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   Table of Contents - Current issue
Coverpage
September-October 2020
Volume 12 | Issue 5
Page Nos. 407-497

Online since Wednesday, October 21, 2020

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REVIEW ARTICLES  

Povidone-iodine in dental and oral health: A narrative review Highly accessed article p. 407
Rahmi Amtha, Jeeve Kanagalingam
DOI:10.4103/jioh.jioh_89_20  
Aim: Proper oral care is an important contributor to overall health, and various antiseptic options are available for the prevention and treatment of oral diseases. Povidone-iodine (PVP-I) oral formulations remain popular for their broad spectrum of effect and favorable tolerability profile. Our aim was to provide a narrative review looking at the past and current studies evaluating PVP-I usage for the maintenance of oral health. Materials and Methods: Querying the PubMed and Web of Science databases using the terms “PVP-I,” “Oral Health,” and “Dental Care,” we identified and systematically reviewed articles for a literature review of PVP-I applications in the area. In addition to potent antimicrobial action against common viruses, fungi, and bacteria, the absence of reported resistance to PVP-I makes it an increasingly attractive option in today’s settings. Results: The applications for PVP-I range from routine oral care and gingivitis through to the management of oral mucositis and surgical site disinfection following dental surgeries. Evidence also suggests that PVP-I confers additional benefits that complement its antiseptic properties. These include anti-inflammatory, anti-edematous, and hemostyptic effects, which can improve clinical outcomes. Conclusion: The clinical benefits of PVP-I warrant its ongoing consideration as a reliable antiseptic for broad oral care needs.
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Biomechanical stress in removable complete dental prostheses: A narrative review of finite element studies p. 413
Mohammed Assayed Mousa, Nafij Jamayet, Edward Lynch, Adam Husein
DOI:10.4103/jioh.jioh_190_20  
Aim: This review aimed to investigate the stress that arises in the conventional and implant-assisted removable complete dental prostheses (RCDPs) and supporting structures. Materials and Methods: A literature survey was conducted for the full-text English articles which only used finite element analysis to examine the stress developed in the conventional and implant-assisted RCDPs from January 2000 to May 2020. Results: In total, 1789 articles were included in the survey. Of the 1789 articles obtained, 1746 were excluded based on initial screening of the title and abstract. Finally, 24 articles were recruited for this study after excluding the duplicated articles with the same results. The significant findings and conclusions were extracted and grouped under biomechanical stress developed in complete dental prostheses, how to manage the stress developed in conventional RCDPs, and the factors affecting the development of stress in implant-assisted RCDPs. Conclusion: The RCDPs subject to different kinds of stress in the form of compressive and tensile strengths. The buccal flanges exhibit compressive strains responding to the vertical forces while labial flanges show the same type of strain responding to all force directions. The highest tensile strain concentration exists at the anterior frenum, midline, and buccal flanges when the forces were horizontal. Whilst, retention and support in implant-assisted prostheses are exceptionally improved, the implants and prostheses are subjected to stress which may result in failure of these kinds of prosthesis. This stress can be managed by increasing the number and size and by decreasing the angulation of the implants, using splinted or short collar unsplinted abutments, reinforcing the denture base, and using canine guidance occlusion.
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ORIGINAL RESEARCH Top

A comparison of the retentive force of ball and socket attachment versus magnet attachment in mandibular overdentures: A randomized control trial p. 420
Mohamed Y Sharaf, El Bakry, Mohamed Farouk Abdall
DOI:10.4103/jioh.jioh_20_20  
Aim: To compare the retention and patient satisfaction of implant-supported mandibular overdentures with ball and socket attachment versus magnet attachment. Materials and Methods: Twenty-four participants (10 males and 14 females) were divided into two equal groups (n = 12). Both groups received implant-supported mandibular overdentures retained by ball and magnet attachment. Two implants were installed in the canine region bilaterally. Evaluation of retention was made at overdenture insertion, 3, 6, and 12 months. Patient satisfaction evaluation with Oral Health Impact Profile Questionnaire-14 (OHIP-14) was made at overdenture insertion 3, and 12 months subsequently. Results: The ball group showed a statistically significantly higher retention force (P < 0.05) than the magnet group at insertion, 3 and 6 months. The ball group had a statistically significantly lower mean of physical disability and physical pain (P < 0.05) than the magnet group through all follow-up. One-way analysis of variance (ANOVA) test was used to compare between groups as well as to study the changes by time within each group. Conclusion: Both implant-supported mandibular overdenture retained with magnet or ball and socket attachments consider a successful treatment option with superior improvement in the ball and socket group.
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Evaluation of serum lipid profile and complete hemogram in patients with oral submucous fibrosis: A case control study p. 427
Soundarya Ramesh, Poornima Govindaraju, Balaji Pachipalusu
DOI:10.4103/jioh.jioh_308_19  
Aim: Not many studies in the literature are found that include all the variables under complete blood picture along with lipid profile. The aim of study was to evaluate the serum lipid profile and complete blood picture in patients with oral submucous fibrosis (OSMF). Materials and Methods: It is a case control study with the sample size of 40 patients considered by random sampling, which includes 20 clinically diagnosed patients with OSMF as per the diagnostic criteria of Passi et al. and 20 sex-matched controls. Five milliliters of blood was collected from the most prominent vein of right cubital fossa and stored in test tubes. Centrifugation was carried out for about 4–5min at 2500rpm and the serum collected was stored at 4°C and subjected to auto analyzer for analyzing complete lipid profile and complete blood picture. Mann–Whitney U test was used to compare mean age, mean values of lipid profile parameters, and hematological parameters between OSMF and healthy group. Results: The serum lipid levels were significantly lower in patients with OSMF than in controls, and also patients with OSMF showed significantly lower levels of hemoglobin (Hb), red blood cells (RBCs), and platelets and increased levels of erythrocyte sedimentation rate (ESR) and white blood cell (WBC) than in controls. Conclusion: This study concluded that the lower serum lipid levels may serve as a diagnostic and prognostic indicator in the early diagnosis of oral premalignant lesions, and the findings in our study emphasize on the assessment of Hb, RBCs, WBCs, platelets, and ESR for patients with OSMF. So it is recommended to subject the patients with oral precancerous conditions to biochemical investigations as it may aid in early diagnosis and prognosis.
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The association between functional oral health literacy and periodontal disease among adults with type 2 diabetes mellitus in the northeast region of Thailand Highly accessed article p. 432
Rajda Chaichit, Supasin Deeraksa
DOI:10.4103/jioh.jioh_338_19  
Aim: To analyze the association between functional oral health literacy (FOHL) and oral health behaviors with periodontal disease among adults with type 2 diabetes mellitus (T2DM). Materials and Methods: A cross-sectional analysis study was conducted among 1110 adults with T2DM who were selected by multistage random sampling from 10 hospitals of five provinces in the northeast region of Thailand. A structured questionnaire was developed, and face to face interview and also clinical oral examination and blood glucose investigation were carried out. Data distribution was performed by descriptive statistic and chi-square test. The multiple logistic regression was used to determine the association between variables after adjustment for confounders. Results: In this study, a total of 1110 adults with T2DM divided into two groups according to the severity of periodontal disease showed 51.89% of moderate–severe periodontal disease. The study examined the association of periodontal disease with the independent variables after adjusted odd ratios, it was found to be statistically significant with the FOHL level (adjusted odds ratio [AOR] = 1.80, 95% confidence interval [CI] = 1.30–2.40), toothbrushing frequency (AOR = 1.73, 95% CI = 1.24–2.40), smoking (AOR = 2.25, 95% CI = 1.45–3.40), and betel nut crewing (AOR = 2.13, 95% CI = 1.28–3.45). Moreover, the demographic characteristics of patients with T2DM associated with the severity of periodontal disease in variables of gender, age, education level, duration with diabetes, and health insurance were also statistically significant at P < 0.05. Conclusion: The FOHL level and oral behaviors among adults with T2DM were statistically significant with periodontal disease. However, the patients of T2DM with low FOHL and poor oral health behaviors need extra support from dental health personnel to reduce the risk of oral disease.
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Analysis of interleukin-10 anti-inflammatory cytokines in salivary lymphocyte surface: A cross sectional study p. 439
Retno Indrawati, Muhammad Luthfi, Aqsa S Oki, Yuliati , Agung Sosiawan, Priyawan Rachmadi, Muhaimin Rifai
DOI:10.4103/jioh.jioh_293_18  
Aim: To analyze the expression of interleukin-10 (IL-10) in children with severe early childhood caries (S-ECC) and caries-free children. Materials and Methods: This was an observational analytic pilot study performed on children with social factors-ECC (S-ECC), and caries-free children as the objects of research with a cross-sectional study design. Saliva of children aged 4–6 years from the group of caries children in severe and caries-free early childhood was taken. Samples were taken by rinsing with 1.5% sterile NaCl for 30s and then accommodated in a sterile tube, to get a 40 mL sample from the aforementioned procedure repeated four times. Flow-cytometry test was used to analyze the IL-10 expression. The results of the study were analyzed using the normality test using Shapiro–Wilk, then continued with t test using the Statistical Package for the Social Sciences (SPSS) software program, version 20.0 (IBM Corp., Armonk, NY, USA). The data were analyzed by independent t test to see the difference between caries-free children and S-ECC. Results: The expression of IL-10 in the saliva of children with severe ECC was 3.32 ± 0.79; meanwhile, in caries-free children it was 4.04 ± 0.65. Conclusion: The IL-10 expression in children with severe ECC was significantly lower than that of in caries-free children.
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The correlation between well-being and stress in a cohort of dental students: A cross-sectional survey p. 443
May Wathiq Al-Khudhairy, Al Bandari Bin Rubayan, Deena Al Khayari, Abrar Al Shahri, Nahlah Al Subhi
DOI:10.4103/jioh.jioh_333_19  
Aim: Mindfulness is the act of “focused at the moment” process encompassing a paradox of terms including and not limited to well-being. The aim of this study was to find a correlation, be it positive or negative, between well-being and stress. Materials and Methods: The cross-sectional study included a questionnaire-type format recruiting a convenient multicenter study sample of 744 participants across the different dental schools in Riyadh, Saudi Arabia. The study design included an operator-designed questionnaire and well-being tool kit having six domains of which some are inherent to the cultural aspects of the region. The domains were religious and meditation wellness, academics wellness, social and cultural wellness, mental wellness, environmental wellness, and physical wellness. Spearman’s correlation, Cronbach’s alpha coefficient, and multivariate analysis were conducted by Statistical Package for Social Sciences. Results: There was a positive inverse relationship between each of the domains relative to the perceived stress scale (P < 0.005). Conclusion: This study is the first of its kind in Saudi Arabia, and the six-domain tool kit with a favorable alpha coefficient can be used in future studies of well-being in such a vulnerable population, university students. “Burn out syndrome” is a reality that must be addressed, better yet to provide prophylaxis against via a custom designed well-being tool kit that can identify those vulnerable to the effects of a world laced with artificial intelligence, technology, and work-related stress.
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General knowledge of marijuana and kratom in an urban dental patient population: A cross-sectional study p. 450
Farzad Baghaie, Sarah Chamseddine, Shaza Awad, Michelle Wheater
DOI:10.4103/jioh.jioh_9_20  
Aim: To analyze the knowledge of dental patients in an urban setting regarding the legality and potential clinical benefits of marijuana and kratom. Materials and Methods: This presented cross-sectional study had 18-item questionnaire consisting of four demographic questions, six questions focused on marijuana, and eight questions focused on kratom, which was distributed in paper and pencil format to a convenience sample of 400 dental patients in the waiting area of an urban dental school. Data were entered into Qualtrics Research Suite software and analyzed using descriptive statistics and χ2 test with significance at P < 0.05. Results: Four hundred (400) surveys were completed anonymously by adult volunteers. Results showed a variable level of knowledge regarding the legality and potential clinical use of marijuana and tetrahydrocannabinol (THC). With some questions, a statistically significant difference in knowledge was observed relative to age and highest level of education of the respondent. In contrast, compared to any knowledge of marijuana, respondents had little to no knowledge of kratom or mitragynine legality, health benefits, or potential as a substitute for opioids. Conclusion: Knowledge of marijuana is to be expected as its widespread use and debates of its legality have been in the public eye for years in the United States. Although similar debates regarding whether kratom should be legal continue, this survey suggests that the public has little to no knowledge of what it is. As opioid use disorder increases, so does the search for opioid substitutes. It is important that the public be made aware of potential opioid substitutes other than marijuana so that personal choices and decisions can be made with current and correct information.
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Effect of four different root canal obturation techniques on marginal adaptation of bioceramic sealer: An in vitro scanning electron microscopic study p. 455
Nawal A Al-Sabawi, Maha M Yahya, Njwan F Shehab
DOI:10.4103/jioh.jioh_75_20  
Aim: Successful endodontic treatment can be achieved with techniques and materials that have the ability to seal root canal space. The aim of this study was to investigate the effect of four techniques of obturation (single cone [SC], cold lateral [CL], continuous wave [CW], and carrier based [CB]) on the marginal adaptation of bioceramic sealer to the root canal walls using scanning electron microscope (SEM). Materials and Methods: Forty, single-rooted lower premolars were included in this study. The teeth were segmented at the level of cementoenamel junction (CEJ). Then, root canals were shaped with rotary ProTaper nickel–titanium (NiTi) files to F3. Instrumented teeth were assigned randomly into four experimental groups (n = 10/group) as follows: (1) SC, (2) CL, (3) CW, and (4) CB. EndoSequence BC sealer was used for the four groups. After root canal obturation, the roots were horizontally cut into three levels and the interface was examined under SEM in the apical, middle, and cervical thirds of each group. The data collected were analyzed using one-way analysis of variance (ANOVA) and Tukey’s post hoc multiple range tests at P ≤ 0.05. Results: CW of obturation technique showed the best marginal adaptation and the least mean of gaps along the interface between the obturating material and the root canal dentine at all sections of the root (apical, middle, and coronal), followed by the CL technique. Also, results found that CW and CL were significantly different from SC and CB techniques. Conclusion: Techniques of obturation had an effect on the marginal adaptation of bioceramic sealer to the root canal walls. CW technique showed the best marginal adaptation for bioceramic sealer followed by the CL technique. Less marginal adaptation was observed in the SC and CB techniques.
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Characteristic assay of incorporation of carbonated hydroxyapatite–propolis as an alternative for alveolar bone loss therapy on periodontitis: An in vitro study p. 463
Suryono Suryono, Indi Kusumawati, Nungky Devitaningtyas, Ayuda N Sukmawati, Puspaneka Wijayanti
DOI:10.4103/jioh.jioh_315_19  
Aim: To examine the characteristics of carbonated hydroxyapatite (CHA) incorporated with propolis in the concentrations of 5%, 7.5%, and 10%. Materials and Methods: In this in vitro study, the CHA bone graft (GamaCHA) material was immersed in the propolis solution with the concentrations of 5%, 7.5%, and 10% by serial dilution method for 24h at room temperature. Absorbance readings of loading and release assay were carried out using UV-Vis spectrophotometers at 289nm. Antibacterial testing was done by calculating the inhibition zone of Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. The microtetrazolium (MTT) assay was used for viability test of fibroblast NIH 3T3 cell culture by measuring the optical density in the enzyme-linked immunosorbent assay (ELISA) reader. The data of the study were analyzed with one-way analysis of variance (ANOVA) (loading, release, antibacterial P. gingivalis, and viability test) and Kruskal–Wallis (antibacterial A. actinomycetemcomitans). Results: The results showed that CHA incorporated with 10% propolis had the highest loading percentage, the largest diameter of bacterial inhibition zone, and the highest fibroblast viability (P < 0.05). However, the difference in the concentrations of propolis incorporated with CHA did not affect the percentage of propolis release (P > 0.05). Conclusion: CHA incorporated with 10% propolis solution showed highest loading percentage, antibacterial activity, and viability.
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The comparison of shear bond strength of metal orthodontics bracket to porcelain surface using silane and single bond: An in vitro study p. 470
Chitra Martalia, Citra Anggitia, Thalca Hamid, Jusuf Sjamsudin
DOI:10.4103/jioh.jioh_52_20  
Aim: To investigate the dissimilarity of the shear bond strength of bracket on porcelain surface using silane and single bond. Materials and Methods: This study was laboratory experimental research with posttest-only group design. Simple random sampling was performed to select the sample. Twenty-eight porcelain veneers were used as sample, then divided into four groups accordingly: hydrofluoric acid, silane, bonding, and adhesive (I); hydrofluoric acid, single bond, bonding, and adhesive (II); hydrofluoric acid, bonding, and adhesive (III); and single bond and adhesive (IV). Shear bond strength of brackets was performed by means of universal testing machine. Scanning electron microscope was used to examine the porcelain surface roughness. Wilcoxon Mann–Whitney test (P < 0.05) was performed to analyze the difference between groups. Result: The shear bond strengths between groups were significantly different (P < 0.05). The greatest bracket shear bond strength and lowest porcelain surface roughness were found in hydrofluoric acid, silane, bonding, and adhesive. Conclusion: Silane applied separately from bonding and acid has great shear bond strength and low porcelain surface roughness.
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Assessment of physical properties of a ZnO/E sealer modified by adding moringa oleifera: An experimental in-vitro study p. 476
Engy M Kataia, Maram E Khallaf, Nada Omar, Yousra Aly, Nancy ElShafei
DOI:10.4103/jioh.jioh_347_19  
Aim: In an attempt to move toward exploration of the antibacterial properties of herbal products, this study evaluated the effect of how the addition of Moringa would affect the physical properties of the commercial Endofil sealer. Materials and Methods: An experimental in vitro study was performed using three experimental sealers. There were four groups in this study: Group A (ZnO/E sealer alone), Group B (ZnO/E and Moringa root), Group C (ZnO/E and Moringa leaf), and Group D (ZnO/E and Moringa leaf extract liquid). Measurements were carried out according to International Organization for Standardization (ISO) standardization 6876:2012. Moringa oleifera was added to Endofil’s powder and liquid and the physical properties of the new sealer were tested according to ISO 6876:2012 and compared to those of Endofil alone. One-way analysis of variance (ANOVA) followed by Tukey post hoc test was used to compare between more than two groups in non-related samples. Results: All groups showed varying degrees of shrinkage with Group B having the lowest shrinkage and setting time, whereas Groups A and D experienced the highest shrinkage. All groups experienced solubility; Group B had the highest mass loss and Group D showed the lowest. Group A showed the lowest film thickness. Radiopacity of all groups satisfies the ISO recommendations for root canal sealers. Conclusion: Moringa added to ZnO/E sealer showed acceptable physical properties of the commercial Endofil sealer.
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Thermoset and thermoplastic elastomeric chain comparative strength: An in vitro study p. 485
Ari Triwardhani, Vindira P Prastiti, Iyanda Vemala, Jusuf Sjamsudin
DOI:10.4103/jioh.jioh_50_20  
Aim: Technology in the field of orthodontic has experienced many developments in the last two decades. The ultimate goal of orthodontic treatment is to provide continuous light pressure to get orthodontic tooth movement with minimum side effects. Elastomeric chains are commonly used materials for moving teeth and closing space. The strength of elastomeric chain results in a tendency for better elastomer selection. Some factories make elastomeric chains with thermoplastic and thermoset materials with thermoset material claims having strength resistance for longer periods of time. The aim of the study was to compare the degradation strength between thermoplastic and thermoset elastomeric chain. Materials and Methods: This was a true-experimental laboratory study (in vitro study). The sample comprised open-type elastomeric chains (power chain) with clear transparent color thermoplastic material, which include original power chain, plastic chain and thermoset material generation II, and memory chain. The samples were divided into four groups (n = 5): 24h, 7, 14, and 21 days. Independent samples t tests and analysis of variance (ANOVA) were performed to analyze the data. Results: There was significant dissimilarity between thermoplastic and thermoset elastomeric chain material in strength. Thermoplastic elastomeric chains decreased by 60.84%–65.51% and thermoset elastomeric chain reached 36.28%–58.80% within 21 days in artificial saliva solution. Conclusion: There was dissimilarity between the thermoplastic and thermoset elastomeric chain materials in force decay due to excessive early withdrawal forces in the elastomeric chains of thermoplastic materials with a more rigid material than the thermoset elastomeric chains of the thermoset material.
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Investigation of the effects of cement in different thicknesses and mechanical properties on implant with zirconia crown: A finite element analysis p. 491
Mahmut Sertac Ozdogan, Harun Gokce
DOI:10.4103/jioh.jioh_348_19  
Aim: To evaluate the stress distribution in the implant-supported mandibular premolar monolithic zirconia crowns with different cement types and thicknesses under constant masticatory force using three-dimensional (3D) finite element analysis (FEA). Materials and Methods: The 3D models of monolithic zirconia crowns, which were cemented on abutment, were generated. Nine numerical models were fabricated by applying different cement thicknesses (0.02, 0.05, and 0.10 mm). The solid models were imported into the FEA software and meshed into tetrahedral elements. All models were simulated under masticatory force loads of 100N at two points, respectively. Results: Stress distribution was affected by cement thickness. When the solutions of total deformation on crown were examined, it was observed that Cement-1 with a thickness of 0.02 mm showed the lowest value (0.07 mm). It was shown that the use of Cement-2 material with a thickness of 0.02 mm provides the lowest maximum principle stress on abutment (4.90MPa). When the stresses on the implant were examined, it was determined that the lowest stress values were again formed in cements with a thickness of 0.02 mm (130MPa). The results showed that 0.05 mm thick High Modulus Resin Adhesive Cement (Panavia, Kuraray, Tokyo, Japan) gave the lowest strain values. Conclusion: It was observed that the different resin and cement thicknesses played an important role in the stresses on the zirconia crown, abutment, and implant. Cement thickness has also been evaluated as an important factor, affecting the material life and leading to the preservation of recovery.
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