International Journal of Clinical Pediatric Dentistry

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2020 | November-December | Volume 13 | Issue 6

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Original Article

Mohit K Gunwal, Rinky Kukreja, Satish Maran

An In Vitro Evaluation of Remineralization Potential of Functionalized Tricalcium Phosphate Paste and CPP-ACPF on Artificial White Spot Lesion in Primary and Permanent Enamel

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:579 - 584]

   DOI: 10.5005/jp-journals-10005-1813  |  Open Access |  How to cite  | 


Aim: Investigation and evaluation of remineralization potential of functionalized tricalcium phosphate paste (fTCP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) paste on artificially created white spot lesion on human primary and permanent enamel through scanning electron microscopy and microhardness assessment. Materials and methods: Sixty freshly extracted primary and permanent teeth were selected and artificial white spot lesion were created by using standardized demineralizing solution. Remineralization was carried out using the test pastes. The assessment of demineralization and remineralization was done through a scanning electron microscope and microhardness assessment. Results: Among the three groups, fTCP shows significantly higher increase in mean microhardness (p < 0.001) through ANOVA and the LSD post hoc test when compared to CPP-ACPF and control group. Also, the unpaired t-test showed that mean change in microhardness in permanent teeth was significantly higher than primary teeth in different time intervals for both experimental groups. Surface morphology was assessed through a scanning electron microscope. Conclusion: Based on the results of the current study, f-TCP showed comparatively more remineralization potential than CPP-ACP with fluoride.


Original Article

R Abinaya, Pallavi Urs, J Janani, S Smitha

Comparing the Efficacy of Three Minimally Invasive Techniques on Demineralized Dentin in Primary Teeth and Evaluating Its Residual Dentin and Microhardness Levels: An In Vitro Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:585 - 589]

   DOI: 10.5005/jp-journals-10005-1815  |  Open Access |  How to cite  | 


Aim: This study aims to compare the caries removal efficacy of three minimally invasive techniques and to analyze qualitatively under stereomicroscopy and quantitatively using Vickers hardness test. Materials and methods: Thirty non-carious anterior primary teeth were selected and subjected to demineralization and the same was confirmed using RadioVisioGraphy (RVG). Samples were divided into three groups: Bromelain gel, smart bur, and atraumatic restorative technique (ART). Caries removal was carried out for a time period of 2 minutes. The remaining demineralized dentin was measured using stereomicroscopy. Random dentin blocks were prepared and a microhardness test was conducted. Statistical analysis: Data were subjected to statistical analysis by one-way analysis of variance (ANOVA) test. Results: Stereomicroscopic analysis revealed bromelain gel and smart burs to be superior to ART. Bromelain gel was found to have comparable microhardness levels as healthy dentin. Statistically significant (p < 0.001) results were obtained. Conclusion: In terms of caries removal and microhardness, bromelain gel was highly efficient when compared to other groups. Clinical significance: Fear and anxiety of children and parents about conventional drills led to the emerging trends of minimally invasive restorative dentistry. This research indicated the use of bromelain gel and smart bur in the process of caries removal and that bromelain was more efficient when compared to other groups.


Original Article

Sana Alia, Saarika Suresh

Comparison of Pain and Anxiety Level Induced by Laser vs Rotary Cavity Preparation: An In Vivo Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:590 - 594]

   DOI: 10.5005/jp-journals-10005-1820  |  Open Access |  How to cite  | 


Aim: To evaluate and compare the pain perception, anxiety level, and acceptance of Er,Cr:YSGG laser (2780 nm) with a conventional rotary method during cavity preparation in children. Materials and methods: In a randomized controlled trial, using split-mouth design thirty 6- to 12-year-old children with 60 carious molars were examined. In one quadrant, cavity was prepared conventionally by airotor while, in the other quadrant, Er,Cr:YSGG laser was used. Anxiety was assessed by measuring pulse rate using a fingertip pulse oximeter, while the pain was measured on the Wong–Baker Faces Pain Rating Scale. After the cavity preparation by both the methods, the child was asked about the preference for future treatment of a carious lesion. Results: Pulse rate was found significantly higher in the airotor group but no significant difference in pulse rate was found in the laser group when compared to the baseline pulse rate. The mean value of pain in the airotor group was slightly higher than the laser group. Fifty-seven percent of children preferred Er,Cr:YSGG laser for cavity preparation in the future. Conclusion: During cavity preparation, Er,Cr:YSGG laser comes out to be more effective and acceptable, as it is less anxiety-provoking and may cause less pain when compared with the airotor. Clinical significance: Er,Cr:YSGG laser helps the children to remain calm during the cavity preparation.


Original Article

Tejaswi Singana, Nelamakanahalli Kempaiah Suma

An In Vitro Assessment of Cariogenic and Erosive Potential of Pediatric Liquid Medicaments on Primary Teeth: A Comparative Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:595 - 599]

   DOI: 10.5005/jp-journals-10005-1824  |  Open Access |  How to cite  | 


Aim: To compare the cariogenic and erosive potential of seven commonly prescribed pediatric liquid medicaments (PLMs) by pediatricians in Kempegowda Institute of Medical Sciences, Bengaluru. The selected medicaments are: • Syp paracetamol (antipyretic). • Syp amoxicillin–clavulanate (antibiotic). • Syp cetirizine (antihistamine). • Syp dextromethorphan (antitussive). • Syp salbutamol (antiasthmatic). • Syp phenytoin (anticonvulsant). • Syp multivitamin (nutritional supplement). Materials and methods: • Quantitative endogenous sucrose estimation: Lane–Eynon volumetric copper reduction method was used for the estimation. • Endogenous pH estimation: The endogenous pH was measured using a digital pH meter at 10% dilution. • Quantification of endogenous erosive potential: few caries and restoration-free, exfoliated or extracted primary teeth were utilized to produce 1–1.5 g of enamel powder. A 50 mg of enamel powder was then added to 1 mL of individual PLM. The mixtures were maintained for three-time intervals, 1 minute, 10 minutes, and 8 hours. The samples were then prepared for the estimation of calcium using Inductively Coupled Plasma Mass Spectrometry. Results: Sucrose was seen in all the PLMs except amoxicillin–clavulanate. Calcium was found to be present in all the PLMs except cetirizine. The highest calcium dissolution was seen within Syp salbutamol and the least with Syp paracetamol. Conclusion: Syp phenytoin can be regarded as medicament with the highest cariogenic potential and Syp salbutamol with the highest erosive potential and Syp paracetamol with the lowest cariogenic and erosive potential among the compared and tested PLMs. Clinical significance: Considering syrups that have high cariogenic and erosive potential, greater knowledge about the detrimental effects of these drugs should direct us to evolve effective programs to alert parents to follow proper oral hygiene practices or to search for alternative drugs void of such detrimental effects.


Original Article

Shahram Mosharrafian, Shayan Lohoni, Saeedeh Mokhtari

Association between Dental Caries and Passive Smoking and Its Related Factors in Children Aged 3–9 Years Old

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:600 - 605]

   DOI: 10.5005/jp-journals-10005-1831  |  Open Access |  How to cite  | 


Aims: Dental caries is the most common chronic and infectious childhood disease. Several studies have investigated the side effects of cigarette smoke on oral health. Caries appear to be higher in children exposed to environmental cigarette smoke, but this relationship has not yet been established. The purpose of this study was to investigate the relationship between dental caries and passive smoker children aged 3–9 years old. Materials and methods: This descriptive analytical study was performed on 75 children aged from 3 to 9 years. The study included two groups (first group: control, second group: passive smoker). Demographic data, frequency of toothbrushing and using toothpaste, sugar consumption, and number of dental visits were recorded in a questionnaire. Then, the children were examined, and dmft and DMFT index and plaque index were recorded. Children's saliva was then collected and sent to the laboratory for determination of cotinine levels. Then, the relationship between passive smoker and caries index and other factors were statistically analyzed. Results: Studying dmft and DMFT, it was found that except for component M (Missing) which was zero in both groups, the other components of these two indices were significantly higher in the group exposed to passive smoker. Plaque index and salivary cotinine level were also significantly different in the two groups and were lower in the control group. Conclusion: According to the results of this study, children exposed to passive smoker have a higher rate of caries than other children. It seems that it is primarily due to its effect on increasing plaque accumulation and then the effect of passive smoker on the physiological structures of the mouth and so on. Clinical significance: We can perform preventive care for children if we know that passive smoking may cause more dental caries.


Original Article

Latha Nirmal, MS Muthu, Madhavan Prasad

Use of Puzzles as an Effective Teaching–Learning Method for Dental Undergraduates

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:606 - 610]

   DOI: 10.5005/jp-journals-10005-1834  |  Open Access |  How to cite  | 


Introduction: Passive teaching in the form of didactic lecture is the usual mode of disseminating knowledge in dental colleges in India. An innovative way to address the diverse learners learning style at the undergraduate level is much sought after in dental education. Puzzles in the form of crossword and word search are structural, self-learning educational tools that review and reinforce knowledge and concepts acquired during the lecture. Objectives: To evaluate the effectiveness of crossword and word search puzzles as an active teaching learning method for dental undergraduates. Materials and methods: This is an open, randomized parallel group interventional study conducted with the final BDS students in the Department of Pediatric and Preventive Dentistry of Sri Ramachandra Institute of Higher Education and Research. Two modules of the “must know” category of the curriculum were selected. The class was divided into two groups (interventional and control) using computerized random generator. Learners in both the groups were exposed to didactic lectures, but the activity of solving the puzzles was undertaken only by the interventional group learners. Questionnaire in the form of MCQ was given at the end of the activity to both the groups, and results were evaluated. Results: Mann–Whitney U test between interventional (Group I) learners revealed an average mean score of 4.2, 6.1, 9.3, and 6 out of 10 in the post-activity test when compared to 2.9, 6.6, 4.6, and 5.1 of the control (Group II) students and was statistically significant in three of four sessions. Conclusion: Our study revealed that puzzles can be used as an effective active learning tool to reinforce lecture material for dental undergraduates.


Original Article

Srihari Nirguna Chandrasekhar, Henna P Salim

Comparative Evaluation of Antibacterial Activity of Probiotics SK12 and SM18: An In Vitro Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:611 - 616]

   DOI: 10.5005/jp-journals-10005-1838  |  Open Access |  How to cite  | 


Aim: To assess the antimicrobial activity of probiotics SK12 and SM18 on Streptococcus mutans and also to compare the antimicrobial activity of SK12 and SM18. Materials and methods: Synthetic strains of Streptococcus mutans were used to study the antimicrobial activity of probiotics SK12 and SM18 using various tests such as disk diffusion, minimum inhibitory concentration (MIC), and minimum bactericidal concentration (MBC). In disk diffusion, the zone of inhibition was measured to assess the antimicrobial activity. Chlorhexidine was used as a control for this test. The MIC and MBC were assessed at different dilutions of the probiotic sample (100 mg/mL, 50 mg/mL, 25 mg/mL, 12.5 mg/mL, 6.25 mg/mL, 3.12 mg/mL, 1.6 mg/mL, 0.8 mg/mL, 0.4 mg/mL, and 0.2 mg/mL). Result: SM18 demonstrated 20 mm of zone of inhibition, whereas SK12 demonstrated 15 mm showing a less antibacterial activity in comparison to SM18. SM18 was found to be bactericidal and effective at a minimum concentration of 0.8 mg/mL, whereas SK12 was bactericidal and effective at a minimum concentration of 1.6 mg/mL. Conclusion: Probiotics demonstrate antibacterial activity against cariogenic microflora. SM is 18 having a better antibacterial activity at lower concentrations than SK12 in reducing cariogenic microorganisms. Clinical significance: BLIS K12 and M18 both demonstrated an antibacterial effect on Streptococcus mutans, wherein the use of probiotic in caries prevention is found to be limited. Hence, it is suggestive to reap the bacterial effects of BLIS K12 and M18 in caries prevention.


Original Article

Shaili Agarwal, Shailesh Gupta, Manish Kumar

Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:617 - 621]

   DOI: 10.5005/jp-journals-10005-1840  |  Open Access |  How to cite  | 


Aim and Objectives: To evaluate clinical and radiographic efficacy of a mix of O. sanctum (tulsi extract) and calcium hydroxide as an obturating material in primary molars and to compare these findings with commercially available iodoform with calcium hydroxide paste (metapex). Materials and Methods: The present study was conducted on sixty children age group 4–7 years requiring multiple visit pulpectomy for their primary molars. The teeth selected were randomly divided into two groups. One group received Metapex and other group received Tulsi extract with calcium hydroxide as an obturating material. Clinical and radiographic evaluation were done between both the groups. Results: There was no significant difference in the clinical and radiographic success rate between both the groups. Conclusion: Tulsi extract with calcium hydroxide can be used as an obturating material in primary molars.


Original Article

Muskaan Nischal, Teena Gupta, Manjul Mehra, Gunmeen Sadana

Clinical Comparison of Three Tooth-colored Full-coronal Restorations in Primary Maxillary Incisors

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:8] [Pages No:622 - 629]

   DOI: 10.5005/jp-journals-10005-1842  |  Open Access |  How to cite  | 


Aim: The aim of this in vivo study was to evaluate the surface texture, anatomical form, marginal integrity, marginal discoloration, and secondary caries of three different types of crowns in primary anterior teeth at different time intervals of 3, 6, and 9 months. Materials and methods: Total 45 primary maxillary incisors were randomly selected and divided into three groups of 15 each: group I—strip crowns (Pedoform strip crowns, 3M, United States), group II—zirconia crown (kids-e-crown, India), and group III—luxa crown (DMG, Germany). All the full-coronal restorations were evaluated at 3, 6, and 9 months. The modified USPHS criteria were used to evaluate different parameters. Data were collected and the nonparametric test (Chi-square) was used to analyze the intergroup data. Results: Statistically nonsignificant difference was observed for most of the parameters except marginal integrity and secondary caries. Resin strip crowns showed maximum cases with distorted marginal integrity and secondary caries. Conclusion: Zirconia crown performed best among the three full-coronal restorations. Luxa crown performed similar to zirconia crown. It can be used as an alternative economical esthetic full-coronal restoration for primary maxillary anterior incisors. Clinical significance: This study illustrates the advantage of the temporization material as a full-coronal restoration option in primary maxillary anterior teeth.


Original Article

Neenu Sukumaran, Vasudha Sharma, Padma K Bhat

Dental Caries, Body Mass Index, and Socioeconomic Status among Preschoolers in Private Preschools and Anganwadi Centers in Bengaluru City: A Comparative Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:630 - 634]

   DOI: 10.5005/jp-journals-10005-1848  |  Open Access |  How to cite  | 


Aim: Preschool is the time when deleterious oral habits, caries pattern, and risk factor are established and is the time to intervene and establish healthy trends which can have a lifelong influence. Individuals living in various socioeconomic conditions have an assortment of hazard factors that impact oral well-being. This work was conducted to study the prevalence of dental caries, body mass index (BMI), and socioeconomic status (SES) among preschoolers in private preschools and Anganwadi centers within Bengaluru. Materials and methods: This cross-sectional study was conducted in Anganwadis and preschools in Bengaluru city. About 800 students were selected by stratified cluster sampling technique. Written informed consent was obtained before the start of the study. Study proforma was used for the recording of sociodemographic details, anthropometric measurements, decayed, missing and filled teeth (dmft), and decayed, missing and filled surfaces (dmfs) index scoring. Statistical analysis was done using SPSS version 22.0. Results: The mean dmf (t) score in Anganwadi children was 1.60, whereas in private preschool children mean dmf (t) was 1.16. The mean dmf (s) score in Anganwadi children was 3.05, whereas in private preschool children mean dmf (s) was 1.76. There was a statistically significant difference between the two groups with respect to dmf (s) score (p = 0.01). Conclusion: It was found that there is an association between dental caries, BMI, and SES among Anganwadi children when a linear correlation was done. Clinical significance: Dental caries can cause serious physical and mental problems in children which affects their quality of life. These problems have their root cause from childhood and are related to their BMI and SES. This can be prevented by giving proper health education and dietary advice to parents.


Original Article

Neethu A Preethy

Comparison of Shear Bond Strength of Three Commercially Available Esthetic Restorative Composite Materials: An In Vitro Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:635 - 639]

   DOI: 10.5005/jp-journals-10005-1849  |  Open Access |  How to cite  | 


Introduction: Dental caries remains to be one of the most prevalent diseases encountered in the field of dentistry. Several restorative materials have been introduced with variable properties and among them, composite restorative materials are most widely used nowadays because of their superior esthetic property as well as minimal hard tissue removal. Shear bond strength of a restorative material plays a key role in deciding the restoration's longevity. Hence, for a better selection of the composite material, shear bond strength needs to be evaluated. Aim: The study aim was to analyze the shear bond strength of three commercially available esthetic restorative composite materials—Dentsply Ceram X, 3M ESPE™ Filtek™ Z350 XT, and GC Solare Sculpt to the tooth surface. Materials and methods: Thirty extracted human mandibular permanent molars that were caries-free were selected and erected in acrylic blocks. The uniform dentinal surface was exposed by cutting with a diamond disk. These were then randomly divided into three groups—groups I, II, and III based on the restorative material which was used, i.e., Ceram X, 3M ESPE™ Filtek™ Z350 XT, and Solare Sculpt, respectively. The restorative materials were applied on the dentinal surface of the prepared tooth specimens with the help of plastic molds, followed up by storing them in distilled water until they were subjected to shear bond strength testing. The collected data were examined by applying a one-way analysis of variance (ANOVA) and Turkey's post hoc test. Results: The Ceram X (21.6155 ± 2.20717) and Solare Sculpt (19.8747 ± 3.99732) were comparable in terms of shear bond strength values; however, they depicted significantly higher bond strength compared to 3M ESPE™ Filtek™ Z350 XT (12.8068 ± 3.99732). Conclusion: Among the three materials compared in this study, Ceram X produced higher shear bond strength to tooth surface when compared to Solare Sculpt and 3M ESPE™ Filtek™ Z350 XT. Clinical significance: Restoration failure continues to be a major problem taking a toll on the dentists’ time and patient satisfaction. Thus, the demand for restorative materials with better shear bond strength as well as excellent esthetics is on the rise. Thus, this particular study compares the shear bond strength of three commercial esthetic nanocomposites.


Original Article

Janani Jagannathan, Arul Selvan Kaniappan, Abinaya Raveendran, Smitha Shekhar

Comparison of Antimicrobial Efficacy of Natural Extracts as a Disinfectant for Removable Orthodontic Appliances: An Ex Vivo Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:640 - 643]

   DOI: 10.5005/jp-journals-10005-1850  |  Open Access |  How to cite  | 


Aim: The purpose of the study is to formulate a standard protocol for cleaning and disinfecting removable appliances by evaluating the antimicrobial efficacy of three natural extracts. Materials and methods: Fifty patients with removable orthodontic appliances were selected and divided into five groups [chlorhexidine 0.2% (positive control), extracts of neem, katha, cinnamon, and normal saline (negative control)] with 10 samples each. Saliva sample from the appliance was collected using a sterile cotton swab and cultured. Agar diffusion method was used and zones of inhibition were measured. Statistical analysis: The obtained data were subjected to statistical analysis by the Kruskal–Wallis ANOVA test and the Mann–Whitney U test. Results: The neem extract had the highest zone of inhibition measuring 14.95 mm (mean) followed by katha extract with the value of 13.85 mm which was found to be comparable to chlorhexidine with 15.85 mm. Conclusion: Thus, neem and katha extracts can be used to disinfect removable appliances because of their good antimicrobial activity. Clinical significance: By following these simple cleaning protocols, it is possible to avoid numerous health hazards caused by unclean removable appliances in children.


Original Article

Siraj DAA Khan, Ali A Assiry, Saleh MH Al Yami, Mansour HT Al Makrami, Faisal HS Al Milaq, Ibrahim SH Al Hareth, Hussain SM Al Yami

Assessment of Knowledge and Attitudes of School Teachers Regarding Emergency Management of an Avulsed Permanent Tooth of Southern Region of Saudi Arabia

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:644 - 649]

   DOI: 10.5005/jp-journals-10005-1851  |  Open Access |  How to cite  | 


Aim: An avulsion is defined as one of the most common dental injuries where the tooth is displaced completely from its socket, followed by trauma. The most important time in managing the avulsed tooth is the first few minutes and as children spend their most of waking time in school so the teacher is considering their immediate caregiver. Hence, this study was done to carry out the knowledge and attitude of school teachers regarding emergency management of avulsed permanent tooth in schools located in the southern region of Saudi Arabia. Materials and methods: The study was conducted at Najran School of Saudi Arabia. All teachers who are willing to participate in the study were involved. A questionnaire was made after reviewing several studies and was administered through emails to 318 teachers. The questionnaire consists of part I regarding demographic questions and part II information related to knowledge, action taken, education, and their way of managing the avulsed tooth at accident place. Statistics analysis was done using SPSS version 16. Results: Fifty percent of the participants know about the tooth avulsion. Fifty percent of the teachers who get information from the school health dental program get the tooth back to the dentist. There is a significant association found between the source of information and choice of treatment. Fifty-nine percent of the participants do not know about the management of tooth avulsion. And workshop plan then 89% was interested to attend the training. Conclusion: The present study revealed that knowledge regarding the management of avulsed tooth is low among the school teachers. There is a strong need for a school health dental program for the management of avulsed teeth among the school teachers.


Original Article

Shivangi Sharma, Radhika Chopra, Vinod Sachdev, Kunal Gupta

Variations in Physiological, Psychomotor, and Analgesic Parameters during Titration of Nitrous Oxide in 3–12 Years Old Children Managed with Inhalation Sedation

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:650 - 655]

   DOI: 10.5005/jp-journals-10005-1852  |  Open Access |  How to cite  | 


Background: The present study was designed to assess variations in physiological, psychomotor parameters, and analgesic effects at various levels of nitrous oxide-oxygen analgesia in 3–12 years old children. Design: One hundred children aged 3–12 years were assessed for physiological, psychomotor, and analgesic parameters at various concentrations of N2O, i.e., baseline, 20, 40, 50, and 0% (100% O2). Physiological, psychomotor, and analgesic effects were assessed using a pulse oximeter, bender visual-motor Gestalt test, and response to electric pulp tester, respectively. Results: Oxygen saturation (SpO2) showed a significant increase while heart rate (HR) showed a significant reduction at 50% N2O. No significant changes were observed in respiratory rate with a change in N2O levels. Significant reduction in the pain scores was found at the same level of stimulation by an electric pulp tester at 40 and 50% levels. The psychomotor changes were consistently higher at every concentration of nitrous oxide. However, no correlation could be found between various parameters tested. Conclusion: N2O caused a significant increase in SpO2 in both the age groups, a decrease in HR, a significant decrease in pain score at 40 and 50% concentration of N2O, and had a significant effect on the psychomotor ability of children.


Original Article

Akhila Abbas, Uday C Birapu, Praveenkanth Reddy

Efficacy of Mineral Trioxide Aggregate and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:7] [Pages No:656 - 662]

   DOI: 10.5005/jp-journals-10005-1853  |  Open Access |  How to cite  | 


Aim: To compare the bacterial leakage of mineral trioxide aggregate (MTA) and biodentine when used as an apical plug in immature permanent teeth. Materials and methods: It was a randomized double-blind in vitro study. A total of 60 teeth were divided into 2 groups of MTA and biodentine, which were further divided into 2 subgroups (n = 30) each based on the apical plug thickness of 2 and 4 mm. The teeth were cleaned and shaped; root-end resection and canal preparation were done. Mineral trioxide aggregate and biodentine were mixed and filled as apical plugs of 2 or 4 mm thickness. Enterococcus faecalis was used to assess the bacterial leakage of the filled samples. Statistical analysis: The comparison between the two groups was done by Chi-square test for categorical data. All p values <0.05 were considered as statistically significant. Results: A 4 mm apical plug of biodentine showed the least amount of bacterial leakage followed by 2 mm MTA and 4 mm MTA. A 2 mm apical plug of biodentine showed the maximum bacterial leakage. But this was not statistically significant over a period of 3 months. There was a statistically significant difference (p value = 0.042) among the total number of samples that leaked in the 2 and 4 mm biodentine group. Conclusion: Mineral trioxide aggregate and biodentine had a similar apical sealing ability. The apical sealing ability of biodentine at 4 mm thickness was greater than 2 mm thickness. Clinical significance: The apical leakage of the materials used in apexification is one of the main causes of endodontic failures in immature necrotic teeth. Materials like MTA and biodentine have overcome various drawbacks of calcium hydroxide as apexification material. The thickness of the apical plug plays an important role in preventing any microorganism from entering the periapical area, hence maintaining an adequate seal.


Original Article

Dipti Barve, Pranav N Dave, Meenal N Gulve, Mohammed AK Meera Sahib, Fariha Naz, Saquib A Shahabe

Effect of Commonly Consumed Beverages on Microhardness of Two Types of Composites

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:663 - 667]

   DOI: 10.5005/jp-journals-10005-1854  |  Open Access |  How to cite  | 


Objective: The objective of the present in vitro study was to assess the influence of commonly consumed beverages on the microhardness of microhybrid and nanofilled composite resins. Materials and methods: Two hundred and forty cylindrical specimens were produced using circular aluminum molds of an internal diameter of 10 mm and a thickness of 2 mm, 120 samples each from microhybrid composite (Filtek Z250, 3M, ESPE, USA) and nanofilled composite (filtek Z250, 3M, ESPE, USA). They were divided into 4 subgroups of 30 specimens each. These specimens were immersed in distilled water, tea, coffee, and cola drink, respectively. Microhardness was calculated using Vickers microhardness tester (MMT-X7 Matsuzawa, Japan). Data were statistically analyzed using paired t-test and one-way analysis of variance (ANOVA) using Tukey's correction was used for multiple subgroup comparison. Results: Microhardness of both the composites reduced after immersing in different beverages compared to water. Nanofilled composites showed more change in microhardness than microhybrid composite. Cola caused a significant reduction in microhardness followed by coffee, tea, and water. Conclusion: The beverages used have negative effects on the hardness of both the type of composites. The surface microhardness of nanofilled composite is significantly reduced when immersed in carbonated beverages like cola.


Original Article

Wenting Zhao, Yan Chen, Hee-Moon Kyung, Jin-Shuai Xu

Effectiveness of Tongue Crib Combination Treating Severe Skeletal Angle Class III Malocclusion in Mixed Dentition

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:9] [Pages No:668 - 676]

   DOI: 10.5005/jp-journals-10005-1855  |  Open Access |  How to cite  | 


Objective: To evaluate the treatment effects of tongue crib combination for treating severe skeletal Angle class III malocclusion in mixed dentition by X-ray cephalometric analysis. Materials and methods: A sample of 22 patients with severe skeletal Angle class III malocclusion of deficiency maxilla and overgrown mandible in mixed dentition was prospectively collected and equally divided into two groups. The patients (males 6 and females 5; mean age 8.35 ± 1.6 years) in the study group were treated with tongue crib combination, and the untreated patients (females 5, males 6; mean age 8.12 ± 1.3 years) served as the control group. X-ray cephalometric films were measured before and after treatment for comparing the change of occlusion, maxilla, mandible, and soft tissue. A paired t-test was used by SPSS 21.0 statistical software. The intragroup data were compared by using the Wilcoxon test, and intergroup data were compared by using the Mann–Whitney U test (p < 0.05). Results: In the study group, all patients got a favorable facial profile. Anterior and posterior teeth crossbite and upper and lower first molars relationships were improved. In cephalometric measurement, significant changes were noted in the maxillary skeletal component. The significant forward growth of the maxilla exhibited in a statistical increase of SNA, ANS-PNS, Wits appraisal, p < 0.05. The mandible revealed slightly posterior rotation by no significant decrease in SNB and no change Co-Gn. After 1-year of retention, the changes of the teeth showed self-correction and facial profile improved further. Regarding vertical changes, maintenance of growth was shown a small non-significant increase of FMA, N-Me, and ANS-Me. There is a significant difference from those in the control group (p < 0.05). Conclusion: Tongue crib combination is an effective device for the patients in the growing period with skeletal Angle class III malocclusion by improving the maxillary growth and limiting the mandibular growth.


Original Article

Bhavna Sabbarwal, Manjunath P Puranik, SR Uma

Association between Parental Behavior and Child's Oral Health among 3–5-year-old Children in Bengaluru City

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:677 - 681]

   DOI: 10.5005/jp-journals-10005-1856  |  Open Access |  How to cite  | 


Aim: Parental behavior is known to influence the well-being and disease outcomes in children. The environment which they create for the child can influence oral health behaviors and status. Hence, the present study aimed to determine the association of parental behavior with oral health status among 3–5-year-old children in Bengaluru city. Materials and methods: A cross-sectional study was conducted among 300 children aged 3–5 years. The child's demographic profile including socioeconomic status, dental history, oral habits, and oral hygiene practices was recorded. A 21-item prevalidated Parenting Style and Dimension Questionnaire (PSDQ) was used to assess parental behavior. WHO oral health pro forma (2013) was used to assess the oral health status of children. Chi-square test, Kruskal–Wallis, and Mann–Whitney U-test and binary logistic regression were applied. Statistical significance was considered at p < 0.05. Results: The majority of parents were authoritative (64.0%). The mean age of children was 4.15 ± 0.74 years. Sixty-one percent of the children had caries experience. The permissive group had a higher mean dmft (4.25 ± 3.43) than the authoritarian (2.1 ± 1.67) and authoritative group (1.51 ± 1.94) (p < 0.001). There was a statistically significant difference between authoritative and permissive (p < 0.001) and authoritarian and permissive (p < 0.001) groups for dt and dmft. Parenting style was significantly associated with dental caries and trauma. Conclusion: There is an association between parental behavior and oral health status among 3–5-year-old children. Hence, a prior appraisal of parental behavior is suggested for better oral health outcomes in children. Clinical significance: A prior appraisal of parenting style aids the clinician in the more efficient management of children through proper choice of behavior guidance technique.


Original Article

Mital V Kevadia, B Sandhyarani, Sachin A Gunda

Comparative Evaluation of Effectiveness of Tell-Play-Do, Film Modeling and Use of Smartphone Dental Application in the Management of Child Behavior

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:682 - 687]

   DOI: 10.5005/jp-journals-10005-1857  |  Open Access |  How to cite  | 


Aim: To evaluate the effectiveness of three different behavioral modification techniques: tell-play-do (TPD), film modeling, and use of smartphone dental app in the management of child behavior. Settings and design: Seventy-five children aged between 6 years and 9 years who were on their first dental visit were randomly divided into three groups. The study was conducted into two visits. Materials and methods: First visit: group I—children watched a film containing various dental procedures performed on a child model followed by oral prophylaxis; group II—TPD techniques were introduced with dental instruments imitating various playing objects followed by oral prophylaxis; group III—children were asked to use mobile dental application followed by oral prophylaxis. Second visit: After 7 days interval, all the children were subjected to class I restorative treatment using glass-ionomer cement. In both visits, the heart rate (HR), facial image scale (FIS) score, and Venham's pictorial index (VPI) score were evaluated before the intervention, after the intervention of behavior modification technique, and during the dental procedure. Statistical analysis used: One-way ANOVA test followed by the post hoc Tukey test was used to compare HR and the Kruskal–Wallis test was used to compare the FIS and VPI of all three groups. Results: The average HR, FIS, and VPI scores were significantly lower among children who received TPD intervention compared to those who received film modeling intervention and mobile dental application. Conclusion: Tell-play-do technique is more effective in reducing children's fear and anxiety for dental treatment. Tell-play-do can be a functional alternative method to tell-show-do (TSD) and modeling techniques during dental treatment.


Original Article

Subhashree Mohapatra, R Pradeep Kumar, D Sri Sakthi

Comparison and Evaluation of the Retention, Cariostatic Effect, and Discoloration of Conventional Clinpro 3M ESPE and Hydrophilic Ultraseal XT Hydro among 12–15-year-old Schoolchildren for a Period of 6 Months: A Single-blind Randomized Clinical Trial

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:688 - 693]

   DOI: 10.5005/jp-journals-10005-1859  |  Open Access |  How to cite  | 


Introduction: Pit and fissures are more prone to caries as compared to smooth surfaces. Sealing the pit and fissures with sealants is considered to be highly effective in the prevention of pit and fissure caries. Hydrophobic sealants are technique sensitive in nature. Ultraseal XT Hydro sealant is moisture tolerant which incorporates the benefits of both hydrophilic and hydrophobic sealants into one unique chemistry. Hence, the study was conducted to compare and evaluate the retention, cariostatic effect, and discoloration of conventional Clinpro™ 3M™ ESPE™ and hydrophilic Ultraseal XT Hydro sealants among 12–15-year-old schoolchildren for 6 months. Materials and methods: It was a single-blinded, randomized split-mouth clinical trial. Schoolchildren aged 12–15 years were recruited in this clinical trial. Clinpro sealant and Ultraseal XT Hydro were placed in the right and left quadrant molars, respectively, and were assigned as group I and II. The sample size arrived was 60 teeth per group and at 30 patients based on the computer-generated random sequence. Sealant coverage between the two sealants was compared using Mann–Whitney test and Z test for proportions. Results: After 6 months, it was seen that 10 teeth out of 44 (22.72%) with Clinpro had the sealant covering all the fissures compared to Ultraseal XT Hydro which was only 9%. Fifty-nine percent of retention rate was seen with Clinpro compared to Ultraseal XT Hydro sealant (27.27%). Caries incidence was higher in the case of group II. No difference was observed with regard to the discoloration of the sealants. Conclusion: It was concluded that for a longer follow-up period conventional Clinpro™ 3M™ ESPE™ was better than Ultra XT Hydro seal in terms of retention and cariostatic effect.


Original Article

Jagriti Kushwah, Rahul Mishra, Vishal Bhadauria

Antibacterial Efficacy of Sodium Hypochlorite, Ozonated Water, and 980 nm Diode Laser Used for Disinfection of Root Canal against Enterococcus faecalis: A Microbiological Study

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:694 - 699]

Keywords: 980 nm diode laser, Enterococcus faecalis, Ozonated water, Sodium hypochlorite

   DOI: 10.5005/jp-journals-10005-1860  |  Open Access |  How to cite  | 


Aim: Evaluation and comparison of the antibacterial efficacy of sodium hypochlorite, ozonated water, diode laser, and diode laser in combination with ozonated water against Enterococcus faecalis. Materials and methods: One hundred and twenty extracted premolar teeth were sectioned at the cementoenamel junction and root canals were prepared using step-back technique with K-file up to #40. The teeth were arbitrarily allocated to four groups and stowed into brain heart infusion broth containing a microbial suspension of E. faecalis. Group I samples were irrigated with 3% sodium hypochlorite. Group II samples were irrigated with ozonated water. Group III samples were irrigated firstly by distilled water followed by laser irradiation. Group IV samples were irrigated by ozonated water followed by laser irradiation. After the treatment, the teeth were kept in vials containing 2 mL of nutrient broth. The vials were then incubated at 37°C for 24 h. Standard methods were then used to identify grown colonies. Statistical analysis: Kruskal–Wallis test, Mann–Whitney test, Chi-square test, and Wilcoxon signed-rank test were used to measure the colony-forming units (CFUs) obtained at the end of the incubation period among the various groups for the evaluation of antibacterial efficacy of various disinfection protocols. Results: The highest mean CFU/mL is recorded in group II (with ozonated water) followed by group I (with sodium hypochlorite), group III (with a laser), and the least mean CFU/mL is seen in group IV (with laser and ozonated water). The variation in CFU/mL among the three groups is statistically significant (p < 0.05). Conclusion: The outcome of this study reveals that 980 nm diode laser along with ozonated water when used together can eliminate and disinfect the root canals with E. faecalis.



Luciana B Oliveira, Carla Massignan, Regina M De Carvalho, Maria G Savi, Michele Bolan, André L Porporatti, Graziela De Luca Canto

Children's Perceptions of Dentist's Attire and Environment: A Systematic Review and Meta-analysis

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:17] [Pages No:700 - 716]

   DOI: 10.5005/jp-journals-10005-1839  |  Open Access |  How to cite  | 


Aim: To assess the children's perceptions of the dentist's attire and environment. The protocol is available in the PROSPERO database. Search strategies: Systematic searches in the databases were performed in Cochrane, Latin American and Caribbean Health Sciences, PubMed, PsycINFO, Scopus, and Web of Science from their inception to December 12, 2019, Google Scholar, Open Grey, and ProQuest Dissertations. Selection criteria: Criteria consisted of descriptive studies regarding the above matter while two authors assessed the information. The risk of bias was also performed. Results: Databases showed 1,544 papers and a two-phase assessment selected 21 studies in narrative and 9 in the quantitative synthesis. A meta-analysis demonstrated no difference between white coat and child-friendly attire (OR = 0.63; 95% CI 0.16–2.49; n = 3,706) and a decorated vs plain dental clinic was the preference of the children's majority (OR = 8.75; 95% CI 1.21–63.37; n = 150). Conclusion: It can be concluded that there is no difference in the children's perception, white coat vs child-friendly attire; however, children prefer a decorated dental clinic.



Ankit Sharma, Snehal N Ingole, Mohan D Deshpande, Noaman Kazi, Deepashree Meshram, Pallavi Ranadive

A Rare Case of Osteoclast-poor Osteopetrosis (RANKL Mutation) with Recurrent Osteomyelitis of Mandible: A Case Report

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:717 - 721]

   DOI: 10.5005/jp-journals-10005-1835  |  Open Access |  How to cite  | 


Osteopetrosis (OP) is a group of rare genetic bone disorders. Osteoclast-poor form of osteopetrosis is much rarer in humans and represents a small percentage of the total cases of autosomal recessive osteopetrosis presenting with impaired bone remodeling due to defective osteoclastic activity and is characterized by distinctive increase in bone density and high bone fragility. Reduction in marrow spaces with decreased vasculature to the bone owing to increased bone mass makes the bones vulnerable for varied infections resulting in osteomyelitis. This case report discusses challenges in management of recalcitrant osteomyelitis of mandible developed as a complication in an 8-year-old girl child identified with rare, dual heterozygous mutations in RANKL (TNFSF11) gene and COL5A1 gene with uncertain significance responsible for osteoclast-poor osteopetrosis and Classic Ehlers-Danlos, respectively.



Tanya Agarwal

A Modified Removable Space Maintainer for Compromised Dentition of Children: A Case Series

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:3] [Pages No:722 - 724]

   DOI: 10.5005/jp-journals-10005-1843  |  Open Access |  How to cite  | 


Despite the attempt in prevention, premature loss of primary teeth remains to be a frequent problem in pediatric dentistry, resulting in disturbance of arch integrity and unfavorably affecting the alignment of permanent successors. Space maintainers (SMs) are distinctive appliances used for maintaining space created due to premature loss of primary teeth. But at times the dentition of children is so compromised that it prevents the use of a conventional SM. Introduced in this article is an innovative modified removable functional SM that offers several benefits over the traditional appliance. It is a straightforward and rapid method to fabricate but also omits band adaptation in uncooperative children and helps restore the functional harmony.



Shanthan Mettu, Nagulapally G Reddy, Keerthi Jangam

Multidisciplinary Approach for the Management of Dilacerated Permanent Maxillary Incisor: A Case Report

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:725 - 728]

   DOI: 10.5005/jp-journals-10005-1847  |  Open Access |  How to cite  | 


Dilaceration is an abrupt deviation along the long axis of the tooth, which may be observed between the crown, root, or both. Management of such teeth poses a unique challenge to the clinician due to its position within the esthetic zone. This case report describes the management of impacted maxillary central incisor with severe root dilacerations (90° angulation and crown directed toward the anterior nasal spine). Surgical extraction of tooth was done after the elevation of the flap and fixed orthodontic treatment was planned to regain the required amount of space followed by prosthetic rehabilitation using the same extracted tooth as pontic.



Supreeya Patel

Impacted Mandibular Premolar Concomitant with Compound–Complex Odontome in a 13-year-old Girl: A Case Report

[Year:2020] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:729 - 733]

   DOI: 10.5005/jp-journals-10005-1858  |  Open Access |  How to cite  | 


Odontomas, the benign odontogenic tumors of epithelial and mesenchymal origin, are very common in occurrence and are now widely accepted as hamartomas. Odontomes are invariably composed of enamel and dentin, and may also have variable amounts of cementum and pulp. Largely, odontomas have been categorized into the compound and complex varieties. Compound odontoma epitomizes itself as aberrations with the presence of all types of dental tissues and showing an orderly distribution in the form of tooth-like structures; whereas complex odontoma describes itself as aberrations in which the presence of some or all dental tissues and in a disorganized distribution. Herein, a case of compound–complex odontome associated with the impaction of a mandibular second premolar is being presented in a 13-year-old girl.


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