Harnessing healing inside the body? SG Damle Contemporary Clinical Dentistry 2018 9(4):511-512

Evaluation of treatment outcomes of en masse retraction with temporary skeletal anchorage devices in comparison with two-step retraction with conventional anchorage in patients with dentoalveolar protrusion: A systematic review and meta-analysis Hanin Nizar Khlef, Mohammad Younis Hajeer, Mowaffak A Ajaj, Omar Heshmeh Contemporary Clinical Dentistry 2018 9(4):513-523 Objective: The main objective is to evaluate the effectiveness of en masse retraction with temporary skeletal anchorage devices (TSADs) versus two-step retraction with conventional anchorage (CA) in terms of the skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment. Materials and Methods: An electronic search of PubMed and nine other major databases for prospective, randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was carried out between January 1990 and April 2018. The bibliography in each identified article was checked out. In addition, manual searching was performed in the same time frame in five major orthodontic journals. Adult patients undergoing fixed orthodontic treatment with extraction of maxillary premolars followed by an en masse retraction in the experimental group and two-step retraction of upper anterior teeth in the control group. Methodological index for nonrandomized studies for CCTs and Cochrane's risk of bias tool for RCTs were applied. Results: Four articles (two RCTs and two CCTs) were included in this review and all articles were appropriate for the quantitative synthesis. There was no significant difference between the en masse retraction and two-step retraction groups in terms of SNA, SNB, ANB, and MP-SN angles. Using TSADs gave significantly better results in terms of posterior anchorage and incisors inclination, and greater anterior teeth retraction in comparison with CA (standardized mean difference [SMD] = –3.03 mm, P < 0.001; SMD = 0.74°, P = 0.003; SMD = –0.46 mm, P = 0.03, respectively). En masse/TSAD combination caused a significantly greater increase in nasolabial angle, higher decrease in facial convexity angle, and greater lower lip retraction in comparison with two-step/CA combination (weighted mean difference = 4.73°, P = 0.007; P = 0.0435; SMD = –0.95 mm, P = 0.01, respectively). Conclusion: There is weak-to-moderate evidence that using either en masse/TSAD combination or two-step/CA combination would lead to similar skeletal improvement. There is a very weak-to-moderate evidence that using TSADs with en masse retraction would cause better posterior anchorage and incisors inclination, and greater anterior teeth retraction than using CA with two-step retraction. There is weak-to-moderate evidence that using en masse/TSAD combination would lead to a better improvement in the facial profile. According to the quality of evidence, we confirm the need for more well-conducted RCTs in the en masse retraction field.

Unveiling the link between prostatitis and periodontitis Ramanarayana Boyapati, Chakrapani Swarna, Narasimhaswamy Devulapalli, Sahitya Sanivarapu, Kishore Kumar Katuri, Lakshmikanth Kolaparthy Contemporary Clinical Dentistry 2018 9(4):524-529 Background: One of the important tumor markers having critically important applications in every aspect of treating men with prostatic illness is prostate-specific antigen (PSA), formed by prostate acini's epithelial cells. Where prostate is affected by inflammation or malignancy, the PSA levels rise to/and above 4 ng/ml. This study analyzes the interlink between different severity of periodontitis and prostatitis by assessment of PSA antigen levels and periodontal clinical parameters. Materials and Methods: In this study, 100 chronic prostatitis patients diagnosed to also have periodontal diseases were divided into four batches on the basis of the nature of prostatitis and levels of periodontal clinical attachment. The grouping was as: group 1A – clinical attachment level (CAL) <3 mm and mild prostatitis, Group 2A – CAL ≥3 mm and mild prostatitis, and Group 1B – CAL <3 mm and moderate-to-severe prostatitis, Group 2B – CAL ≥3 mm and moderate-to-severe prostatitis. Readings of CAL, probing pocket depth, bleeding on probing, plaque index, and gingival index (PI and GI) were recorded, followed by calculation and assessment of PSA values and correlation of periodontal parameters, respectively. Results: An important and affirmative correlation (r = 0.5549, P < 0.05) was seen between PSA and CAL scores at significance level of 5%, and also between PSA and probing depths (PD) scores at 5% (r = 0.5315, P < 0.05), indicating that PSA and CAL scores, as also PSA and PD scores are mutually dependent. The similar positive correlation was seen between PSA with PI (r = 0.3231, P < 0.05) and GI (r = 0.3567, P < 0.05) scores, respectively, at 5% level of significance, which shows PSA is also mutually dependent on PI and GI scores. Conclusion: Patients with of grades, moderate-to-severe prostatitis as well as periodontitis were found having higher PSA levels. The clinical readings of periodontal parameters were significantly higher in patients with moderate-to-severe prostatitis which shows a pathological link between the above two.

Bilateral cleft lip repair – advantages of pfeifer's technique Yaratha Sivanagendra Reddy, Rayadurgam Venkata Kishore Kumar, Devireddy Sathya Kumar, Gali Rajasekhar, Vaka Ramesh Babu, Kanubaddy Sridhar Reddy, Kuruganti Prasanna Purna Contemporary Clinical Dentistry 2018 9(4):530-534 Context: Primary repair of bilateral cleft lip depends on the sound knowledge of anatomy, identification of landmarks, clinical variation of presentation, surgical expertise of the operator, etc., Herewith, we present the results of 129 cases performed during our study. Aim: To evaluate the advantages of Pfeifer's technique in bilateral cleft lip repair. Design: This was a retrospective analysis of the results of repair. Patients and Methods: The study was carried out on 129 patients using Pfeifer's technique. Pfeifer described a technique which involves changing the lip skin incision to a wavy line, thus making it less conspicuous, using the concept of “morphological order.” The basis of this technique is, a skin incision between two points can be lengthened if both points are joined in a curved or wavelike manner rather than in a straight line. Results: Lip parameters improved by 70% as viewed in frontal profile in terms of white roll match, vermilion match, and Cupid's bow. Nasal parameters improved by 80% as viewed in basal view in terms of alar symmetry, nasal dome and alar base. Conclusions: We found four advantages by strict adherence to the steps in the technique as given in the available literature. This technique is easy to learn and teach with satisfactory results.

Concentrated bone marrow aspirate-coated hydroxyapatite for reconstruction of small-to-moderate-sized mandibular defects caused by the removal of benign pathologies Raja Sekhar Gali, Ravindran Chinnaswamy, Sathya Kumar Devireddy, Mahaboob Vali Shaik, Rayadurgam Venkata Kishore Kumar, Sridhar Reddy Kanubaddy, Ramesh Babu Vaka, YS Harish, Rama Mohan Pathapati Contemporary Clinical Dentistry 2018 9(4):535-540 Purpose: The aim of this study was to evaluate the bone regeneration potential of concentrated bone marrow aspirate (BMA)-coated hydroxyapatite (HA) for reconstruction of mandibular defects caused by the removal of benign pathologies. Patients and Methods: This prospective clinical study included ten patients with histopathologically proven benign pathologies of the mandible measuring <5 cm anteroposteriorly, who were treated with enucleation or marginal resection, followed by autologous concentrated BMA-coated synthetic biphasic HA (HA and beta-tricalcium phosphate) graft placement. Clinical and radiological evaluations of grafted sites of the mandible were done at 1 week, 1, 3, and 6 months postoperatively using Irwin's radiologic staging and grayscale histogram. Results: All patients (10/10, 100%) had proper incorporation of the graft with the normal adjacent bone. Grayscale histogram revealed the initial stages of graft resorption, followed by formation of new bone-grafted sites. No complications such as infection and total graft loss were encountered except for one patient who had partial wound dehiscence that responded well to local wound care and resuturing. Conclusion: Concentrated BMA-coated synthetic HA effectively promotes bone regeneration in small-to-moderate-sized defects of the mandible.

Do children of working mothers experience more dental caries? RM Baiju, Elbe Peter, Vivek Narayan, Jolly Mary Varughese, NO Varghese Contemporary Clinical Dentistry 2018 9(4):541-547 Background: Pain and discomfort due to untreated dental caries lead to eating and sleep disruptions, behavioral changes, and poor quality of life. Among adolescents, severe dental caries may lead to activity restriction, school absenteeism, and poor academic performance. Dietary factors, parent's socioeconomic status, and family income have been associated with dental caries experience. The employment status of the mother is a measure of socioeconomic status of the family. Aims: This study aims to estimate the prevalence of dental caries and to find out its sociodemographic, oral health behavioral, and clinical determinants among older adolescent (15–18 years) students in Kerala. Settings and Design: This was a cross-sectional study conducted at higher secondary schools. Methods: Oral examination and sociodemographic and oral health behavioral data collection were done among 1065 older adolescent students in the age group 15–18 across five districts of Kerala by a multistage cluster sampling design. Decayed, missing, and filled teeth (DMFT) and Significant Caries (SiC) index were taken. Statistical Analysis Used: SPSS version 16 software was employed. Multiple regression analysis was done to estimate adjusted odds ratios (OR) of predictors of dental caries experience. Results: The overall dental caries experience for the group was 59.8% (95% confidence interval [CI]: 56.9–62.7). About 40% of students had no caries experience, 43% had DMFT score 1–3, and only 16.8% had DMFT score 4 and more. Mean DMFT was 1.67 (95% CI: 1.56–1.79). Diet preference, timing of sugar intake, and sugar form were not significantly associated with caries. Mean SiC index was 3.90 (95% CI, 3.75–4.05). In the unadjusted analysis, age, gender, place of residence, mother's employment status, school type, frequency of sugar intake, oral hygiene status, and timing of last dental visit were significant. In the adjusted analysis, however, age, male gender, government schools, timing of last dental visit, and employed mothers were significant predictors for higher dental caries experience. Conclusions: Mother's employment was the strongest predictor (OR 2.82, 95% CI: 2.15–3.69) for dental caries experience among adolescents when adjusted to other variables in the final multivariate model.

Distribution of dendritic cells and langerhans cells in peri-implant mucosa Jagadish Reddy Gooty, Deepthi Kannam, Vikram Reddy Guntakala, Rajababu Palaparthi Contemporary Clinical Dentistry 2018 9(4):548-553 Background: Peri-implant diseases leading to the failure of dental implants is concern in the field of dentistry. Difference in immune response around peri-implant tissues with healthy tissue might be responsible for the hidden cause of peri-implant diseases. Hence, in the current study, the dispersion of the dendritic cell (DC) subpopulations and Langerhans cells (LCs) was evaluated in healthy peri-implant mucosa (HPIM) and healthy mucosa (HM) to know the imbalance in immune homeostasis. Subjects and Methods: A total of 15 nonsmoker participants were selected for the study. First sample of the HM was obtained before the implant placement (Group I) and second sample of peri-implant mucosa was obtained at the time of placement of the gingival former (Group II). Immunochemistry was used to quantify DCs and LCs in the samples. Statistical Analysis Used: To analyze the distribution of cells in the epithelium and lamina propria, Wilcoxon matched pairs test was used. Results: Mean numbers of CD1a (LCs) in the epithelium and lamina propria of Group I and Group II were 25.2 ± 6.41 and 27.47 ± 10.26 and 19.27 ± 7.27 and 12.46 ± 3.04, respectively. Mean numbers of factor XIIIa (DCs) in the epithelium and lamina propria in Group I and Group II were 30.37 ± 5.42 and 86.93 ± 13.99 and 50.47 ± 7.27 and 124.33 ± 10.27, respectively. Statistically significant differences in the number of cells in the epithelium and lamina propria of Group I and Group II were noted (P = 0.001 and P = 0.001). Conclusions: CD1a-positive LCs were more in the epithelium rather than lamina propria in Group II. Higher numbers of factor XIIIa-positive DCs were observed in the lamina propria than epithelium in Group I and II.

Influence of toothpaste pH on its capacity to prevent enamel demineralization Lidia Gavic, Kristina Gorseta, Ali Borzabadi-Farahani, Antonija Tadin, Domagoj Glavina Contemporary Clinical Dentistry 2018 9(4):554-559 Aim: This study evaluated in vitro the remineralization capacity of commercial toothpastes with different fluoride (F) concentrations and their effectiveness when they are acidified. Materials and Methods: One hundred and twelve caries-free teeth were used to prepare enamel specimens, and the specimens were divided into 16 groups (n = 7). Baseline surface Vickers microhardness was measured for all the specimens and all the tested groups were subjected to the pH-cycling regime involved five demineralization challenges each day for 10 days, and surface Vickers microhardness was then measured. Once daily, specimens were exposed for 30 min after last demineralization challenge of the day to the slurry of each toothpaste containing 1450 ppm F, 1000 ppm F, 450 ppm F, and 0 ppm F. The slurry was in original pH or acidulated on 6.5, 6.0, or 5.5 pH. The difference among tested group was assessed by analysis of variance and Newman–Keuls test (P < 0.05). Results: The highest increase in microhardness was detected after treatment with toothpaste containing 1450 ppm fluoride (percentage of increase in microhardness was 6.20%), and the biggest loss was detected after treatment with toothpaste containing no fluoride (percentage of decrease was 6.82%), but there was no significant difference between tested groups. Conclusions: The highest increase in microhardness was detected after treatment with toothpaste containing more fluorides (1450 ppm F) regardless of the acidity.

Comparing the effectiveness of probiotic, green tea, and chlorhexidine- and fluoride-containing dentifrices on oral microbial flora: A double-blind, randomized clinical trial Jayashri Prabakar, Joseph John, I Meignana Arumugham, R Pradeep Kumar, D Sri Sakthi Contemporary Clinical Dentistry 2018 9(4):560-569 Introduction: Oral cavity harbors wide variety of microorganisms; these are considered crucial for the dental caries initiation and progression. Plaque-induced caries is a local disease; therefore, dentifrices are the most ideal vehicle for the daily delivery of antibacterial agents. In recent years, alternatives to fluorides such as green tea, probiotic, and chlorhexidine (CHX) toothpastes have been proposed to possess antiplaque and anticariogenic properties. Aim: To compare the effectiveness of probiotic, green tea, and CHX- and fluoride-containing dentifrices on oral microbial flora. Materials and Methods: A double-blinded, parallel group, randomized controlled clinical trial was conducted among healthy adults. Fifty-two individuals were randomly allocated to four groups (n = 13): Group I – green tea dentifrice, Group II – fluoridated dentifrice, Group III – CHX dentifrice, and Group IV – probiotic dentifrice. Plaque and saliva samples were evaluated for Streptococcus mutans and Lactobacillus at baseline and 15th and 30th days of follow-up. Paired t-test and one-way ANOVA were used to compare the mean differences of plaque and salivary S. mutans counts at two and three time periods. Wilcoxon signed-rank and Kruskal–Wallis tests were used to compare the mean Lactobacillus count in plaque and saliva samples at two and three time periods, respectively. Results: The mean S. mutans and Lactobacillus counts in plaque and saliva samples were significantly reduced by all the treatment groups at the 30th day of follow-up. However, Group III showed the highest reduction and was found to be statistically significant (P < 0.05). Conclusion: All the four groups exhibited antimicrobial activity by bringing about a significant reduction in the mean S. mutans and Lactobacillus colony counts at the 30th day of follow-up. Among all the preventive modalities, Group III (CHX dentifrice) showed better results compared to other groups.

Erbium-doped, yttrium-aluminum-garnet laser debonding of porcelain laminate veneers: An ex vivo study Yong Zhang, Jean-Paul Rocca, Carlo Fornaini, Yinghua Zhen, Zengyi Zhao, Elisabetta Merigo Contemporary Clinical Dentistry 2018 9(4):570-573 Background: The use of ceramic laminate veneer has considerably and successfully grown to improve anterior tooth esthetics in recent years. The removal of ceramic laminate veneers with laser is reported only in a scanty number of publications and for this reason the importance and the aim of this ex vivo study consist to verify the ability of Er: YAG laser for laminate veneers debonding with the preserving of the tooth structures (scanning electron microscopy [SEM] observations). Aim: The purpose of this study consists to verify if erbium-doped, yttrium-aluminum-garnet (Er:YAG) laser, at low fluences, is able to debond porcelain veneers, successfully used to improve anterior tooth esthetics, without damaging the tooth structures. Settings and Design: A total of 12 freshly extracted teeth were used, and samples were decontaminated, stored, and bonded to obtain veneers adhesion. One week after, Er:YAG laser with a non-contact sapphire tip with air-water spray was used for veneer debonding at 100 mJ of energy and 30 Hz of frequency (Fluence 19.94 J/cm2). Results: Results demonstrated that veneer debonding is possible with an Er:YAG laser and the total number of pulses seems not related to its efficiency. SEM observation confirms that residual tooth structure is not altered when using these low fluences. Conclusions: Low fluences with Er:YAG laser are able to debond veneers while preserving the tooth structures and SEM observation confirmed that residual tooth structure is not altered with low fluences.