3.20 95% confidence interval [CI]: 1.06–9.66 P < 0.001), be happier when brushing their teeth (AOR: 4.65 95% CI: 1.41–15.38 P < 0.001) when the caregivers were their mothers, had an above-average knowledge score (AOR: 1.86 95% CI: 0.72–4.85) and positive attitudes (AOR: 3.20 95%CI: 0.46–22.00). Conclusion: Parents in the rural community have satisfactory knowledge and a positive attitude toward oral health and children display good practices; however, there are a number of gaps noted in overall parental knowledge.
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Influence of neuroticism on the prognosis of nanoceramic and microhybrid composite restoration: A comparative 1-year clinical study p. 613
Sulthan Ibrahim Raja Khan, Dinesh Rao, Anupama Ramachandran, Bhaskaran Veni Ashok, Abdulmohsen Alfadley
DOI:10.4103/jispcd.JISPCD_274_20  
Aim: This study aimed to compare the clinical performance of nanoceramic and microhybrid-based composite restorations in adult patients with different personality traits. Materials and Methods: Patients in accordance with the inclusion and exclusion criteria were asked to complete the BFI (Big Five Inventory) questionnaire. Of a total of 323 patients, 124 (67 males and 57 females) patients were categorized into agreeableness and neuroticism traits and were included in the study. The patients were randomly divided into two subgroups: SG I A (n = 31) and II A (n = 31) for microhybrid composite (Spectrum TPH 3, Dentsply/DeTrey, Konstanz, Germany), SG I B (n = 31) and II B (n = 32) for nanoceramic composite restorations (Ceram X mono, Dentsply/DeTrey, Germany). At baseline, 6 and 12 months, the restorations were evaluated using the Modified USPHS (United States Public Health Service) evaluation criteria. The Pearson chi-square and the Fisher’s exact test were used to assess the difference between the personality traits and restorative material groups where a probability value of P < 0.05 was considered to be statistically significant. Result: Most of the restorations scored alfa (A), whereas very few scored bravo (B) in all the subgroups. However, there were no charlie (C) or delta (D) scores. Overall, Spectrum TPH and Ceram x mono displayed superior performances in retention and postoperative sensitivity than all the other clinical parameters. Furthermore, Ceram x mono restorations showed more surface roughness than Spectrum TPH. No statistical differences in the restoration performance were found between both personalities and restorative material types. Conclusion: Although neuroticism has an effect on various health outcomes, its impact on the clinical performance of composite restorations during the follow-up period was not observed. In addition, there was no difference between the performance of nanohybrid and microhybrid composite.
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Comparison of primary stability of implants installed by two different methods in D3 and D4 bone types: An in vitro study p. 620
Vinod Bandela, Bharathi Munagapati, Jayashree Komala, Ram B Basany, Santosh R Patil, Saraswathi Kanaparthi
DOI:10.4103/jispcd.JISPCD_160_20  
Objective: The purpose of the study is to assess the method of implant insertion in D3 and D4 bones and influence of insertion torque for achieving better primary implant stability. Materials and Methods: A total of 32 specimens (wood blocks) simulating D4 and D3 bone were grouped into 1, 2, 3, and 4. In groups 1 and 3, the implant and abutment were placed by manual method while in groups 2 and 4 by motor-driven method. The osteotomy site was prepared as per the protocol for soft bone, and implants were placed till the implant platform was in flush with the surface of the block. After achieving a standard insertion torque of 40 N.cm, pullout test was carried out with a universal testing machine and results were analyzed by one-way analysis of variance. Results: An intergroup comparison of peak loads revealed an overall statistically significant difference (P < 0.0001) with a mean of 442.638 N, maximum in group 4 and least (202.963 N) in group 1. The mean elongation break was found to be maximum in group 3 samples (81.67600%) and less in group 4 (37.15113%). Intergroup comparison of Young’s modulus was statistically significant (P < 0.0001) with a mean value found to be minimum among group 1 samples (597.54750 MPa) and maximum in group 2 (1056.76463 MPa). An intergroup comparison of yield points was found to be maximum among group 4 samples (16.17238MPa) and least in group 1 (5.77438MPa). Conclusion: The D3 bone sample provided greater primary stability of implant than D4 bone samples, and the motor-driven implant seemed to have improved stability than that placed manually.
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Detection and categorization of biofilm-forming Staphylococcus aureus, Viridans streptococcus, Klebsiella pneumoniae, and Escherichia coli isolated from complete denture patients and visualization using scanning electron microscopy p. 627
Andonissamy Leoney, Suma Karthigeyan, Ali Seyed Asharaf, A J W Felix
DOI:10.4103/jispcd.JISPCD_256_20  
Aims: Complete denture patients have a plethora of microorganisms inhabiting their complete dentures. Some bacteria are capable of causing systemic illness such as aspiration pneumonia and infective endocarditis. Hence, detection as well as the categorization of biofilms, which form on the denture surface is vital in the study of denture biofilm-associated local and systemic diseases. This study aimed at the detection and categorization of biofilm-forming Staphylococcus aureus, Viridans streptococcus, Klebsiella pneumoniae, and Escherichia coli isolated from complete dentures and visualization of biofilms using scanning electron microscopy (SEM). Materials and Methods: Thirty complete denture patients were selected for the study and swabs were collected from their complete denture surfaces. Isolation of the bacteria was done using selective media and confirmed using biochemical tests and 16SrRNA sequencing. The bacteria were subjected to biofilm assays via Microtiter plate assay. The biofilm-forming bacteria were categorized as weak, moderate, and strong biofilm formers based on optical density (OD) values. As a visual confirmation of the biofilms, scanning electron microscopic (SEM) images were taken for each of the strong biofilm-forming bacteria. Descriptive statistical analysis was carried out with the help of Statistical Package for the Social Sciences (SPSS) statistical package version 20.0. Results: The average OD of S. aureus was 1. 333±0. 015 and the average OD of V. streptococcus species was 1. 304 ± 0.023. The average OD value of K. pneumoniae was 0.8 ± 0.012 and the average value of E. coli was 1.014 ± 0.01. Conclusions: The study of biofilms especially the strongly biofilm formers is very useful to understand the potential pathogenic effect of biofilms. These biofilms cause the systemic spread of the planktonic bacteria which could lead to systemic diseases that are resistant to conventional treatment. This could be due to the inherent nature of the biofilm to offer drug resistance to existing antibacterial agents.
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Physicochemical characterization of five different bone graft substitutes used in periodontal regeneration: an in vitro study p. 634
Aiswarya Anil, Arun Sadasivan, Elizabeth Koshi
DOI:10.4103/jispcd.JISPCD_263_20  
Background: Periodontal regeneration involves using a variety of bone graft substitutes (BGS) of varying origin and manufacturing processes. These include a wide range of biomaterials that are mainly of two types: the xenografts and alloplasts. The efficacy of these BGS depends upon the physical characteristics such as particle size, porous nature, surface morphology, as well as the chemical characteristics like composition, crystallinity and resorption properties. Aims: The present study is a descriptive study that focuses on describing the physicochemical characteristics of five selected commercially available BGS that are frequently used in periodontal regeneration procedures. The BGS studied here included two xenografts (colocast and osseograft) and three alloplasts (B-OstIN, biograft HABG active and biograft HT). Materials and Methods: The physical properties of the BGS, including particle size, morphology, and surface topography, were analyzed using SEM. The mineral phases and crystallinity of the BGS were analyzed using XRD. Results: The results showed that the xenografts (colocast and osseograft) had minimal mineral composition and crystalline structure. The physical properties such as surface roughness and porosity were less compared to alloplastic materials. The alloplasts (B-OstIN, biograft HABG and biograft HT) that had different chemical compositions showed varying physical and crystalline properties. Biograft HT showed a superior porous scaffold architecture among all BGS studied. Conclusion: It is important for a clinician to have a thorough understanding about the physicochemical characteristics of BGS they use in periodontal regeneration. The xenografts evaluated here had minimal physical and crystalline properties. Among the alloplasts studied, biograft HT showed superior physicochemical properties, while the presence of bioactive glass in biograft HABG enhanced regeneration.
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Dental and orofacial barotraumas among Saudi Military Naval Divers in King Abdul Aziz Naval Base Armed Forces in Jubail, Saudi Arabia: A cross-sectional study p. 643
Deema M Alwohaibi, Lamia M Alohali, Ghadah S Al-Takroni, Bandar Al-Abdulwahab, Ashraf El-Metwally
DOI:10.4103/jispcd.JISPCD_165_19  
Background: The aim of this study was to assess dental as well as orofacial pain under atmospheric pressure in military divers. Materials and Methods: Cross-sectional study was conducted in King Abdulaziz Naval Base Armed Forces (KANB) in Jubail, Saudi Arabia involving 216 Saudi military divers. Questionnaire was formulated to assess the prevalence and factors associated with dental as well as orofacial pain among divers. Results: Of total 216 participants, 35.6% participants dive 10-50times/year; whereas 52.8% dive in more than 20 m depth and 67.2% dive in the atmospheric pressure of >1.5bar. Majority (81.9%) used compressed air when diving. Sudden pain during or after diving was experienced by 67.1% in head or facial area, 69.2% in nose and paranasal sinuses, and 52.3% have experienced dental injury. Statistically significant associations were found between pain during diving with a frequency of diving, diving depth, and atmospheric pressure with P < 0.001, 0.001, and 0.011, respectively. Conclusion: Through this study, we concluded that dental and orofacial pain were experienced by more than half of the military divers at least once during their dive. Factors like increased frequency of diving, deep divers, and increased atmospheric pressure increases the extent of pain. Findings of this study suggested that more studies focusing on diving centers should be performed to realize the complete range of the issue.
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Marginal fit of full contour monolithic zirconia in different thicknesses and layered zirconia crowns p. 652
Mina Mohaghegh, Maryam Firouzmandi, Elham Ansarifard, Laleh Ramazani
DOI:10.4103/jispcd.JISPCD_25_20  
Aim: Use of monolithic zirconia for fabrication of all-ceramic crowns eliminates several shortcomings of layered zirconia crowns. Long-term success of restorations highly depends on the marginal fit. The crown thickness is among the factors that affect the marginal integrity. Meanwhile, reduced thickness of crowns has several advantages such as preservation of tooth structure. The aim of this study was to evaluate the marginal fit of monolithic zirconia crowns in reduced thickness and to compare the marginal fit of full-contour monolithic zirconia in different thicknesses with layered zirconia crowns. Materials and Methods: In this in vitro study, two standard brass dies (7 mm × 5 mm length diameter) were prepared with a heavy chamfer finish line with 0.5 and 1 mm depth. By using a CAD-CAM system, 30 crowns were made in three groups (n = 10) of 1-mm thick layered zirconia, 1-mm thick monolithic zirconia, and 0.5-mm thick monolithic zirconia. Crowns were placed on master dies and randomly numbered. The marginal gap was measured on 18 points by using a digital microscope (×230). The mean ± standard deviation (SD) values were calculated and analyzed by Statistical Package for the Social Sciences (SPSS) software program through Kruskal–Wallis and Mann–Whitney tests (α = 0.05). Results: The marginal gap of 1-mm layered zirconia was significantly different from that of 1-mm monolithic zirconia (P = 0.001) and 0.5-mm monolithic zirconia (P = 0.004). Analysis of variance (ANOVA) revealed no significant difference between 0.5 and 1 mm thicknesses of monolithic zirconia (P = 0.141). Conclusion: Marginal gap in all the three groups was clinically acceptable. The two different thicknesses of monolithic zirconia crowns had no significant effect on the restoration marginal fit; however, layered zirconia crowns showed a significantly higher marginal gap than monolithic zirconia crowns.
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Comparison of digital and paper assessment of smile aesthetics perception p. 659
Shoroog Hassan Agou
DOI:10.4103/jispcd.JISPCD_323_20  
Objectives: Despite the widespread of assessment of smile aesthetic perception in many areas, there has yet to be a direct comparison of digital and paper-based photographs for the assessment of smile aesthetics. Here we compared digital and paper-based photographs representing different smile aesthetic features using visual analog scale (VAS) scoring. Materials and Methods: One hundred students were randomly recruited from a university campus. Participants were asked to record their perception of smile aesthetics via paper and digital-based platforms. The minimum clinically important difference between platforms was set at 15 mm. The percentage of participants who rated smile attractiveness worse on digital images was recorded. The paired one-tailed Student’s t test was used to determine differences between digital and paper platforms, and Bland–Altman analysis and intraclass correlations (ICCs) were used to test for agreement between paper and digital photographs. Results: Ninety-nine subjects participated, 55 men (mean age = 22.05, standard deviation [SD] = 1.91) and 44 women (mean age 22.05, SD = 1.84). There were statistically significant differences between paper-based and digital photographs for all images except one (paired t test; P < 0.05). Digital ratings were lower than paper-based ratings for all images, and differences were clinically significant in four out of eight images. A high percentage of participants (50.5%–85.9%) rated smile attractiveness worse on digital images than on paper for all images. There was poor agreement between the two methods as assessed by ICCs and Bland–Altman analysis. Conclusion: Equivalence between paper and digital images for smile aesthetics cannot be assumed, and paper-based photographs may lead to clinically relevant overestimations of perceived attractiveness. As academic dentistry increasingly relies on digital imaging and sharing in the post-COVID-19 world, further validation of digital platforms for smile aesthetics assessment is warranted, and care should be taken when interpreting the results of studies assessing smile perception based on different platforms.
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Retention of provisional intraradicular retainers using fiberglass pins p. 666
Otavio Alberto da Costa Fartes, Leandro Marques de Resende, Renato Cilli, Antônio Márcio Resende do Carmo, Kusai Baroudi, José Roberto Cortelli
DOI:10.4103/jispcd.JISPCD_298_20  
Objectives: The purpose of this study was to compare the retention properties between fiberglass pins with chemically activated acrylic resin and metallic intraradicular retainers often used for the purpose of temporary prosthetic retention. Materials and Methods: Two mechanical tests, pushout and traction, were performed on specimens distributed in three groups (n = 10) for each test; two metal pins G1: Metalpin Ângelus and G2: Provisional Pivot Jon in addition to one fiberglass pin G3: Whitepost DC-E, FGM. One-way analysis of variance (ANOVA) followed by Tukey’s post hoc test was used at the level of significance α = 0.05. Results: The fiberglass pins (G3) showed higher values in the traction test than the metal pins (G1 and G2) with a statistically significant difference (P < 0.05); however, they performed similarly to the metal pin groups in the pushout test (P > 0.05). They also presented a lower occurrence of failure in the relining acrylic resin. Conclusion: The study pointed out the use of fiberglass pins as suitable alternatives for provisional intracanal metallic retainers.
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CASE REPORT Top

Thermal condition of muscle area around the temporomandibular joint in patient with systemic lupus erythematosus using infrared thermography application: A case report p. 674
Liana Rahmayani, Mustanir Yahya, Cut Soraya, Saumi Syahreza
DOI:10.4103/jispcd.JISPCD_126_20  
Recently, the use of infrared thermography in medical has been increasingly developed and widely used in medical devices to detect diseases, including one used in the field of dentistry, which can be used to detect joint conditions in case of temporomandibular disorder (TMD). Some literature has shown this method of infrared thermography was used to determine the surface temperature of the skin based on the emission of infrared radiation from the body. Thermal measurement is also a noninvasive method that does not provide patient inconvenience, but its application until now has not been so wide. The case study reported on the description of thermal condition of muscle area around temporomandibular joint (TMJ) in a 42-year-old woman with systemic lupus erythematosus (SLE) disease. She had experienced TMD. Infrared thermography is applied to observe the thermal condition of the muscle area around the right and left joints by thermal detection. Thermal measurement was obtained on infrared image capture, and the temperature difference was found to be greater than 0.3°C. Several studies have shown that temperature in the area around TMJ was higher, and thermal asymmetry was greater in individuals with joint disorder/TMD when compared with normal groups.
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