Contemporary Clinical Dentistry

Our role in the changing face of research AR Prabhakar Contemporary Clinical Dentistry 2020 11(4):299-300

Biomimetic properties of engineered periodontal ligament/cementum in dental implants Anil Mathew, Anna Serene Babu, Arun Keepanasseril Contemporary Clinical Dentistry 2020 11(4):301-310 The conventional concept of osseointegrated dental implants based on direct connection to alveolar bone lacks a structured periodontal ligament (PDL) as in natural tooth. This limits the physiologic and functional efficiency of the implant in cushioning occlusal overload, orthodontic tooth movement, and proprioception. Development of bio-mimetic implants that can satisfy the bio-functional requirements of the natural tooth will be an innovative approach and preliminary researches in this area has been reported. This review includes in vivo studies which reported structural features and functional efficiency of an artificial PDL or cementum developed around dental implants. The electronic search identified 12 animal studies and one human trial which utilized retained or adjacent natural tooth roots, exogenous scaffold materials, dental progenitor cells derived from PDL of extracted tooth root as PDL substitutes. The result of the review is dominated by bio-hybrid implants that used dental follicles separated on the particular embryonic day and cell sheets from immortalized human cells. A summary of the currently available research on artificial PDL/cementum around dental implants highlights the potential need of autologous cell-derived tissues to bioengineer a fully functional implant design

Efficacy of herbal interventions in oral lichen planus: A systematic review Ashita R Kalaskar, Rahul R Bhowate, Ritesh R Kalaskar, Sheelpriya R Walde, Rachana D Ramteke, Priyanka P Banode Contemporary Clinical Dentistry 2020 11(4):311-319 Introduction: Oral lichen planus (OLP) is a chronic autoimmune condition requiring prompt treatment to alleviate the signs and symptoms. There is weak evidence emphasizing the efficacy of any one therapy. Steroids, of all the therapies, have proved to be effective and hence considered as the standard care for OLP. However, the complications associated with it further worsen the patient's condition. Alternative safe approaches such as herbal interventions (HIs) have been tried in OLP. Their efficacies could only be evaluated from properly designed research protocols such as randomized controlled trials (RCTs). The present systematic review aims to assess the efficacy of HIs compared to steroids in RCTs involving OLP. Materials and Methods: An extensive search for HIs in OLP was conducted in PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and gray literature. Eight studies fulfilled the eligibility criteria. Results: In all the studies, clinical severity was significantly reduced in within-group comparisons, whereas between-group comparisons showed nonsignificant results, except for total glucosides of paeony capsules. Conclusion: Efficacy of herbal therapy in OLP should be weighed against the high bias in the studies.

Is there a need to increase palatal root torque of upper incisors in lingual appliance? A finite element analysis SP Lekshmi, Elbe Peter, G Suja Ani Contemporary Clinical Dentistry 2020 11(4):320-326 Objectives: To understand the effect of the biomechanical differences by assessing pre and post retraction torque, amount of retraction and arch width changes in both techniques. Methodology: A three-dimensional geometric model of maxilla with all upper teeth except first premolar was generated based on computed tomography radiograph of a dry skull using the computer program Hypermesh. 13.0. Virtual models of 0.022 ” Roth labial brackets and 0.018 ” ORMCO 7th generation lingual brackets; and for labial brackets 0.019 × 0.025” SS archwire and for lingual brackets 0.016 × 0.024” SS archwire were constructed. Sliding mechanics was used during en-masse retraction by applying a 300 g distal force on both sides of the dentition from canine to the second premolar brackets in the labial and lingual simulation. The finite element program ANSYS 12.1 was used to calculate the torque and displacement. Results: The results stipulated that in transverse direction there was lingual tipping of anteriors, mild buccal flaring in second premolars and first molars and lingual tipping in second molar in lingual appliance. In the sagittal plane, the greater distal movement of posteriors and an up-righting tendency of molars were observed in lingual appliance. Extrusion of anterior teeth were observed in both appliances. Regarding the premolars and first molars, labial movements and relative intrusion were observed in lingual appliance compared to labial appliance. Conclusion: In lingual treatment, it is crucial to increase the lingual root torque. The amount of retraction and arch widening were more in lingual appliance compared to labial technique.

Antibacterial efficacy of muringa seed extract and potato peel extract Against Enterococcus faecalis MC Noushad, K Ashraf, MP Suneetha Contemporary Clinical Dentistry 2020 11(4):327-331 Background: Elimination of infection and prevention of reinfection should be the main goal in the treatment of apical periodontitis. The most challenging part of endodontics is the complete disinfection of root canal system. Herbal alternatives have emerged as the more biofriendly approach in root canal irrigation and disinfection. Aim and Objective: The aim of this study was to evaluate the antimicrobial efficacy of natural extracts like muringa seed and potato peel extract against Enterococcus faecalis. Materials and Methods: The antimicrobial activity was determined using agar diffusion test. The solutions were divided into three groups: Group I- Muringa seed extract, Group II- potato peel extract, and Group III-5.25% sodium hypochlorite. The zones of inhibition of growth were recorded. The strain used for this study was Enterococcus faecalis ATCC 29212. Results and Conclusion: Muringa seed extract (Group I) demonstrated the best result among the tested solutions. Although there was no significant difference between potato peel extract (Group II) and 5.25% sodium hypochlorite (Group III). Within the limitations of this study, herbal extracts tested has shown significant antimicrobial action against Enterococcus faecalis.

Validity of diagnostic criteria for temporomandibular joint disorder in the diagnosis of disc displacement disorders of temporomandibular joint Shikha N Goyal, Freny R Karjodkar, Kaustubh Sansare Contemporary Clinical Dentistry 2020 11(4):332-335 Objective: The objective of this study is to assess the validity Diagnostic Criteria for Temporomandibular joint Disorder (DC/TMD) in the diagnosis of disc displacement (DD) disorders of temporomandibular joint (TMJ). Study Design: It was a prospective study in which total of 55 patients accounting to 110 TMJ; with clinical diagnosis of DD disorder as per DC/TMD criteria and all above age of 18 years were included. All the patients with clinical diagnosis of DD disorder were advised MRI. All the MRI scans were read by single radiologist. Clinician and Radiologist were blinded to each others findings. MRI diagnosis and clinical diagnosis were compared and results were formulated. Results: The use of the Kappa statistic test indicated a good diagnostic agreement (k = 0.68) between the clinician and the radiologist. The DC/TMD criterion was found to have good validity and reliability in the diagnosis of DD disorders with sensitivity of 91.57% and specificity of 77.78%. The positive predictive value and negative predicted value calculated were 92.68% and 78%, respectively. The positive and negative likelihood ratio found was 4.12 and 0.11, respectively. Conclusion: DC/TMD is a simple, reliable, valid, cost-effective tool in the diagnosis of DD disorders.

Influence of implant dimensions in the resorbed and bone augmented mandible: A finite element study Doriana Agop Forna, Norina Consuela Forna, Sînziana Anca Butnaru Moldoveanu Contemporary Clinical Dentistry 2020 11(4):336-341 Aims: The scope of this study was to analyze the influence of clinically feasible implant diameter and length on the stress transmitted to the peri-implant bone in the case of a resorbed and bone augmented mandible through finite element analysis. Settings and Design: The study was carried out in silico. Subjects and Methods: Resorbed and bone-augmented 3D models were derived from in vivo cone-beam computed tomography scans of the same patient. Corresponding implant systems were modeled with the diameter ranging from 3.3 to 6 mm and length ranging from 5 to 13 mm, and masticatory loads were applied on the abutment surface. Statistical Analysis Used: None. Results: In the bone augmented ridge, maximum stress values in the peri-implant region drastically decreased only when using implants of a diameter of 5 mm and 6 mm. Implants up to 4 mm in diameter led to comparable stress values with the ones obtained in the resorbed ridge, when using the larger implants. The increase of length reduced stress in the resorbed mandible, whereas in the bone augmented model, it led to small variations only in implants up to 4 mm in diameter. Conclusions: It was concluded that bone augmentation provides the optimal framework for clinicians to use larger implants, which, in turn, reduces stress in the peri-implant region. Diameter and length play an equally important role in decreasing stress. Implant dimensions should be carefully considered with ridge geometry.

Comparative evaluation of serum tumor necrosis factor α in health and chronic periodontitis: A case–control study Prince Jain, Aditi Ved, Rajat Dubey, Neha Singh, Anuj Singh Parihar, Rochira Maytreyee Contemporary Clinical Dentistry 2020 11(4):342-349 Background: Tumor necrosis factor-alpha (TNF-α), a ” major inflammatory cytokine,” not only plays an important role in periodontal destruction but also is extremely toxic to the host. Till date, there are not many studies comparing the levels of TNF-α in serum and its relationship to periodontal disease. Aim: Our study aimed to compare the serum TNF-α among the two study groups, namely, healthy controls and chronic periodontitis patients and establish a correlation between serum TNF-α and various clinical parameters. Hence, an attempt is made to estimate the level of TNF-α in serum, its relationship to periodontal disease and to explore the possibility of using the level of TNF-α in serum as a biochemical ” marker” of periodontal disease. Materials and Methods: Forty individuals participated in the study and were grouped into two subgroups. Group A – 20 systemically and periodontally healthy controls. Group B – twenty patients with generalized chronic periodontitis. The serum samples were assayed for TNF-α levels by enzyme-linked immunosorbent assay method. Results: The mean serum TNF-α cytokines for Group B Generalized chronic periodontitis (GCP) was 2.977 ± 1.011, and Group A (healthy) was 0.867 ± 0.865. The range of serum TNF-α was from (0.867 to 2.977). Serum TNF-α cytokines had highly significant correlation with all clinical parameters (plaque index, probing pocket depth, clinical attachment loss, and gingival index) among all study participants (P = 0.001). Conclusion: These observations suggest a positive association between periodontal disease and increased levels of TNF-α in serum. It can be concluded that there is a prospect of using the estimation of TNF-α in serum as a ” marker” of periodontal disease in future. However, it remains a possibility that the absence or low levels of TNF-α in serum might indicate a stable lesion and elevated levels might indicate an active site but only longitudinal studies taking into account, the disease ” activity” and ” inactivity” could suggest the possibility of using TNF-α in serum as an ” Indicator” of periodontal disease.

Effects of habit-breaking appliances on tongue movements during deglutition in children with tongue thrust swallowing using ultrasonography – A pilot study Mihir Nayak, Sandya Devi S Patil, Madhu Kakanur, Snehalika A More, S Ravi Kumar, Rachna Thakur Contemporary Clinical Dentistry 2020 11(4):350-355 Objective: The aim of this study is to evaluate and compare the duration and range of tongue movements in tongue thrust swallow patterns with and without habit-breaking appliances using computer-aided M-mode ultrasound images. Also to record the corresponding position of the tongue associated with normal and tongue thrust swallowing pattern using B-mode ultrasound images. Methodology: Ten patients with mature swallow pattern, ten subjects with anterior tongue thrust (ATT) and ten patients with lateral tongue thrust (LTT) swallowing habit were analyzed for the duration and range of tongue movement using two-dimensional ultrasound M-mode images before and after insertion of three habit-breaking appliances (anterior tongue crib [ATC], double oral screen [DOS] and DeLuke oral trainer [DOT]). Further, B-mode images were examined for the tongue positions in different swallow patterns with and without appliances. Results: Duration and range of tongue movement for the entire swallowing phase did not show a statistically significant difference for mature, ATT and LTT. Statistical significant difference existed in the duration between ATC and DOS with DOT for ATT patient (P = 0.05). Furthermore, a significant difference existed in the range of tongue movement between DOS and DOT in LTT patients (P = 0.05). Conclusion: Remarkable changes in the tongue position were observed postinsertion of DOT in both anterior and LTT swallow patterns where the tongue tip and anterior tongue dorsum shifted upward toward the anterior palate resembling that of a mature swallow pattern.

Evaluation of the bioactivity of surface modified polyetheretherketone (PEEK) as an implant material: An In Vitro study Asish Martin, NS Azhagarasan, Mahadevan Ravichandran, Hariharan Ramakrishnan, S Jaya Krishnakumar, Vallabh Mahadevan Contemporary Clinical Dentistry 2020 11(4):356-366 Purpose: The purpose of this study was to evaluate the bioactivity of polyetheretherketone (PEEK) used as an implant material after surface modification by electron beam deposition of titanium. Materials and Methods: Twenty-two samples of PEEK were obtained from a single manufacturer, water jet sectioned, and divided randomly into two groups of eleven each (Group I and Group II). Eleven PEEK samples from Group II were coated with Grade II commercially pure titanium by electron beam deposition technique. One representative sample from each group was evaluated for surface roughness, topography and composition using three dimensional surface profilometer, scanning electron microscope coupled with energy dispersive X-ray (SEM-EDX) analysis. Simulated body fluid (SBF) was prepared and calcium (Ca) content in it was quantitatively analyzed by inductively coupled plasma mass spectrometry (ICP-MS) technique. Ten samples from each group were then immersed in SBF for a period of 21 days and amount of calcium depletion was analyzed to determine the bioactivity of two groups. Surface characteristics and elemental composition of immersed samples were analyzed by SEM-EDX and correlated with results of ICP-MS tests. The data obtained were then subjected to statistical analysis using independent t-test. Results: Group II samples showed a significant increase in surface roughness compared to Group I (P < 0.02). There were significant differences in Ca depletion of Group I and Group II samples when compared to preimmersion Ca content (P < 0.001). When compared between two Groups, Group II samples showed higher Ca depletion (P < 0.001). Conclusion: Within the limitations of this study, it was concluded that PEEK dental implants which were surface modified by electron beam deposition of titanium had enhanced bioactivity when compared to unmodified PEEK. Hence, they can serve as a valuable alternative to conventional dental implant materials.

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