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   2016| Nov-Dec  | Volume 6 | Issue 6  
    Online since December 12, 2016

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Stress and professional burnout among newly graduated dentists
Suhas Kulkarni, Namrata Dagli, Prabu Duraiswamy, Harshit Desai, Himanshu Vyas, Kusai Baroudi
Nov-Dec 2016, 6(6):535-541
DOI:10.4103/2231-0762.195509  PMID:28032045
Background: Dentists encounter numerous professional stressful situations, beginning from education to day-to-day practice. The resulting stress tends to have a negative impact on their personal as well as professional lives. Objectives: To measure daily burnout, and to investigate the extent of expectations from dental career and the feeling of being unqualified new dental practitioner. Materials and Methods: A close-ended questionnaire, i.e., “the Copenhagen Burnout Inventory,” was utilized for evaluation. A total of 121 dentists with an experience ranging between 6 months and 5 years were included. The period was considered initiating from graduation to dental practicing in urban or rural areas. Ninety-seven dentists replied with filled questionnaires (80.16%). The multivariant analysis was done using SPSS 11.0 ver. (Chicago, USA). Results: Using measures analysis, the mean scores for dentists on the basis of age and sex (n = 97) were calculated. The factors most commonly considered responsible for professional burnout were emotional exhaustion (39.27%), frustrations (47.83%), feeling worn out at the end of the day (35.05%), feeling worn out at the end of the working day (46.80%), exhaustion in the morning at the thought of another day at work (35.05%), feeling that every working hour is tiring (46.80%), less energy and less time for family and friends (47.83%). The most common cause for stress was professional burnout that was recorded commonly in females in the age range of 26–28 years. Conclusions: Dentists are more prone for professional burnout, anxiety, and depression. The main reason for this is the nature of their practice and their personality traits, especially while pursuing dentistry as a carrier. Stress may lead to negative impact on dentists' personal as well as professional lives.
  5 2,462 213
Impact of implant diameter and length on stress distribution in osseointegrated implants: A 3D FEA study
R Eazhil, Siva Vadivel Swaminathan, Madhan Gunaseelan, G Vijay Kannan, Chandrapandian Alagesan
Nov-Dec 2016, 6(6):590-596
DOI:10.4103/2231-0762.195518  PMID:28032053
Aims and Objectives: Dimension of dental implant is an important parameter which has a considerable impact on the biomechanical load transfer characters and its prognosis. Excessive stress in the bone–implant interface may result in the failure of the implant. The aim of this study was to evaluate the impact of implant diameter and length on neighboring tissues around the implant. The results of the study will help in developing a scientific methodology to select appropriate implant diameter and length. Materials and Methods: In this study, tapered implants of different diameter and length were numerically analyzed using bone–implant models developed from computed tomography generated images of mandible with osseointegrated implants. The impact of various diameters on stress distribution was examined using implants with a length of 13 mm and diameters of 3.5 mm, 4.3 mm and 5.0 mm. Implants with a diameter of 4.3 mm and lengths of 10 mm, 13 mm, 16 mm was developed to examine the impact of various implant length. All materials were assumed to be linearly elastic and isotropic. Masticatory load was applied in a natural direction, oblique to the occlusal plane. The Statistical Package for the Social Sciences software package was used for statistical analysis. Results: Maximum von Mises stresses were located around the implant neck. It was demonstrated that there was statistically significant decrease in von Mises stress as the implant diameter increased. Conclusion: Within the limitations of this study there was statistically significant decrease in von Mises stress as the implant diameter increased.
  5 2,377 204
Effect of education based on the theory of planned behavior on adoption of oral health behaviors of pregnant women referred to health centers of Birjand in 2016
Sediqe Ebrahimipour, Hossein Ebrahimipoiur, Fateme Alibakhshian, Marzieh Mohamadzadeh
Nov-Dec 2016, 6(6):584-589
DOI:10.4103/2231-0762.195514  PMID:28032052
Objective: Oral health of pregnant women is very important because of the adverse effects of pregnancy on the oral hard and soft tissues and vice versa. The aim of this study was to evaluate the effect of education on oral health behaviors of pregnant women based on the theory of planned behavior in Birjand. Materials and Methods: This quasi-experimental study was carried out among 150 pregnant women admitted to health centers, who were selected using simple sampling (75 females in each case and control group). Educational program through face-to-face training was performed in the case group, and the control group received only usual training through leaflet distribution. Data were collected using a questionnaire and analyzed by the Statistical Package for the Social Sciences version 18 software at 0.05 significance level. Results: The most frequent age group was 26–30 years. Before the intervention, the mean scores of knowledge, attitude, perceived behavioral control, subjective norms, behavioral intention, and performance of the intervention and control groups showed no significant difference (P ≥ 0.05). After the intervention, the average of all scores in the intervention group showed significant increase compared to the control group (P ≤ 0.05). Conclusion: Face-to-face training using the theory of planned behavior has positive impact on oral health behaviors of pregnant women. Accordingly, training sessions in order to raising awareness and positive attitude and controlling healthcare behaviors can improve oral health behaviors of pregnant women.
  4 1,605 167
Dental fluorosis, fluoride in urine, and nutritional status in adolescent students living in the rural areas of Guanajuato, Mexico
Aguilar-Diaz Fatima del Carmen, de la Fuente-Hernández Javier, Cintra-Viveiro Cristina Aline
Nov-Dec 2016, 6(6):517-522
DOI:10.4103/2231-0762.195510  PMID:28032042
Objective: The aim of this study was to assess urine fluoride concentration, nutritional status, and dental fluorosis in adolescent students living in the rural areas of Guanajuato, Mexico. Materials and Methods: A cross-sectional study was conducted including participants aged 11–20 years. The presence and severity of dental fluorosis was registered according to the Thylstrup and Fejerskov index (TFI) criteria. Anthropometric measures were also recorded. Urine sample of the first morning spot was recollected to assess urine fluoride concentration by using the potentiometric method with an ion-selective electrode. Water samples were also recollected and analyzed. Bivariate tests were performed to compare urine fluoride concentration according to different variables such as sex, body mass index, and TFI. Nonparametric tests were used. A logistic regression model was performed (SPSS® 21.0). Results: This study included 307 participants with a mean age of 15.6 ± 1.6; 62.5% of the participants showed normal weight. A total of 91.9% of the participants had dental fluorosis, and 61.6% had TFI > 4. Mean fluoride content in urine ranged between 0.5 and 6.65 mg/L, with a mean of 1.27 ± 1.2 mg/L. Underweight children showed greater urine fluoride concentration. The increment of urine fluoride was a related (OR = 1.40) to having severe dental fluorosis. Conclusions: Most of the studied population had moderate or severe dental fluorosis. Urine fluoride concentration was related to fluorosis severity and nutritional status. Underweight children showed greater urine fluoride concentration as well as severe dental fluorosis.
  4 1,771 180
Parents' satisfaction with pediatric dental care provided by dental college, Riyadh
Manal A AlMutairi
Nov-Dec 2016, 6(6):542-548
DOI:10.4103/2231-0762.195520  PMID:28032046
Aims and Objectives: To evaluate the level of parents' satisfaction with pediatric dental care provided by dental students at the College of Dentistry and explore the factors associated with various parents' demographics. Materials and Methods: A cross-sectional study was conducted among parents (n = 150) whose children received dental care in dental colleges in King Saud University (KSU) in Riyadh. The parents were asked to fill a self-administered dental satisfaction questionnaire between Februry and April 2016. Data were recorded and analyses using the Statistical Package for the Social Sciences Version 20 (SPSS Inc., Chicago, IL, USA). Results: Results indicated that only 10.7% of the parents strongly agreed that before being seen they had to wait for a long time in the waiting area, and 36% strongly agreed that one of the causes for which they went to the KSU dental college is that there were inadequate pedodontics in their region. More than half of parents (60%) strongly agreed that the KSU dental clinic is up to date and very modern. Conclusions: The results indicate that the pediatric department has been successful in achieving parents' satisfaction with dental students, their treatment, as well as operational aspects related to access. There was a strong degree of satisfaction from parents regarding the KSU dental college being modern and up to date.
  2 1,576 143
A novel clinical approach for long-term retention and durability of resin restorations bonded to multiple developmental defects of enamel
Rapala Harika, Brahmananda Dutta, Parsa Arun, Raveen P Teja
Nov-Dec 2016, 6(6):597-601
DOI:10.4103/2231-0762.195507  PMID:28032054
Dental enamel is a unique, highly mineralized tissue of ectodermal origin. It is characterized by lack of metabolic activity once formed, implying that disturbances during development can manifest as permanent defects in the erupted tooth. Although the etiology of enamel defects may be attributed to local, systemic, genetic, or environmental factors, most are likely to be multifactorial in nature. The time frame of exposure and the mechanism underpinning the causative factors determine the presentation of these defects. These developmental defects of enamel (DDE) may range from slight abnormalities of the tooth's color to a complete absence of the enamel, some of which may be sensed by an individual as being disfiguring and call for treatment to improve the appearance of the dentition. Molar incisor hypomineralization (MIH) is a relatively common condition that varies in clinical severity, remains localized to permanent incisors and first permanent molars, and whose prevalence varies between 2.8 and 25% depending upon the study. Adhesion and retention of resin restorations is challenging in long-term rehabilitation in these cases. This paper presents a novel approach in the functional and esthetic rehabilitation of a 13-year-old female child diagnosed with multiple DDEs.
  1 2,593 192
Psychosocial factors associated with reverse smoking: A qualitative research
G Harini, KV Krishnam Raju, D. V. S. Kiran Raju, K Kalyan Chakravarthy, S Nagasri Kavya
Nov-Dec 2016, 6(6):529-534
DOI:10.4103/2231-0762.195521  PMID:28032044
Objectives: Reverse smoking is a peculiar form of smoking in which the smoker puts the lit end of the cigarette into the mouth and then inhales the smoke. There may be many predisposing factors that influence an individual to cultivate this habit, of which psychosocial habits could be the predominating factor. Hence, the present study was undertaken to evaluate the psychosocial factors that influence an individual to undertake this peculiar habit of reverse smoking. Materials and Methods: A total of 128 habitual reverse smokers were included in the study, out of which 121 were females and 7 were males. A pretested open-ended questionnaire was used for data collection. Data was collected by direct interview method. Snowball sampling technique was employed in collecting the information regarding regular reverse smokers. Interviews were continued until new information did not provide further insights into the categories. The people who could not understand verbal commands and questions and who did not give an informed consent were excluded from the study. Statistical analysis was done using MS Office Excel using Chi-square test of Goodness of fit. Results: In contrast to the conventional smokers, various new reasons were identified for starting reverse smoking, of which the most important was that they had learned this habit from their mothers. This was followed by other reasons such as peer pressure, friendship, and cold climatic conditions. Conclusion: This study provided an insight into the various factors that could influence an individual to take up this peculiar habit of reverse smoking.
  1 2,105 141
Problem-based learning: Dental student's perception of their education environments at Qassim University
Shahad S Alkhuwaiter, Roqayah I Aljuailan, Saeed M Banabilh
Nov-Dec 2016, 6(6):575-583
DOI:10.4103/2231-0762.195512  PMID:28032051
Aims: The objectives of this study were to assess perceptions of the Saudi dental students of the problem-based learning (PBL) curriculum and to compare their perceptions among different sex and academic years. Subjects and Methods: Data was collected through a questionnaire-based survey at Qassim College of dentistry. The questionnaire consisted of 19 questions regarding the perception of PBL curriculum and was distributed to 240 students. The chi-square test was used for statistical analysis of the data. Results: Out of the 240 students recruited for this study, 146 returned a complete questionnaire (the response rate was 60.8%). The majority of the students perceived that PBL enhances the ability to speak in front of people (91.1%); improved the ability to find the information using the internet/library (81.5%); enhances the problem-solving skills (71.3%); increases the practice of cooperative and collaborative learning (69.2%); improves the decision-making skills (66.4%). Sixty-five percent (n = 96) noted that some students dominate whereas others are passive during PBL discussion session. Statistically, significant differences were found in the following variables according to the academic year students assuming before responsibility for their own learning (P < 0.037) and the role of facilitator in the process (P < 0.034). Moreover, according to gender; there were statistically significant differences in the following variables, assuming responsibility for own learning (P< 0.003); activating prior knowledge and learning to elaborate and organize their knowledge (P< 0.009); enhancing the ability to find the information using the Internet/library (P< 0.014); PBL is effective without having lecture of the same topic (P< 0.025); helping in identifying the areas of weakness for improvement (P< 0.031); student understanding the objectives of the PBL session better than the conventional way (P< 0.040); and enhancing the ability to speak in front of people (P< 0.040). Conclusions: Perceptions of Saudi dental students regarding their education environments at Qassim College of dentistry using PBL hybrid curriculum were more positive than negative. However, improvements are still required to provide students with stimulating favorable learning environment and to take the students recommendations into consideration.
  1 1,948 203
Pain and distress induced by elastomeric and spring separators in patients undergoing orthodontic treatment
Hana O Al-Balbeesi, Sahar M Bin Huraib, Nadia W AlNahas, Huda M AlKawari, Abdulrahman B Abu-Amara, Sajith Vellappally, Sukumaran Anil
Nov-Dec 2016, 6(6):549-553
DOI:10.4103/2231-0762.195519  PMID:28032047
Aims and Objectives: The objective of the present investigation is to evaluate patients' pain perception and discomfort, the duration of pain and the level of self-medication over time during tooth separation, and the effectiveness of elastomeric and spring types of orthodontic separators in Saudi population. Materials and Methods: The study group consisted of 30 female adolescent patients who had elastomeric/spring separators as part of their orthodontic treatment. A self-administrated questionnaire comprising 16 multiple choice questions and another with visual analog scale were used to record the patient's pain perceptions at 4 hours, 24 hours, 3 days, 5 days, and 7 days from the time of insertion. The level of pain and discomfort during these time periods were assessed by a visual analog scale. After a separation period of 7 days, the amount of separation was measured with a leaf gauge. Type and frequency of analgesic consumption was also recorded. The Statistical Package for the Social Sciences (SPSS) version 20 (IBM SPSS -Chicago, IL: SPSS Inc.,) was used for statistical analysis. Results: The data showed significant increase in the level of pain at 4 hours, 24 hours, and 3 days from separator placement. The elastomeric separators produced significantly more separation than the spring separators and also caused maximum pain during the first 3 days after insertion. However, there was no significant difference between the score of pain between two separators at all time intervals.Conclusion: Both elastomeric and spring separators showed comparative levels of pain and discomfort during the early phase of separation. Elastomeric separators were found to be more effective in tooth separation than spring separators. However, further studies are necessary to substantiate this preliminary observation.
  1 2,074 161
Radiographic technical quality of root canal treatment performed by undergraduate dental students at the Academy Dental Teaching Hospital, UMST, Sudan
Elhadi M Awooda, Reem I Siddig, Ruaa S Alturki, Nada M Sanhouri
Nov-Dec 2016, 6(6):554-558
DOI:10.4103/2231-0762.195515  PMID:28032048
Aim: To radiographically evaluate the technical quality of root canal treatment performed by undergraduate dental students and compare the findings with other institution's work. Materials and Methods: A retrospective, cross-sectional study was conducted at the Academy Dental Teaching Hospital involving postoperative periapical radiographs of patients who were endodontically treated by batch #14 undergraduate dental students of final year (2013–2014) from UMST, Sudan. The total number of the students was 21, while periapical radiographs fulfilling the required criteria were 173. The radiographs of each case were evaluated in terms of length, density, and taper of the root canal filling. Procedural errors such as presence of a ledge, perforation, and a separated instrument were also recorded. Chi-square test was used to determine statistically significant differences between variables, with the level of significance set at P ≤ 0.05. Results: The overall quality of performed root canal treatment was adequate in almost half (55.5%) of the evaluated teeth. The length and taper of the root canal filling were found to be significantly associated with maxillary and mandibular posterior teeth with P = 0.018 and 0.006, respectively. No associations were found between the density and presence of separated instrument in the maxillary and mandibular posterior teeth, P = 0.314 and 0.480, respectively. Conclusion: The radiographic quality of root canal treatment performed by undergraduate students of batch #14 UMST was acceptable in 55.5% of the cases. Special emphasis must be placed on the educational methods and training of students for providing root canal treatment on molar teeth.
  1 1,489 125
The efficiency of child formula dentifrices containing different calcium and phosphate compounds on artificial enamel caries
Praphasri Rirattanapong, Kadkao Vongsavan, Chavengkiat Saengsirinavin, Ploychompoo Khumsub
Nov-Dec 2016, 6(6):559-567
DOI:10.4103/2231-0762.195517  PMID:28032049
Objectives: Fluoride toothpaste has been extensively used to prevent dental caries. However, the risk of fluorosis is concerning, especially in young children. Calcium phosphate has been an effective remineralizing agent and is present in commercial dental products, with no risk of fluorosis to users. This in vitro study aimed to compare the effects of different calcium phosphate compounds and fluoride-containing dentifrices on artificial caries in primary teeth. Materials and Methods: Fifty sound primary incisors were coated with nail varnish, leaving two 1 mm2 windows on the labial surface before immersion in demineralizing solution for 96 hours to produce artificial enamel lesions. Subsequently, one window from each tooth was coated with nail varnish, and all 50 teeth were divided into five groups (n = 10); group A – deionized water; group B – casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) paste (Tooth Mousse); group C – 500 ppm F (Colgate Spiderman®); group D – nonfluoridated toothpaste with triple calcium phosphate (Pureen®); and group E – tricalcium phosphate (TCP). Polarized light microscopy and Image-Pro® Plus software were used to evaluate lesions. Results: After a 7-day pH-cycle, mean lesion depths in groups A, B, C, D, and E had increased by 57.52 ± 10.66%, 33.28 ± 10.16%, 17.04 ± 4.76%, 32.51 ± 8.99%, and 21.76 ± 8.15%, respectively. All data were processed by the Statistical Package for the Social Sciences (version 16.0) software package. Comparison of percentage changes using one-way analysis of variance and Fisher's least squares difference tests at a 95% level of confidence demonstrated that group A was significantly different from the other groups (P < 0.001). Lesions in groups B and D had a significant lesion progression when compared with groups C and E. Conclusions: All toothpastes in this study had the potential to delay the demineralization progression of artificial enamel caries in primary teeth. The fluoride 500 ppm and TCP toothpastes were equal in the deceleration of enamel caries progression and better than CPP–ACP paste and TCP toothpaste.
  1 2,209 187
The Olympic legacy: Journal metrics in sports medicine and dentistry
Joel Thomas, Tom W. M. Walker, Stuart Miller, Alistair Cobb, Steven J Thomas
Nov-Dec 2016, 6(6):501-508
DOI:10.4103/2231-0762.195513  PMID:28032040
Systematic analysis of integral aspects within sport enables improvement in performance. One key aspect is the management and prevention of injuries. Bibliometrics is a systematic method for evaluating research output. It may be expected that the quantity and quality of sports injury research over time may strongly correlate with the timing of the Olympic games. This study was conducted to determine the effect of the Olympic legacy on academic sports medicine and evidence to prevent injuries of the face and teeth. A literature search within the PubMed database was undertaken to identify the quantity of literature published annually between 1996 and 2015 in the fields of sports injuries and injury prevention. The top 5 journals publishing in each field were then identified and the change in their impact factor (IF) was investigated. It was seen that, since 1996, there has been an overall increase in the quantity of literature published regarding sports injuries and prevention of sports injuries of 209% and 217%, respectively. Publications regarding facial injuries and dental injuries within sport show an increase of 114% and 71%, respectively. There was an increase in IF since 2000 in almost every journal investigated. A strong, positive correlation is seen among journals publishing on the prevention of sports injuries, showing a median IF increase of 2.8198. No statistical significance was found between Olympic years and the number of publications. Hence, there has been a gradual increase in both the quality and quantity of publications regarding sports injuries since 1996. However, there appears to be no immediate added effect of the “Olympic legacy” following each Olympic games on the quantity or quality of publications in these fields.
  1 1,595 131
Erratum: Assessment of oral health attitudes and behavior among students of Kuwait University Health Sciences Center

Nov-Dec 2016, 6(6):602-602
DOI:10.4103/2231-0762.195522  PMID:28032055
  - 939 108
Caries risk in children of Udaipur City, India using genetic taste sensitivity to 6-n-propylthiouracil
Payel Karmakar, Ruchi Arora, Chhaya Patel, Bhumi Sarvaiya, Aditi Singh, Mittal Patel
Nov-Dec 2016, 6(6):523-528
DOI:10.4103/2231-0762.195508  PMID:28032043
Aims and Objectives: Dental caries still remains the single most common disease of childhood. The present study was conducted to test the hypothesis that a higher prevalence of dental caries would be observed among nontaster children compared to medium tasters or supertasters of 6n propylthiouracil impregnated filter papers. Materials and Methods: The present study was conducted on a random sample of 600 school children aged 6–12 years in Udaipur city. 6-n-propylthiouracil strips were prepared. The food preference questionnaire was filled by the participants, and their decayed missing filled status as well as taste sensitivity to the propylthiouracil impregnated filter papers were noted. The data obtained was then used for statistical analysis using chi square, analysis of variance, and Students t-tests with the consult of a statistician using the Statistical Package for the Social Sciences version 17 software. Results: Nontasters had a greater caries experience than the supertasters and medium tasters. Females were found to be more tasters than nontasters. It was also found that nontasters belonged to caries active group more than the tasters. Conclusion: The caries status was higher among the nontaster children with more sweet preference than in taster children and they belonged more to the caries active group.
  - 1,596 138
Discrepancies between dental and medical records of cardiac patients in AlHada Armed Forces Hospital, Taif, Saudi Arabia
Sana M Al Hibshi, Rajaa Mohammad Al Raddadi, Mansour K Assery
Nov-Dec 2016, 6(6):568-574
DOI:10.4103/2231-0762.195511  PMID:28032050
Aims and Objectives: This study aims to estimate the prevalence of medical information discrepancies between dental and medical records of cardiac patients at AlHada Armed Forces Hospital in Taif and to identify the factors contributing to these information discrepancies. Materials and Methods: The study applied a descriptive retrospective medical and dental records review of a stratified proportional sample of 289 cardiac patients, which was extracted from 1154 cardiac patients who visited both the cardiology and dental clinics at the AlHada Armed Forces Hospital between 2007 and June 2012. Data were analyzed using the Statistical Package for the Social Sciences version 19. Results: The main results of this study are the following: The mean and standard deviation of patient's age was 56 ± 16.9, female patients represented 47.8% of the study population. A total of 78.5% of dental records were documented by dental residents whereas 48.4% of the dentists had more than 6 years of experience. Two hundred and seventy-nine (96.5%) of the 289 dental records had medical information discrepancies compared to the corresponding medical records. One hundred percent of systemic lupus erythematosus and rheumatic fever cases were not documented in the dental records followed by 93% of medications, 92% of stroke, and 88.5% of hyperlipidemia, whereas the least prevalent were cardiac disease (26%) and diabetes mellitus (22.2%). Conclusion: Approximately 75% of the patients who directly or indirectly accessed the dental services showed discrepancies. The researcher concludes that critical information gaps exist between dental and medical records that mostly attributed to system level problems. A well-established model for efficient communication among medical and dental care providers caring for cardiac patients does not appear to exist. The absence of such a model can threaten the overall health of patients.
  - 1,418 117
In vitro and ex vivo microbial leakage assessment in endodontics: A literature review
Sohrab Tour Savadkouhi, Hengameh Bakhtiar, Safoura Emami Ardestani
Nov-Dec 2016, 6(6):509-516
DOI:10.4103/2231-0762.195516  PMID:28032041
The aim of this study was to perform a literature review of published in-vitro and ex-vivo studies, which evaluated microbial leakage in endodontics in the past 10 years. A comprehensive electronic literature search was carried out in PubMed database for English articles published from 2005 to 2016 using the keywords “endodontics,” “in vitro,” “ex vivo,” “microbial leakage,” “microbial penetration,” “saliva,” “Enterococcus faecalis,” “E. faecalis,” “endodontic sealers,” “temporary filling material,” “apical plug,” “mineral trioxide aggregate,” and “MTA.” The keywords were combined using Boolean operators AND/OR. Based on our search strategy, 33 relevant articles were included in the study. There are three main methods for assessment of bacterial microleakage, namely, (A) the dual-chamber leakage model, (B) detection of bacteria using a scanning electron microscope (SEM), and (C) polymerase chain reaction. All bacterial leakage models have some limitations and may yield different results compared to other microleakage evaluation techniques (i.e., dye penetration, fluid filtration, or electrochemical tests). The results of SEM correlated with those of microbial leakage test in most studies. Microbial leakage test using saliva better simulates the clinical setting for assessment of the leakage of single or mixed bacterial species.
  - 2,181 244