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   2021| November-December  | Volume 11 | Issue 6  
    Online since November 30, 2021

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Association between periodontitis and metabolic syndrome in females: A systematic review and meta-analysis
Ghousia Sayeed, Sheeja S Varghese
November-December 2021, 11(6):609-625
Background: Metabolic syndrome (MetS) and periodontal diseases (PDs) have shown a bidirectional and vice versa relationship. Hence, this study aimed to identify the extent and magnitude between MetS and PDs in females. Materials and Methods: A published literature was explored by considering case–control, cross-sectional, and cohort studies that involved patients with measurements of MetS and PD. Ovid MEDLINE, EMBASE, LILACS, and Cochrane Library databases were used for the search. This study examined the relationship between the MetS and PD among females. Results: Of the initial 4150 titles screened, a total of 37 reported papers were eligible for quantitative review. A gender-wise analysis of the findings revealed a crude odds ratio (OR) of 1.385 [95% confidence interval (CI): 1.043–1.839, I2 = 94.61%, P < 0.001] for the females relative to the average OR of 1.54 (95% CI: 1.39–1.71, I2 = 90.95%, P < 0.001). Further subgroup analysis for directionality in females revealed the crude ORs of 1.28 (95% CI: 0.91–1.79, I2 = 96.44%, P < 0.001) for the relationship between PD and MetS, whereas an OR of 2.12 (95% CI: 0.78–5.73, I2 = 88.31%, P < 0.001) was found between MetS and PDs. Conclusion: This study lacks convincing proof of a link between MetS and PDs in females when compared with an overall association between MetS and PDs. Directionality indicated higher odds of linking between MetS and PD than PD and MetS among females. Further longitudinal and treatment trials are needed to confirm the association among females.
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Association between periodontal disease and the risk of COVID-19 complications and mortality: A systematic review
Daniel Alonso Kim Espinoza-Espinoza, Julissa Amparo Dulanto-Vargas, Oswaldo Andreé Cáceres-LaTorre, Fiorella Estefanie Lamas-Castillo, Carlos Flores-Mir, Luis Adolfo Cervantes-Ganoza, Carlos López-Gurreonero, Marysela Irene Ladera-Castañeda, César Félix Cayo-Rojas
November-December 2021, 11(6):626-638
Aim: The COVID-19 pandemic has strained the world’s healthcare systems. Studies have identified how the COVID-19 infections are linked to several co-morbidities such as hypertension, diabetes, cardiovascular disease, renal and pulmonary disease. It is known that periodontal disease (PD) shares the same risk factors. Moreover, both diseases are characterized by an exaggerated immune response. The aim of the study was to investigate the available evidence of a potential association between PD and the risk of COVID-19 complications and mortality. Materials and Methods: MEDLINE/PubMed, EMBASE, Scopus, and ProQuest were searched. Studies that assess the association between PD and the risk of COVID-19 complications and mortality were eligible for inclusion. Two independent reviewers performed the selection of articles and data extraction. The New Castle Ottawa Scale was used to assess the quality of the selected studies, and the GRADE system was used to evaluate the level of confidence to support the conclusions. Results: Only two studies met the eligibility criteria. One study had a low risk of bias, whereas the other had a high risk of bias. Conclusion: The level of confidence in the available evidence is very low. A close association between periodontitis and the risk of COVID-19 complications and mortality can neither be supported nor refuted.
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Natural extracts as biological smear layer removing agents: A literature review
Sawsan Taha Abu Zeid, Hagar A Bastawy, Abeer A Mokeem Saleh
November-December 2021, 11(6):589-600
Objectives: The aim of this article is to identify whether natural irrigants are better than synthetic conventional irrigants for smear layer removal and to analyze their influence on mechanical and chemical radicular dentin properties. Materials and Methods: The last electronic search was performed on June 2020 through five databases, limited to articles either published or accepted for publication in the English language using the following keywords: “Natural extracts” or “Fruit and plant extracts” and “Smear layer removal.”Results: According to the inclusion criteria, 36 articles were included. Most studies revealed that apple or apple cider vinegars, grape seed extract, citrus aurantifolia, 5–10% glycolic acid, and 0.5–1% phytic acid effectively removed the smear layer better or similar to synthetic conventional agents. Conclusion: Natural irrigants are effective smear layer removing agents with the least deteriorated effect on mechanical and chemical radicular dentin properties compared with synthetic agents.
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Prevalence of oral lesions in COVID-19 Egyptian patients
Walid Aly Hamed Elamrousy, Mohamed Nassar, Dalia Rasheed Issa
November-December 2021, 11(6):712-720
Objectives: The aim of this article is to detect whether oral lesions affect the tongue mainly due to higher cells expressing angiotensin-converting enzyme 2 (ACE2) than in other oral sites in COVID-19 patients. Moreover, the etiology of oral lesions was evaluated either resulting from SARS-CoV-2 sequelae or from adverse effects of drugs used for COVID-19 treatment. Materials and Methods: One hundred and twenty-four patients were admitted to the study. All patients’ data were obtained including age and gender, laboratory testing, drug administration, respiratory and systemic conditions, signs and symptoms, and oral manifestations. Results: Oral manifestations were seen in 112 (90.3%) of all patients. Oral ulcers represented the most prevalent lesions in the oral cavity in 104 patients (92.8%). Lip, tongue, and labial mucosa showed the most common sites for oral ulcers. Most of oral lesions were displayed in the tongue in 96 patients (85.7%). Various medications were used in the treatment of patients. Conclusion: The tongue represented the most common site of oral lesions in COVID-19 patients followed by the labial mucosa. No correlation was found between the oral lesions and the drugs used for the treatment of SARS-CoV-2 infection. The systemic health and the severity of the disease were not related to the spread of the oral lesions.
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Comparing the effectiveness of herbal and conventional dentifrices in reducing dental plaque and gingivitis: A systematic review
Sushanthi Suresh, Indiran Meignana Arumugham, Srisakthi Doraikannan, Pradeep Kumar Rathinavelu, Jayashri Prabakar, Arthi Balasubramaniam
November-December 2021, 11(6):601-608
Introduction: The important cause of chronic gingivitis was proved to be dental plaque, which is a well-organized biofilm. However, self-care efforts or mechanical control of dental plaque by toothbrushing was important; these alone will not be enough to prevent gingivitis. Aim: The aim of the present systematic review was to compare the effectiveness of herbal and conventional toothpastes on reduction of dental plaque and gingivitis. Materials and Methods: Data from original scientific papers published in PubMed, Cochrane, Lilacs, and Google Scholar were taken for review up to November 2020. Randomized controlled trials and clinical trials compare the effectiveness of herbal and non-herbal toothpastes on reduction of dental plaque and gingivitis. Articles published in English language only were included. References from the identified publications were manually searched to identify additional relevant articles. Seven publications fulfilled all the inclusion criteria and were finally selected for systematic review. Outcome measurements for gingivitis were gingival index and dental plaque index. Results: As all the studies were randomized controlled trials, level of evidence was II. Among all studies, green tea dentifrice toothpastes showed significant reduction when compared with conventional dentifrice, and ayurvedic toothpaste and Carica papaya leaf extract were also effective. Conclusion: Herbal toothpaste seems to be powerful similar to non-herbal toothpaste; however, it is no longer extra superior to fluoride toothpaste. Further, long-term randomized studies of >6 months are needed to investigate the beneficial effects of intervention alone.
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The effect of speed and rotation for Protaper file systems on post-obturation pain in a single visit and multiple (two) visits in root canal therapy: An in vivo study
Navdeep Jethi, Jyoti Beniwal, Ruby Yadav, Sharanjit Kaur, Vikram J Nain, Charvi Gupta
November-December 2021, 11(6):695-702
Introduction: The basic idea of a root canal treatment is to alleviate the pain and heal the infection within the infected tooth, which can be resolved in a single visit or multiple visits in root canal therapy. Therefore, in this article, an in vivo comparison of single visits and multiple visits using different rotation and speed for two Protaper universal design file systems is done on the basis of time taken and incidence of pain. Materials and Methods: One hundred single-rooted premolars with irreversible symptomatic pulpitis were assigned to two groups of 50 patients each using the odd–even method, GA to be treated endodontically in a single visit and GB to be treated endodontically in multiple visits. Each group was further divided into two subgroups of 25 patients each on the basis of two different variations of speed and rotation for two Protaper file systems of the same design, GA1 (Hand Protapers) and GA2 (Rotary Protapers), GB1 (Hand Protapers) and GB2 (Rotary Protapers), respectively. After proper biomechanical shaping and cleaning, obturation was done with Gutta-percha cones and Ah plus sealer using Fast Pack obturation pen for warm vertical compaction. The pain was measured by a 100mm modified visual analogue scale, and time was measured using a stopwatch. Results: At 6-h intervals, post-obturation pain was more in single-visit root canal therapy than multiple-visit root canal therapy (P < 0.01). Single-visit rotary Protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1) (P < 0.05). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2) (P > 0.05). Preoperative pain significantly influences the post-obturation pain. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 statistical Analysis Software. Conclusions: The presence of preoperative pain can significantly influence the presence of postoperative pain. Most of the pain in both single-visit and multiple-visits root canal therapy occurred in the first 48 h after obturation, which decreases thereafter. Single-visit rotary protaper (GA2) had less incidence of post-obturation pain as compared with single-visit hand protapers (GA1). There was no significant difference in post-obturation pain in the multiple-visit hand protaper subgroup (GB1) and multiple-visit rotary protaper subgroup (GB2). Presence of sealer puff influences the duration of pain.
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Socioeconomic inequalities in oral health-related behaviors in 18-year-old adolescents: A cross-sectional study
Leopoldo Lúcio da Mata, Alvaro Azevedo, Maria de Lurdes Pereira
November-December 2021, 11(6):703-711
Aims: This study aimed to assess the socioeconomic inequalities in oral health-related behaviors, such as frequency of toothbrushing, flossing, and dental appointments, in 18-year-old Portuguese adolescents. Materials and Methods: Data were obtained from the third National Prevalence Study of Oral Health Diseases (III ENPDO), which was carried out in Portugal between 2012 and 2013. This study included 1075 adolescents aged 18 years. The information on socioeconomic status and oral health behaviors was collected using a semi-structured questionnaire. Binary logistic regression models were used to assess the association between social determinants and oral health-related behaviors. Unadjusted and adjusted odds ratios and confidence intervals were estimated. Results: The results found that father’s educational level and both father’s and mother’s employment status were associated with adolescents not visiting a dental professional before the last 12 months. Male sex, living in a rural area, and lower adolescent’s educational level were associated with toothbrushing less than twice a day. Furthermore, father’s educational level and mother’s employment status were also associated with a lower frequency of toothbrushing, whereas only mother’s employment status was associated with a lower frequency of flossing. Conclusion: These findings demonstrated that socioeconomic inequalities in oral health-related behaviors of 18-year-old adolescents were associated with parental employment status and educational level, adolescent’s educational level, sex, and residential zone.
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Applications of teriparatide for alveolar bone regeneration: A systematic review
Rupali Agnihotri, Sumit Gaur
November-December 2021, 11(6):639-643
Aim: The aim of this study was to systematically review the applications of teriparatide (TP) for alveolar bone regeneration in oral cavity. Materials and Methods: An electronic search of the data was conducted in Medline (PubMed), Scopus, Web of Science, and Embase. The original research associated with the applications of TP for alveolar bone regeneration was evaluated. Cochrane’s tool [for human randomized controlled trials (RCTs)] and SYRCLE’s tool (for animal RCTs) were used to assess the risk of bias. About two human and four animal studies had low risk of bias. Results: The results from the 11 studies that were included in the review showed that TP enhanced alveolar bone formation in osteonecrosis of jaws, chronic periodontitis (CP), osseointegration of dental implants as well as orthodontic tooth movement. Conclusion: The TP may be applied for alveolar bone regeneration in osteonecrosis of jaws and CP. However, further human clinical trials are required to verify its applications and adverse effects in various oral bone conditions.
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Sealing ability of various types of root canal sealers at different levels of remaining gutta percha after post space preparation at two time intervals
Wiaam M O Al-Ashou, Rasha M Al-Shamaa, Shaymaa S Hassan
November-December 2021, 11(6):721-728
Objective: This study evaluated the apical sealing ability of various types of sealers (Sure-Seal Root, AH Plus, and GuttaFlow2) at different levels of remaining gutta percha after post space preparation at two time intervals (1 day and 1 week after obturation). Materials and Methods: One hundred and two single canal mandibular premolars were decoronated at the cement–enamel junction and biomechanically prepared. Twelve samples served as negative and positive controls (n = 6). The remaining 90 samples were distributed into three groups (n = 30 each), based on the used sealer for obturation with gutta percha (Sure-Seal Root, AH Plus, GuttaFlow2). Each experimental group was divided into two subgroups (n = 15 each), subgroup I: post space prepared 1 day after obturation and subgroup II: post space prepared 1 week after obturation. For each subgroup, the post space was prepared to a length that remained 3, 4, or 5 mm of gutta percha apically for each of five samples. Then, the dye penetration technique was used to measure the apical microleakage. Data were analyzed using “ANOVA test” and “post hoc Duncan’s test.”Results: Sure-Seal Root sealer demonstrated the best apical seal compared with other tested sealers. Post space preparation 1 day after obturation exhibited less microleakage than the group with 1 week after obturation. Additionally, 5 mm of remaining gutta percha showed superior sealing value than 3 and 4 mm. Conclusion: Bioceramic (Sure-Seal) sealer is the material of choice to be used when post space preparation is required. Post space preparation was preferred to be done 1 day after obturation than 1 week after obturation. Superlative apical seal was obtained with a maximum length of remaining gutta percha.
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Accidental swallowing of dental objects during pediatric dental care in Thailand
Pornpoj Fuangtharnthip, Patr Pujarern, Praewpat Pachimsawat, Phaingruethai Loeksomphot, Prow Janjarussakul, Somchai Manopatanakul
November-December 2021, 11(6):671-677
Aim: Accidental swallowing of dental objects can occur at any time during dental treatment, especially in child patients. Its severity and sequelae can range from minor to life-threatening. The study aimed to find out the occurrence of accidental swallowing and type of swallowed objects regarding pediatric dental treatment in Thailand. Materials and Methods: A nationwide questionnaire survey was performed among Thai dentists to anonymously report child patients’ accidental swallowing throughout their working experience for up to 10 years. Percentage and frequencies of accidental swallowing in child patients, as well as types of dental objects swallowed, were investigated. Association between factors of the respondents and their experiences was assessed by the logistic regression analysis. Results: Among 408 respondents, 99 respondents [24.26%, 95% confidence interval (CI): 20.10–28.42] had experienced accidental swallowing during pediatric dental treatment. All of them reported ingestion with only one respondent reporting aspiration. Extracted teeth, stainless steel crowns, and rubber cups were top on the list of swallowed items experienced by 11.52%, 8.33%, and 3.92% of respondents, respectively. Dental sharps such as endodontic files and orthodontic wires were reported as well. Dentists with higher educational backgrounds, mostly exposed to more complicated cases, were more likely to experience accidental swallowing (odds ratio of 2.90, 95% CI: 1.61–5.21). Conclusion: Our results indicate that accidental swallowing in child patients appeared to occur more frequently than anticipated. Awareness on patient safety of dental professionals and preventive measures against accidental swallowing when dealing with child patients should be greatly emphasized.
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An experimental and clinically controlled study of the prevention of dental caries using 1.23% fluoride gel in elderly patients
Chieu H Ngoc, Dung T Manh, Hung Le
November-December 2021, 11(6):661-670
Aim: To describe the enamel and dentin fluoride mineralization process in practical application and assess the fluoride gel (NaF 1.23%) effectiveness in dental caries prevention for elderly patients. Materials and Methods: Two different types of study were applied: (a) experimental study of fluoride mineralization of enamel and dentin in vitro; (b) clinical controlled interventional studies of the effectiveness in dental caries prevention using 1.23% fluoride gel. Experimental research was performed in laboratory conditions. Teeth of the elderly extracted due to dental diseases served as research objects. Enamel surface and dental root surface were examined under a scanning electron microscope (SEM) before and after demineralization with 37% phosphoric acid within 15 s, as well as after remineralization with toothpaste and 1.23% fluoride gel. Controlled clinical research included 218 older people divided into two groups (intervention group, n = 106; control group, n = 112). In the intervention group, the application of the gel lasts 4 min in the morning for 18 months. The control group received adult P/S toothpaste and a P/S toothbrush. The DIAGNOdent device was used to assess damage both before and after demineralization. For the clinical evaluation of dental caries, international caries detection and assessment system (ICDAS) has been used. Decay missing-filled index (DMFT), effective index (Ef-I), and intervention index (In-I) were determined. Statistical data were analyzed using Mann–Whitney U test and χ2 test. Differences were considered significant at P < 0.05. Results: An SEM image of the enamel surface and dental root surface after teeth remineralization with fluoride gel shows a hard enamel surface without cracks, even in color and structure. After brushing with toothpaste, numerous cracks remain on the surface of the enamel, and the surface layer of the enamel with a depth of 9.64 microns remains damaged without remineralization. After 18 months of intervention, the rate of dental caries in the control group increased from 42.1% to 68.8%, and in the intervention group it increased from 30.8% to 17.0%. A comparison of the 1.23% fluoride gel with toothpaste shows that the former exhibits performance in protecting teeth from decay and it is 108.2% more effective than the latter. Conclusions: Practical experiments proved the function of remineralizing the enamel and dentin of 1.23% fluoride gel on the teeth of the elderly. Intervention research has proven the performance of preventing dental decay from 1.23% fluoride gel for the elderly in question.
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Comparative analysis of change in pH, oral health status, and the count of Streptococcus mutans and Lactobacillus species in the oral cavity in patients with gastroenteral diseases using saliva: A pilot study
Mahima Seetaram, Vaidhegi Muralivel, Sangeeta Umesh Nayak, Suchitra Mala Shenoy, Sudha Kuthethur, Srikant Natarajan, Suresh Shenoy
November-December 2021, 11(6):644-651
Background: Seventy million people are affected by gastroenteral (GI) disturbances throughout the world. Oral cavity possesses various bacteria that remain as healthy commensals or turn pathogenic due to shift of balance with disturbances in health, which is reflected in the oral cavity too. Studies have shown a possible oro-systemic link. This study aimed at assessing the effect of GI disease on oral health comparing levels of pH, microbiological counts, and oral health status between test and control groups. Materials and Methods: This pilot study consisted of two groups: test group containing 14 participants (GI disease) and control group (healthy) containing 3 participants. Two saliva samples were collected per patient. One sample was inoculated onto Mitis Salivarius and Rugose agar plates at 37oC in the CO2 incubator for 2 days. The second sample was used for recording pH. Parameters such as decayed, missing, and filled teeth, plaque index, gingival index, probing pocket depth, and clinical loss of attachment were also recorded. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. Regression analysis was applied to predict the three-microbe culture based on the pH and GI disease. Results: The oral health parameters showed a higher number of missing teeth, higher bleeding on probing, higher values of plaque and gingival index, a higher amount of clinical loss of attachment, and acidic pH of saliva in the test group. Microbiological analysis showed more Streptococcus mutans in the control group (7,500–10,000 cfu/mL), with a mean of 8,833.33±1,258.31 cfu/mL; S. salivarius was more in the test group (2,000–25,000 cfu/mL) with a mean of 15,866.67±6,697.76 cfu/mL. Candida was seen only in the test group (2,166.67±2,549.51 cfu/mL) and absent in the control group. Lactobacillus was absent in both the groups. Conclusion: The present study suggests the relation between oral health and GI diseases. Hence, saliva could be used as an easy, non-invasive biomarker to analyze the gastroenteric status of the patient.

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A comparative evaluation of endodontically treated root canals obturated using gutta-percha with two different protocols: An in-vitro study
Arnaldo Munive-Degregori, Frank Mayta-Tovalino, Cecilia Lúcar-Flores, Roman Mendoza, Daniel Alvitez-Temoche, Carlos Guillen-Galarza
November-December 2021, 11(6):678-684
Objective: The aim of this article is to evaluate the quality of filling in endodontically treated root canals using the lateral condensation technique and modified lateral condensation technique. Materials and Methods: Thirty-two single-rooted teeth were divided into two groups that were assigned by simple randomization according to the filling technique. Once the endodontic treatment was performed, a periapical radiograph was taken to assess the quality according to the radiographic density and tomography was taken to evaluate the quality according to the tomographic volume of spaces, compared with the post-preparation biomechanical tomography. Finally, we performed a statistical analysis (Student’s t-test) to evaluate whether there were differences between the types of filling. Results: Radiographic radiodensity was 182.89 ± 9.81 and 186.72 ± 6.97 HU for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively. The void volume was 3.75 ± 2.35 and 2.43 ± 1.18 mm3 for teeth treated with the lateral condensation technique and modified lateral condensation technique, respectively. Conclusion: No significant differences were found between the techniques for both filling quality parameters.
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Development and validation of oral health literacy questionnaire for Thai adults
Songwit Charophasrat, Songchai Thitasomakul, Sukanya Tianviwat
November-December 2021, 11(6):685-694
Aim: The purpose of the study was to develop a valid and reliable oral health literacy questionnaire for the Thai adults. It measures functional, communicative, and critical competency, covering four competencies according to the context of daily living, namely, oral health service, home and community, marketplace, and community public forums. Materials and Methods: A cross-sectional study was carried out in 420 Thai adults who were the dental clients of an oral health service system. Subjects were recruited into the study by multistage stratified random sampling. Data were collected by interviewing using the newly developed oral health literacy questionnaire. After checking for the completeness and correctness of the data, the validity and reliability of the questionnaire were analyzed by calculation of the sensitivity, specificity, and positive predictive and negative predictive values. Receiving-operating characteristic (ROC) curve was performed and showed the area under ROC that indicates the diagnostic performance of the questionnaire. Results: High reliability was found as Cronbach’s alpha = 0.878 and the validity proved by known-group method, presented as ability to classify subjects as having adequate, or inadequate oral health literacy was also high, given the sensitivity = 0.853, the specificity = 0.848, and the area under ROC curve = 0.858. Conclusion: The newly developed oral health literacy questionnaire for Thai adults was valid and reliable.
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Evaluation of buccal bone wall thickness of anterosuperior teeth and nasopalatine duct morphology in cone beam computed tomography of patients living at different altitudes: A two-year retrospective study
Nancy E Córdova-Limaylla, José C Rosas-Díaz, Rocío Alvarez-Medina, Jerson J Palomino-Zorrilla, Maria E Guerrero-Acevedo, Luis A Cervantes-Ganoza, Carlos López-Gurreonero, César F Cayo-Rojas
November-December 2021, 11(6):652-660
Aim: To evaluate the buccal bone wall thickness of anterosuperior teeth and the dimension and morphology of the nasopalatine duct in cone beam computed tomography (CBCT) of patients treated in two cities at different altitudes. Materials and Methods: In this retrospective analytical study, 79 CBCT scans were selected from a total of 347 in Juliaca, Peru (3824 m a.s.l.) and 171 CBCT scans were selected from a total of 622 in Lima, Peru (154 m a.s.l.). The buccal bone wall thickness of anterosuperior teeth was measured at 1 mm, 3 mm, and 5 mm from the alveolar crest. For the nasopalatine duct, its length and diameter were measured, and its anatomical shape was determined in coronal view. Descriptive statistical data such as mean and standard deviation were used, and Mann–Whitney U test was used for bivariate analysis. Results: When comparing the CBCT scans from both cities, significant differences were observed in buccal bone wall thickness at 3 mm and 5 mm from the alveolar crest (P < 0.01 and P < 0.01, respectively); for men, at 1 mm and 3 mm (P = 0.04 and P = 0.04); for the age group from 33 to 47 years, at 3 mm and 5 mm (P < 0.01 and P < 0.01); and for the age group from 48 to 77 years, at 1 mm (P = 0.02). Regarding the nasopalatine duct, significant differences were observed in women in relation to length and nasal opening diameter (P < 0.01 and P < 0.01) and for men, in length (P < 0.01); for the age group from 18 to 32 years, in all three levels (P < 0.01); for the age group from 33 to 47 years, in length and diameter of the oral opening (P < 0.01 and P < 0.01); and for the age group from 48 to 77 years, in length and diameter of the nasal opening (P < 0.01 and P < 0.01). The most frequent nasopalatine duct shape was a single canal with more than 66% of cases, according to sex and age group. Conclusion: Patients living at different altitudes presented significant differences in buccal bone wall thickness according to sex and age; however, there were no differences related to dental inclination. Significant differences were found in the length and diameter of the nasopalatine duct at the nasal opening. In addition, the most frequent shape of the nasopalatine duct was the simple canal.
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