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   Table of Contents - Current issue
Coverpage
July-August 2022
Volume 12 | Issue 4
Page Nos. 385-473

Online since Monday, August 29, 2022

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REVIEW ARTICLES  

Teledentistry and online referral system in Indonesian primary health care center during the COVID-19 pandemic: A narrative review p. 385
Ninuk Hariyani, Namita Shanbhag, Ekawati Wasis Wijayati, Arie Wahyu Prananta, Dini Setyowati, Retno Palupi
DOI:10.4103/jispcd.JISPCD_244_21  
Aims: This review aims to map the needs and challenges in the application of teledentistry and online referral system encountered by dental health care professionals in Indonesian primary health care centers (puskesmas) to provide safe dental health service to the population during the COVID-19 pandemic. Materials and Methods: Literature search was undertaken of both in Indonesian and overseas context related to teledentistry. Narrative review of the literature was written to present the challenges, solutions, and application of teledentistry at Puskesmas to optimize oral health services during the COVID-19 pandemic. Results: Online referral system and teledentistry are options to help dental health service delivery in the pandemic era. While it has been adopted in many private clinics, there are many challenges to adopt it at the puskesmas level due to a lack of infrastructure, human resources, and budget allocation. While the Indonesian government has plans to support the digitization in the education and health sector, this pandemic shall pose an opportunity for Indonesian health department to develop and facilitate the use of teledentistry and online referral system. During this situation, health cadres can bridge the relationship between Puskesmas and the poor community through the help of teledentistry. Conclusions: The government commitment in applying online referral system and teledentistry in Puskesmas is needed. Dental education institutions can help to supply human resources, who are capable of developing and carrying out the most suitable teledentistry application for all stakeholders.
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Estimation of serum, salivary, and gingival crevicular uric acid of individuals with and without periodontal disease: A systematic review and meta-analysis p. 393
Rabiya B Uppin, Sheeja S Varghese
DOI:10.4103/jispcd.JISPCD_84_22  
Introduction: Uric acid (UA) levels in serum, salivary, and gingival crevicular fluid (GCF) may be associated with periodontal diseases. Hence, this study aimed to estimate the UA concentration in serum, saliva, and GCF of periodontal disease and non-periodontal disease subjects by conducting a systematic review and a meta-analysis of the reported studies. Materials and Methods: A review of the available literature was searched in the electronic databases of PubMed, Cochrane, Science Direct, and EBSCO for the relevant publications. All the related case–control, cross-sectional, and cohort studies reporting the UA levels in the blood, salivary, and GCF between periodontal disease patients and healthy controls were analyzed. Significant heterogeneity was observed in the studies. Hence, a continuous random-effects model was used. The findings are described in forest plots with the point estimations and 95% confidence interval (CI). A value of P less than 5% was considered as a significant heterogeneity test. Results: Of the initial 166 study titles screened, 14 reported papers were eligible for quantitative review. The subgroup analysis of serum UA revealed a mean difference of 0.299 (95% CI: 0.029–0.569, I2=85.64%, P<0.001), indicating an increase in the UA levels in periodontal disease. However, the subgroup analysis by salivary UA demonstrated a mean difference of −0.783 (95% CI: −1.577–0.011, I2= 94.62%, P<0.001), suggesting a lower side of the UA level in periodontal diseases. The subgroup analysis based on case–control studies showed a mean difference of 0.004 (95% CI: −0.286–0.294, I2=84.99%, P<0.001), indicating no changes in UA levels in periodontal disease. On the contrary, cohort studies and cross-sectional studies showed a mean difference : 95% CI: −1.016, −3.272–1.241, I2=97.84%, P<0.001 and 95%: −1.230, −4.410–1.949, I2=97.7%, P<0.001, indicating reduction in UA levels in periodontal disease cases. Conclusion: The current review suggests an increase in the serum UA levels in periodontal disease than in healthy controls. Contrarily, the salivary UA levels decreased in periodontal disease patients. It is unknown why UA levels are opposite in the blood and saliva of periodontal disease patients requiring further explanation.
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ORIGINAL ARTICLES Top

Effect of treated zirconium oxide (ZrO2) nanoparticles on the color and surface properties of interim fixed prostheses p. 404
Faris Abdullah Alshahrani
DOI:10.4103/jispcd.JISPCD_24_22  
Objective: Zirconium oxide (ZrO2) nanoparticles addition to interim fixed prostheses (IFPs) was suggested to improve the mechanical properties. However, the effect of ZrO2 on the color and surface properties of IFP was neglected. Therefore, this study aimed to investigate the effect of ZrO2 on the color, hardness, and surface roughness of IFP. Materials and Methods: Customized split-press metal molds were used for the fabrication of forty disk-shaped acrylics (10 mm × 1.5 mm). The salinized ZrO2 particles were weighed using an electronic balance and added in concentrations of 1wt %, 2.5wt %, and 5wt % of auto-polymerized acrylic polymer powder. Based on ZrO2 concentrations, specimens were divided into one control group without ZrO2 and three ZrO2 study groups 1 ZrO2, 2.5 ZrO2, and 5 ZrO2, respectively. A double beam ultraviolet-visible reflection spectrophotometer was the instrument used for recording the color measurements (CIEDE2000). The Microhardness and surface roughness (Ra, μm) of all samples were tested. ANOVA test was used for data analysis (α = 0.05) Results: Notable changes were seen between the group containing 1% and the other two groups in Δa*, ΔΕab, and ΔΕ00 parameters. Statistically significant differences were observed among the three groups for the ΔL* parameter. No notable changes were seen between the group containing 1% and the group containing 5% for the Δb* parameter. The 1% group showed a statistically significant difference in hardness in comparison to the 5% group. For surface roughness, the 2.5% group presented statistically significant higher surface roughness as opposed to the 0% control group. Conclusions: The addition of ZrO2 in high concentrations resulted in a noticeable color change in IFP. However, the surface properties did not change hardness and roughness with ZrO2 addition except roughness increased with 2.5% ZrO2. Low ZrO2 addition did not result in a change in color and surface properties of IFP.
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Modified analytic hierarchy process site selection model for dental clinics in high-rent commercial buildings p. 411
Umaporn Vimonkittipong, Kongkoon Tochaiwat, Suriya Sirithanyarat, Varalee Thumvisuttivarakorn
DOI:10.4103/jispcd.JISPCD_89_22  
Introduction: Location is a factor that highly influences a business’s ability to carry out various activities. Site selection, therefore, must take into account all the potential benefits. A dental clinic is an enterprise that should prioritize the site selection. In Thailand, many dental clinics operate in rented commercial buildings on a long-term lease basis. Objective: The objective of this research was to create a model for selecting suitable sites for dental clinic businesses in commercial buildings in Bangkok with rental fees exceeding $750 per month. Materials and Methods: The research was conducted by collecting data from a sample group consisting of 30 participants who were owners, partners, or dentists of dental clinics located in commercial buildings in Bangkok with rental fees more than $750 per month. Data were then analyzed with descriptive statistics: namely, frequency, percentage, mean, and modified analytic hierarchy process. Results: The results revealed the ranking of the main criteria, as well as their weights, for the site selection of commercial buildings in Bangkok with rents greater than $750 per unit per month to be used as a dental clinic: transportation (39.40%), neighborhood (23.61%), facilities (19.45%), parking (12.82%), and competition (4.72%), respectively, with three most important subcriteria: namely, being on a major road (19.00%), being near an electric express train station (9.10%), and being on the secondary road (8.92%), respectively.
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Color stability of bioactive restorative materials after immersion in various media p. 418
Shara I Sajini, Ali B Mushayt, Talal A Almutairi, Roaa Abuljadayel
DOI:10.4103/jispcd.JISPCD_40_22  
Objectives: The aim of this article is to assess the color stability of the bioactive restorative materials (Activa Bioactive, Beautifil II) compared with the conventional resin composite and resin-modified glass ionomer cement after immersion in different staining solutions overtime. Materials and Methods: This is an in-vitro study that investigated four different material groups: (1) bioactive composite (ACTIVA Bioactive-Restorative, Pulpdent, USA), (2) Giomer composite (Beautifil II, SHOFU Dental GmbH, Japan), (3) resin-modified glass ionomer cement (Fuji II, GC Corporation, Japan), and (4) resin composite (Filtek Z350XT, 3M ESPE, USA). One hundred samples (n=25 each group) were fabricated using a custom acrylic mold (1 mm thick × 10 mm diameter) and then immersed in five different staining solution groups: coffee, black tea, cola, mixed berry juice, and saline. Baseline (T0) shade of samples was recorded using two spectrophotometers: VITA Easyshade Digital Advance and a spectrophotometer. Then shade was recorded at the intervals of 7 (T1), 14 (T2), and 28 (T3) days of immersion. Measurements were obtained and then ΔE was calculated for each group at each time point. Three-way analysis of variance tests were used to test the interactions between different variables at the 0.05 significance level. Results: All specimens showed a significant color change (P<0.001), following 7, 14, and 28 days of storage. Activa Bioactive and Filtek Z350 showed the highest color stability overtime in different staining solutions, whereas Fuji II and Beautifil II showed the least color stability. The most significant color change was noticed in the coffee group and then in the mixed berry juice group. Conclusion: Resin-based restorative materials showed higher color stability than glass ionomer-based restorations. Both spectrophotometers gave comparable results for materials’ color stability.
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Perceptions of dental health professionals (DHPs) on work challenges in Fiji: A qualitative study p. 426
Samantha Kumar, Masoud Mohammadnezhad
DOI:10.4103/jispcd.JISPCD_74_22  
Introduction: Reviewing factors that affect work challenges is crucial for any organization as it has an impact of organizational commitment for a better service delivery and job satisfaction. This study aimed to explore the perceptions of dental health professionals (DHPs) on work challenges and the impact it has on job satisfaction in Fiji. Materials and Methods: A descriptive, qualitative method approach (nationwide) was done commencing from August to November, 2021. DHPs who provide prosthetic services in Fiji were selected using purposive selection located at Nakasi Dental Clinic, Lautoka Dental Clinic, Labasa Dental Clinic, and Fiji National University. A total of 29 DHPs participated in the in-depth interview, and the responses were grouped into nine themes: working conditions, the location of practice, equipment and material, a lack of specialization, service delivery, organizational support, remuneration, career development, and promotions. A semi-structured open-ended questionnaire in the form of an interview via a virtual platform—Zoom was used for data collection. Thematic analysis was used to transcribe and analyze the audio recordings. Results: The findings from the study indicated that factors such as working conditions, the location of practice, equipment and material, a lack of specialization, service delivery, organizational support, remuneration, career development, and promotions were associated with work challenges. Conclusion: Gaps and areas for the improvement of work challenges and its impact on job satisfaction were identified for DHPs who provide prosthetic services in Fiji such as a need for more career and professional development pathways, improved infrastructure to support prosthetic service delivery, and better remuneration.
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Comparative study on the efficacy of OliNano Seal and Curodont D’Senz in the treatment of dentin hypersensitivity (clinical trial and in vitro study) p. 436
Asmaa A Mosleh, Heba E Eltayeb
DOI:10.4103/jispcd.JISPCD_25_22  
Purpose: The present study was carried out to assess and compare the efficacy of OliNano Seal (OS) and Curodont D’Senz (CS) in the treatment of dentin hypersensitivity (DH) and the reduction of dentin permeability. Materials and Methods: The current study was a single-blinded, clinical trial and in vitro study using OS and CS in the treatment of DH. A total of 72 hypersensitive teeth were selected from 18 patients and randomly divided into two groups. Prior to the desensitizing agent’s application (the baseline), as well as immediately, 2 weeks, 4 weeks, and 3 months afterward, the evaluated materials were applied. Patients were instructed to use the visual analogue scale (VAS) to score their perception of tactile, air, and cold stimuli (VAS). In total, 90 samples were used for the evaluation, and they were randomly divided into two main groups: group A1, which had the smear layer fully removed, and group A2, which had the smear layer partially removed. According to the desensitizing agent used, each group was divided into three subgroups: OS, CS, and the control group that was left untreated. The results of the dentin permeability test were analyzed using the analysis of variance test, whereas the pain scores were analyzed using the Mann–Whitney test. Results: The study showed that there was a high statistically significant difference between pain scores prior to and after the application of both tested desensitizing agents. Permeability results revealed a high statistically significant difference between the study groups, with the lowest statistically significant mean depth of dye penetration found with OS-treated samples. Conclusion: OS and CS were both effective in the treatment of DH and the reduction of dentin permeability, with OS being more effective within 1 week and sustained up to 3 months.
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Treatment outcome and prognostic factors of orthograde retreatment: A retrospective study p. 442
Saranya Ponsri, Titalee Jirathanyanatt
DOI:10.4103/jispcd.JISPCD_26_22  
Aims: This study aims to evaluate the outcome and prognostic factors related to post-treatment disease in orthograde retreatment after a minimum of 1-year follow-up period. Materials and Methods: A retrospective cohort study was performed. The data of all orthograde retreatment charts between January 2006 and March 2019 from two endodontic centers in Thailand were collected. Retreatment outcomes were evaluated and prognostic factors were analyzed by multivariable binary logistic regression. Results: The average recall period was 4.3 years, ranging from 1 to 12 years. The sample in the present study consisted of 245 teeth in 220 patients, of which 161 teeth (65.70%) were classified as “healed,” 28 teeth (11.40%) were classified as “healing,” and 56 teeth (22.90%) as “diseased.” The bivariate analysis showed that the statistically significant factors included the presence of pre-operative lesions, the pre-operative lesion size, access opening through the crown, chlorhexidine adjunctive irrigation, and solvent usage. Multivariable binary logistic regression identified pre-operative lesions and solvent usage as significant prognostic factors with adjusted odds ratios of 6.30 (confidence interval [CI], 2.72–14.63; P < 0.01) and 2.54 (CI, 1.24–5.23; P = 0.01), respectively. The healed rate was higher when the pre-operative lesions were absent and when the solvent was used. Conclusion: The healed rate of orthograde retreatment after 1 to 12 years of follow-up was 65.70% and 77.10% for a lenient success rate. Pre-operative lesion and solvent usage were significant prognostic factors. The healed rate was higher with the absence of pre-operative lesions and usage of solvent.
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Surface treatments on repair bond strength of aged resin composites p. 449
Manal A Almutairi, Fouad S Salama, Lujain Y Alzeghaibi, Sarah W Albalawi, Basmah Z Alhawsawi
DOI:10.4103/jispcd.JISPCD_99_22  
Aims: The aim was to evaluate the effect of different surface treatments on the repair shear bond strength of aged resin composites. Materials and Methods: Forty cylindrical-shaped specimens were treated from each material: Tetric Evo Ceram, Neo Spectra, and Filtek Ultimate Universal Restorative and allocated into four groups according to the surface treatment planned to use: Group 1: diamond, Group 2: silica coating, Group 3: carbide burs, and Group 4: control group. Following the surface treatment, composites were repaired with flowable resins. The shear bond strength was tested using a universal testing machine at a crosshead speed of 0.5 mm/min. The fracture mode was assessed under 50× magnification. The data were analyzed statistically using a two-way analysis of variance (ANOVA) test followed by a one-way ANOVA test. Multiple comparison procedures were performed using Tukey’s test. The level of significance was set at P < 0.05. Results: The lowest mean value of the shear bond strength was for the Filtek Ultimate Universal Restorative in the control group, whereas the highest mean value was in the silica group. Silica and carbide groups had significantly higher mean values of the shear bond strength than diamond and control groups in Tetric EvoCeram and Filtek Ultimate Universal Restorative. In contrast, in Neo Spectra St HV, the carbide group had a higher mean value but was not statistically significant. Conclusion: Combinations of mechanical and chemical retentive systems enhance the shear bond strength of the repair composite to the aged composite. Among the different surface treatments employed in this study, silica and carbide groups show higher repair bond strength of new composite to aged composite.
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Seasonal variations in the groundwater fluoride of Swarna river basin in southern India: A GIS-based study p. 456
Kush Kalra, Ramprasad Vasthare, Harikripa N Udayashankar, Vishnu Sharma, Nishu Singla, Prajna P Nayak
DOI:10.4103/jispcd.JISPCD_109_22  
Objectives: The study aimed (1) to assess fluoride concentration of groundwater along the Swarna river basin in Udupi District; (2) to investigate variations in fluoride concentration with respect to rainfall status in Udupi district; and (3) to develop a spatial distribution map for the groundwater fluoride concentration in Udupi district. Materials and Methods: Water samples were procured from 30 different sampling points across three time zones in a year: pre-monsoon, monsoon, and post-monsoon. The samples thus collected were analyzed for fluoride ion concentration using fluoride ion selective electrodes (Orion™). Mean determination readings at each time zone were calculated. Repeated-measures analysis of variance was done to analyze whether there was a difference in the concentration of fluoride over different time zones. Results: The mean (SD) pre-monsoon concentration was 0.25 (± 0.07) ppm, whereas the mean monsoon and post-monsoon concentrations were 0.26 (± 0.09) and 0.57 (± 0.23) ppm, respectively. There was a significant increase in post-monsoon fluoride levels when compared with the pre-monsoon and monsoon levels. Conclusion: The groundwater fluoride concentration in the Swarna river basin was found acceptable for human consumption at all the sampled sites and across all time zones. As the fluoride concentration was found to be lower than the recommended values for dental caries prevention at most of the sampling sites, use of topical fluorides needs to be encouraged.
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Effect of lipid peroxidation on dental healthcare workers p. 463
Fazladin T Temurov, Gamal K Ashyrbekov, Serikkali K Esengeldi, Maksut B Tolepbergenov, Bekjan A Akhmet
DOI:10.4103/jispcd.JISPCD_7_22  
Aim and Objective: The relevance of the study was explained by the fact that free radicals, known to be a product of lipid peroxidation, damage the integrity of cell membranes and corresponding intracellular structures, disrupting their functioning. The purpose of this cross-sectional study was to investigate the effect of free-radical lipid peroxidation in the blood on the body of dentists without diseases of the bronchi and lungs. Materials and Methods: The chemiluminescent properties of the blood hemolysate of 65 dentists were measured. Blood was collected in a test tube with an anticoagulant, and the plasma was aspirated with a Pasteur pipette. The hemolysate was aspirated two times. Distilled water was added to the sediment of erythrocytes, the mixture was shaken, and centrifuged. Statistical processing of morphometric indicators was carried out using the software package “Statistica 6.0.”Results: The direct dependence of the spontaneous chemiluminescence (SCL) growth parameters in the blood hemolysate of dentists on their length of service was determined. Conclusion: The conclusions indicate a direct correlation between the growth parameters of the SCL index in the blood hemolysate of dentists and their length of service. The applied value of this study lies in the possibility of practical application of the results obtained to qualitatively investigate the effect of lipid peroxidation processes on the body of dentists.
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CASE REPORT Top

Regenerative endodontic therapy for management of an immature permanent tooth with recurrent post-treatment apical periodontitis: A case report p. 468
Renato Lenzi, Sandra R Hernández, Flávio R. F. Alves, Isabela N Rôças, José F Siqueira
DOI:10.4103/jispcd.JISPCD_71_22  
This case report describes the treatment outcome and further retreatment of an immature permanent maxillary right central incisor with necrotic pulp and chronic apical abscess using regenerative endodontic therapy (RET). The patient had a history of traumatic injury. The initial periapical radiographic and cone-beam computed tomographic (CBCT) examinations revealed tooth #8 had incomplete root formation, thin dentinal walls, and pulp necrosis associated with a large apical periodontitis lesion. RET was conducted in two visits and included a disinfection protocol with 5.25% NaOCl irrigation and medication with a double antibiotic paste (metronidazole and ciprofloxacin). At the second visit, a blood clot was induced, and the cervical third was sealed with a mineral trioxide aggregate plug and the coronal portion with light-cure composite. The tooth was asymptomatic at the 12-, 24-, and 36-month follow-ups, and radiographs showed continued root development with healed periradicular tissues. However, the 4-year radiographic follow-up revealed a recurrent apical periodontitis lesion. A second attempt of RET was conducted in one visit using 1% NaOCl irrigation and stimulation of a blood clot. A double seal with silicate-based cement and composite was placed. At the 24-month follow-up, the tooth remained asymptomatic, and both radiographic and CBCT examinations showed apical closure and complete repair of the periradicular tissues. When a tooth develops recurrent apical periodontitis, a second attempt of RET is a feasible option to control infection, helping to promote tooth retention associated with healthy periradicular conditions.
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