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   Table of Contents - Current issue
September-December 2020
Volume 7 | Issue 3
Page Nos. 129-217

Online since Thursday, November 12, 2020

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Training strategy for today's full-time dental research scholars p. 129
HA Mosadomi
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A memory-recall checklist for dental services during the COVID-19 outbreak: A clinical recommendation p. 131
Amal A Al-Khotani, Haila A Al-Huraishi, Dalia E Meisha
The epidemic coronavirus disease 2019 (COVID-19) has infected millions of people and put a huge amount of stress on the health-care system. Health-care professionals, including dental professionals, are at a high risk of acquiring COVID-19. Therefore, extra precautions need to be implemented for routine dental infection control procedures. It is encouraged to have a written reminder in the form of a checklist to recall these crucial steps, especially when nonroutine procedures must be followed. The aim of this special communication is to present a proposed mnemonic or memory-recall, user-friendly checklist to be used in the dental clinic during the COVID-19 outbreak. The checklist was created following the guidelines for reopening dental services in governmental and private sectors during the COVID-19 pandemic that were published by the Ministry of Health on June 5, 2020. Based on the patient's score and the urgency of the dental situation, specific steps should be followed. When the patient's score is ≥ 4 and needs an emergency aerosol-generating procedure, REDS steps should be recalled. Further, MRS steps must be followed if the patient's score is < 4. For both groups, GAMES can be followed when personal protective equipment is needed before the patient examination and HD steps should be applied after finishing the dental procedure. In conclusion, this written reminder in the form of a checklist can be helpful for a safe dental practice during pandemics to recall the crucial nonroutine steps. We recommend that the dental staff place those steps as a written reminder in an accessible, visible place.
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The effect of in vitro aging on the color stability of cubic and tetragonal zirconia materials p. 139
Maha S Mezied, Fawaz S Alqahtani
Aim: The aim of this study is to evaluate the effect of artificial-accelerated aging (AAA) on the color stability of three types of monolithic cubic Zirconia materials of the third generation compared with tetragonal Zirconia materials of the first generation. Materials and Methods: A four groups of 10 disc-shaped specimens (10 mm × 1.2 mm) were made from the following CAD/CAM Zirconia blocks: first-generation Zirconia (Ceramill Zi LT) as a control, and three brands of third-generation Zirconia (Ceramill Zolid FX UT, Katana UTML, and Cercon XT) as the experimental groups. Ten discs from each group were subjected to the color measurement using a Spectrophotometer (Hunterlab, EasyMatch QC. Ver 4.90). Then, same discs were subjected to AAA for 3500 cycles. The data were analyzed with the one-way analysis of variance (ANOVA) and Tukey's post hoc test. Data analyses were evaluated at a statistically significance level of P < 0.05. Results: Statistically significant differences were detected in the L*, a*, and b* values among the four groups both before and after AAA. One-way ANOVA was used, which showed statistically significant differences among the groups (P < 0.001). The Ceramill ZI LT showed the greatest change in color (ΔE = 2.74 ± 0.23), followed by Katana UTML (ΔE = 1.91 ± 0.23), Ceramill Zolid FX UT (ΔE = 1.52 ± 0.43), and least change in color was seen in Cercon XT (ΔE = 1.44 ± 0.25). Tukey's post hoc test showed a statistically significantly difference among the test materials, except between Ceramill Zolid Fx UT and Cercon XT, where there was no significant difference seen in ΔE. Conclusion: The AAA protocols used in this study resulted in a significant effect in the (ΔE) of the four-tested Zirconia materials. The Ceramill ZI LT (First Generation) showed the greatest change in color and the least change in color was observed with Cercon XT (third generation). The color changes in all four tested Zirconia, though statistically significant was not a clinically perceivable
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The effect of levodopa in combination with Hank's balanced salt solution in enhancing periodontal ligament cell viability: An in vitro study p. 145
Smita P Patil, Prashant B Patil, Meena V Kashetty
Aim: This study aims to study the viable property of periodontal ligament (PDL) cells in the avulsed teeth using Hank's balanced salt solution (HBSS) storage medium with levodopa (L-dopa) and without L-dopa. Materials and Methods: The study samples included 40 freshly extracted, noncarious, non-impacted human teeth with closed apices. The teeth were then randomly divided into four groups containing four different experimental storage solutions, namely Group 1: Deionized water; Group 2: Deionized water with L-dopa (1 μg/μl); Group 3: HBSS; and Group 4: HBSS with L-dopa (1 μg/μl). All the teeth were stored in different test solutions for 60 min. Collagenase assay was performed followed by analyses of the number of viable PDL cells using a hemocytometer under a light microscope at ×20 magnification. The mean and standard deviation (SD) of viable PDL cells of all the four groups obtained were evaluated using Kruskal–Wallis test. P < 0.001 was considered statistically significant. Comparison between the four groups was done using Mann–Whitney test and U <23 and P < 0.05 was considered statistically significant. Results: Comparison of mean and SD of viable PDL cells showed a significant difference between the four groups (P < 0.001). Group 4 showed the highest mean number of PDL cells, followed by Group 3, Group 2, and Group 1, respectively. These findings indicate that the viability of PDL cells was highest when teeth were stored in HBSS with L-dopa, followed by HBSS, than de-ionized water with L-dopa and least in de-ionized water. Conclusion: The results of the study showed that the PDL cells were rendered more viable by the synergistic effect of L-dopa along with HBSS as a storage medium for an avulsed tooth.
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The range of pathological diagnoses of oral diseases in Jordan: An 11-year-retrospective study p. 151
Yazan Hassona, Doaa Al Boosh, Asmaa Al Saed, Mohammad Al Mousa, Nicola Barghout, Awni Al Kayed, Faleh Sawair
Objectives: The objective of this study is to describe the pattern of oral and maxillofacial diseases in Jordan and to compare it with global trends. Materials and Methods: A retrospective analysis of pathology records in a major university hospital in Jordan was conducted. Age, gender, anatomical site, and pathological diagnosis were assessed. Results: A total of 1062 records were included. There were 525 (49.4%) females and 537 males (50.6%). The mean age of the study sample was 39 ± 18.7 years (range = 2–88 years). Nearly half of the lesions originated from the jaw bones (48.8%, n = 518), followed by oral mucosa (38.3%, n = 407), and gingivae (7.1%, n = 75). Cystic lesions were the most common type of pathologies (35.8%, n = 380), followed by reactive lesions (25.8, n = 274), and tumors (13.9%, n = 148). The most common individual pathologies were radicular cyst (19.8%, n = 210), followed by dentigerous cyst (11.3%, n = 120), and fibroepithelial polyp (8.8%, n = 93). Conclusion: Reactive and cystic lesions are the most common type of diseases encountered in the present study. The pattern of oral and maxillofacial diseases reported here is consistent with global trends.
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Clinical practice preferences of Australian and New Zealand practitioners in the implant management of the edentulous mandible p. 156
James Dudley, Fiza Mughal
Introduction: Mandibular edentulism remains a widespread health burden with a variety of available treatment modalities, but without an accepted single best practice approach. The purpose of the present study was to survey clinical practice preferences of Australian and New Zealand practitioners in the management of patients with edentulous mandibles with a specific focus on the use of dental implants. Materials and Methods: A questionnaire comprising thirty questions was developed and administered online via a unique web link sent to all known Australian and New Zealand general dental and specialist professional membership bodies. Results: Responses received from the members of five of the ten membership bodies constituted 7.35% overall response rate. Respondents who had undertaken implant training and were involved in implant treatment of the edentulous mandible totaled 65.5%. The pattern of referral to specialists for surgical implant placement varied according to the type of prosthesis being constructed. Of 111 respondents, 72% preferred two implants for mandibular implant overdentures (MIODs), whereas 97% of 98 respondents preferred four or more implants for a mandibular fixed complete implant denture. The main reasons for choosing MIOD instead of fixed complete implant denture were cost, patient preference, and available jaw bone. Conclusions: The highest level of education in implant dentistry varied significantly between respondents and was potentially reflected in the wide variety of reported treatment approaches. Even within a specific implant prosthesis type, there was no universally accepted modality of management. Future research should focus on alternative survey strategies for obtaining important data representative of the total practicing population.
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The effect of pediatric dental clinical environment on children's behaviors in Riyadh City p. 164
Haneen Alshukairi, Dalal Al Muhaidib, Saja Aleidan
Background: Fear of dental treatment prevents children from cooperation in the dental clinic. Children's behavior can be improved if the environment of the dental practice is modified. Aim: This study aims to assess the effect of the atmosphere of the dental clinic and the dentist's attitude on the patient's behaviors. Materials and Methods: A 13 questions survey was developed to assess the various factors contributing to childhood fears in the dental clinic. One hundred and thirty children presenting to Riyadh Elm University who agreed to participate consented. Results: Fifty percent of children prefer to have a female doctor, and 60% of them like to see a dentist in a white coat. Furthermore, 46% of children are happy watching a cartoon, and 44% enjoy listening to a story during treatment. The presence of parents during the procedure and getting a reward at the end show significant children satisfaction. In addition, having a play station in the waiting room and having a dental tour before starting treatment were useful tools to reduce the fear of children. Finally, the color and the smell of the clinic, as well as the time of the dental appointment, were not significant factors to improve children anxiety. Conclusion: Improving the environment of the dental clinic and the attitude of the dentist are crucial elements to reduce children's fear during dental treatment.
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Assessment of the low-speed centrifugation concept modified in the release of fibroblast growth factor-2 in Saudi healthy patient p. 169
Abdulrahman Alshehri, Salah Alokaili, Sami Shafik, Nasser M Assery, Naghshbandi Jafar, Khalid Alhezaimi
Introduction: Alteration of the centrifugation time and protocol may impact the release of platelet-rich fibrin (PRF) scaffolds. The current study purpose was to investigate the released levels of fibroblast growth factor-2 (FGF-2) in standard PRF (S-PRF) and low-speed centrifugation concept known as advanced PRF (A-PRF and A-PRF+). Measurements were done at five times interval over 42 days. The aim was to assess the FGF release and the relation between initial platelet counts and the concentrations of FGF-2 release using the following technique: (1) S-PRF, (2) A-PRF, and (3) A-PRF+. Materials and Methods: Twenty-four blood samples were taken from eight random Saudi Arabian national healthy subjects enrolled in the investigation. Blood samples were processed using S-PRF, A-PRF, and A-PRF+ centrifugation protocols. Protein quantification was performed using enzyme-linked immunosorbent assay at 1, 7, 14, 28, and 42-day intervals. Results and Discussion: A statistically significant difference in the mean of FGF-2 measurement between protocols at the 7th day where both S-PRF and A-PRF were significantly higher than A-PRF+ (P < 0.012). Initial platelets' significant count for S-PRF, A-PRF, and A-PRF+ was on day 1, day 7, and 7th day, respectively. Both protocols S-PRF and A-PRF yielded significantly higher release of the FGF-2 when compared to A-PRF+ in Saudi healthy subjects.
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Caries-related treatment decisions of general dental practitioners in Riyadh, Saudi Arabia p. 174
Marwa Eltayeb Elagra, Haya Fahad Alzaid, Mai Mohammad Alsabeh, Nada Abdulaziz Altoub, Sahar Fahad Binhowaimel
Introduction: For decades, caries management strategies followed G. V. Black's concept, which has been considered an invasive approach since the development of operative care. Several studies showed a wide variation in restorative treatment decisions even among dentists within the same country. Aim: The aim of this study is to investigate treatment decisions for carious lesions in relation to the patients' caries risk among general practitioners. Materials and Methods: A cross-sectional study using a self-administered paper-based questionnaire was conducted among general dental practitioners in Riyadh city. The demographic characteristics of the practitioners were obtained. The questionnaire included five clinical scenarios aided by photographs; each scenario involved either a high- or a low-caries risk condition, and the scenarios were presented alternately. The recall interval was recorded. Occlusal and proximal caries thresholds were also explored. Data were analyzed using SPSS version 21 software. Chi-square and logistic regression analyses were conducted, and values of P ≤ 0.05 were considered statistically significant. Results: A total of 340 participants were included in the analysis. The treatment decisions of the general dental practitioners for the International Caries Detection and Assessment System code 2 scenarios were mostly preventive. Proximal carious lesions extending to the dentinoenamel junction were the principal indication for operative treatment. Most participants preferred to recall patients after 6 months. Conclusion: There was vast discordance between knowledge and practice in restorative treatment decisions for occlusal carious lesions. The general dentists tended to opt for restorative treatment in high-risk patients three times more often than in low-risk patients. Clinical Significance: A low level of clinical implementation of evidence-based information was observed in this study regarding occlusal caries.
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Pulp therapy of primary molars using lesion sterilization tissue repair and traditional endodontic treatment Highly accessed article p. 181
Prerna Beniwal, Namita Kalra, Rishi Tyagi, Amit Khatri
Aim: This study aimed to compare the clinical and radiographic success of lesion sterilization and tissue repair (LSTR) therapy and traditional endodontic treatment for pulp therapy of primary molars over a period of 6 months. Materials and Methods: Fifty primary mandibular molars from children aged 3–8 years in need of pulp therapy presenting with signs of irreversible pulpitis and those meeting our inclusion criteria were selected for the study. The teeth were randomly divided into two groups: Group 1 individuals received intervention by LSTR therapy and Group 2 individuals were treated with the principles of traditional pulpectomy procedures using a mixture of zinc oxide (ZnO) and calcium hydroxide (Ca(OH)2) as the obturating material. Patients were reviewed clinically and radiographically at 1, 3, and 6 months. Results: At the end of 1 and 3 months, both the study groups were comparable in their overall success rates. At 6 months, the clinical success was comparable between the two study groups. Radiographic success rate of the two study groups achieved statistically significant difference, with Group 2 faring better than Group 1. Conclusion: Primary mandibular molars showing signs of irreversible pulpitis, particularly those which were destined to have a poor prognosis, were successfully treated in Group 1 using LSTR and in Group 2 with traditional endodontics using a mixture of Ca(OH)2and ZnO as obturating material.
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Dental esthetics and its effect on psychological well-being in a university hospital in Riyadh, KSA p. 189
Yasmine Tarek Ahmed, Abdulrahman Al Saffan, Atheer Saleh Al Malky, Haila Ahmed Al Nughaimshi, Reem Jasir Al Herbisch, Reema Ebrahim Al Yahya, Sultana Mohammed Al Zain
Background: The importance of dental esthetics among young adults is significantly increasing, affecting their self-confidence and self-image, especially with the major role being played by the media. Objective: The objective of this study was to assess the impact of dental esthetics on the psychological well-being of adult patients attending a university hospital in Saudi Arabia. Materials and Methods: A total of 613 patients attending university hospitals participated in this study by answering the online and printed version of the questionnaires. A Psychosocial Impact of dental aesthetics questionnaire was used in self-assessment for satisfaction with dental esthetics, and a self-perceived dental treatment needs. Collected data were analyzed using descriptive statistics and Chi-square tests. Results: The participants reported smile satisfaction with satisfied (52.4%) and highly satisfied (22.8%), while only 24.8% reported dissatisfaction. Tooth color was the most common cause of dissatisfaction (49.3%). Conclusions: The majority of the participants were satisfied with their smiles, however, a large percentage are still in need of further esthetic dental treatments as their smiles have a major impact on their social and psychological well-being. Hence, more public awareness programs should be directed to educate our community to make better choices of cosmetic dental procedures.
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Problem-based learning in dentistry, implementation, and student perceptions p. 194
Jayashri Tamanna Nerali, Lahari Ajay Telang, Ajay Telang, Pishipati Vinayak Kalyan Chakravarthy
Introduction: Problem-based learning (PBL) is one of the most comprehensive and widely accepted student-centered tool for teaching and learning health professions education, wherein students define the problem, establish learning objectives, undergo self-directed learning and facilitate understanding of the problems. This study has been carried out with an aim of assessing 3rd year dental student's perception of PBL as a teaching and learning method over a 5-year period based on problem-solving and self-directed learning, cooperative learning, role of facilitator and product discussion. Methodology: The perception of 3rd year students from year 2014 to 2018 was assessed at the end of PBL sessions using a self-administered, structured questionnaire. Their responses were recorded using a five point Likert scale and data collected retrospectively was analyzed. Students' open feedback regarding the PBL process was also recorded and analyzed. Results: A total of 376 participants responded to the questionnaire (female = 250 [65%], male = 126 [35%]). Majority of students agreed that PBL improved problem-solving skill, self-directed learning and perceived that it had a positive impact on cooperative learning. Students also felt that PBL product discussion prepared them for future presentation and helped to clarify concepts. Conclusion: The results suggested that students had a positive attitude toward PBL and it improved their problem-solving skills as well as motivated them to learn and participate actively. Some students felt that PBL was time consuming, yet it was a fun and interesting way to learn.
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Characterization of oral lichen planus in a subset of patients: A single-center experience p. 199
Azza F Alhelo, Soulafa A Almazrooa, Ghada A Mansour, Sana A Alhamed, Sara Alfarabi, Sara K Akeel, Nada O Binmadi, Nada A Alhindi, Lujain Alsulaimani, Manal A Alamri, Hani H Mawardi
Introduction: Lichen planus (LP) is a common chronic, mucocutaneous inflammatory disorder with unclear pathophysiology. The aim was to describe the epidemiology and clinicopathological characteristics of oral lichen planus (OLP) patients at King Abdulaziz University Dental Hospital (KAUDH) in Jeddah. Materials and Methods: This was a retrospective, chart-review study which included OLP patients previously seen at KAUDH from June 2012 to June 2018. Demographic data, clinical features, management, and outcome were collected and analyzed. Diagnosis of LP was done using clinical criteria with or without histopathologic diagnosis, and the scoring system by Escudier et al. was used. Results: Fifty patients with a mean age of 48 years (range: 21–71) and 2.5:1 female-to-male ratio were included in this study. The most concomitant systemic diseases were diabetes mellitus (30%) and hypertension (26%). Reticular OLP was the most common form (98%), followed by erythematous (66%), ulcerative (26%), and plaque-like type (8%). More than half of the patients were asymptomatic (64%), whereas twenty-two symptomatic patients were managed with either topical steroids, a combination of topical and systemic steroids, and/or intralesional steroid injections with 68% improvement. Conclusion: Based on the current data, clinical features at KAUDH matched what has been previously reported in the literature. In addition, the response to different treatment modalities varied between patients which could be linked to factors such as disease extension and severity.
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The impact of presurgical nasoalveolar molding on the surgical and quality of life outcome: A case report with 1-year follow-up p. 206
Fatmah Nasser Almotawah
Since its introduction in 1996, the use of presurgical nasoalveolar molding (P-NAM) has been a controversial topic. While P-NAM has become routine in many cleft centers, there have been others who have refused to adopt it. Difficulties cited have included the apparent lack of parent co-operation and perceived challenges in parent compliance. This report looks at both the esthetic postsurgical outcomes and the impact the procedure has on the overall oral health-related quality of life. The report looks at not only the procedure of P-NAM but also examines the steps a multidisciplinary team would need to take in order to make the experience beneficial to both the surgeon and the parent.
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Regenerative endodontic therapy using platelet-rich fibrin in children p. 210
Parul Singhal, Bindu Kadian, Pawan Midha, Ritu Namdev
Regeneration of pulp–dentin complex in an infected necrotic tooth with an open apex is possible if the canal is effectively disinfected. The purpose of this case report is to add regenerative endodontic cases to the existing literature about the use of plateletrich fibrin (PRF). Three clinically and radiographically diagnosed necrotic immature permanent teeth were treated using PRF as a scaffold for revascularization. The therapeutic protocol involved accessing the pulp chamber, irrigating copiously with sodium hypochlorite, applying a triple antibiotic paste as intracanal dressing, and then provisionally sealing it. After 3–4 weeks, the canal was cleaned and PRF was introduced in the canal that would serve as a scaffold for pulp revascularization. Mineral trioxide aggregate was used to seal the chamber and finally restored with composite. All the cases treated with PRF as a scaffold showed magnificant healing and apical end closure along with thickening of dentinal walls. On the basis of the results obtained in our case reports, we conclude that the revitalization of necrotic infected immature tooth is possible under conditions of total canal disinfection, and PRF is nearly an ideal biomaterial for pulp–dentin complex regeneration.
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Management considerations for the patient and the prosthodontist during coronavirus disease-2019 pandemic p. 216
Rajkiran Chitumalla, Abdulkader Aljarrah, Swapna Munaga
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