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   Table of Contents - Current issue
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October-December 2021
Volume 21 | Issue 4
Page Nos. 317-433

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EDITORIAL  

Mucormycosis and prosthodontic management p. 317
N Gopi Chander
DOI:10.4103/jips.jips_436_21  PMID:34810358
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REVIEWS Top

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system p. 319
Priyanka Vaibhav Sutariya, Hitendra Mohanlal Shah, Surbhi Dipakbhai Patel, Hemil Hitesh Upadhyay, Mansoorkhan Rafikahmed Pathan, Rutu Paresh Shah
DOI:10.4103/jips.jips_158_21  PMID:34810359
Aim: This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system. Settings and Design: This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines. Materials and Methods: A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies. Statistical Analysis Used: The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020. Results: Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10). Conclusion: It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.
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Comparative evaluation of crestal bone level by flapless and flap techniques for implant placement: Systematic review and meta-analysis p. 328
Krishankumar Lahoti, Sayali Dandekar, Jaykumar Gade, Megha Agrawal
DOI:10.4103/jips.jips_208_21  PMID:34810360
Aim: To compare the crestal bone level of flapless technique of dental implant placement with the flap technique. Setting and Design: This Systematic review and Meta-analysis was conducted according to the Preferred Reporting Items For Systematic Review and Meta-Analyses (PRISMA) Guidelines and registered with PROSPERO. Materials and Methods: Electronic search of Medline and Google scholar databases for articles from 2010 till March 2020 was performed. Studies comparing the crestal bone level with both the techniques were included. After the collection of data, the risk of bias was assessed for each study. Statistical Analysis Used: Meta-analysis was executed using RevMan 5 software version 5.3. Results: 23 studies were included. Statistically significant difference in crestal bone level was found between flapless and flap surgery with mean difference of −0.14 (flapless placement versus flap surgery; 95% CI: −0.24 to −0.03; P = 0.01*). The difference in crestal bone level between the 2 groups was not statistically significant with a mean difference of –0.05(Guided flapless placement versus flap surgery; 95% CI: −0.10 to 0.00; P=0.06). Meta-analysis of the freehand flapless surgery with flap surgery generated a mean difference of −0.20 which was found to be statistically significant (Freehand flapless placement versus flap surgery; 95% CI: −0.37 to −0.03; P=0.02*). Conclusions: Flapless placement of implant can positively influence crestal bone loss in comparison with conventional flap technique.
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Use of silicone finger prostheses in amputee patients: An integrative review p. 339
François Isnaldo Dias Caldeira, Victor Alves Nascimento, Kellen Cristina da Silva Gasque, Marcela Filié Haddad
DOI:10.4103/jips.jips_175_21  PMID:34810361
This study aimed to perform an integrative review of the literature on the use of silicone finger prostheses in amputee patients. Searches were performed in the PubMed, EMBASE, Web of Science, Scielo, and Cochrane Library databases until July 2021. Descriptors used in this article were: Silicone, finger, rehabilitation, and prosthesis. Clinical research and clinical reports on silicone finger prostheses, available in full and in English were included. Initially, 152 articles were identified. After establishing the inclusion/exclusion criteria, 23 studies were identified and constituted the final sample. Regarding the publication date of the included studies, 17.2% of them were published between 2012 and 2016. Most of the rehabilitations occurred in India (69.9%; n = 16), and the mean age of patients who used prostheses was 38.1 years. The level of scientific evidence of the included studies was IV and VI. Therefore, patients rehabilitated with silicone finger prostheses highlighted significant improvements in functional range of motion, restoration of self-esteem, advantages in psychological therapy, more pleasant social interaction, and changes in their quality of life.
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ORIGINAL ARTICLE Top

Biological and esthetic outcome of immediate dental implant with the adjunct pretreatment of immediate implants with platelet-rich plasma or photofunctionalization: A randomized controlled trial p. 348
Shahid Ahmad Shah, Balendra Pratap Singh, Jitendra Rao, Lakshya Kumar, Mayank Singh, Punit Kumar Singh
DOI:10.4103/jips.jips_217_21  PMID:34810362
Aim: The purpose of the study was to assess biological and esthetic outcomes of immediate dental implant in esthetic zone with the adjunct pretreatment of immediate implants with photofunctionalization or platelet-rich plasma in comparison to standard tapered root form implant without pretreatment. Settings and Design: Patients visiting department of Prosthodontics of a tertiary care health Institution. Design of the study was randomized controlled trial. Materials and Methods: Ninety subjects who required replacement of maxillary anterior teeth immediately after extraction were selected and randomly divided into three groups: control group and two case groups. Two case groups were treated with immediate implants with pretreatment with Photofunctionalization (PF group) or platelet-rich plasma (PRP group). Delayed loading protocol was followed with prosthesis given after 6 months. Follow-up was performed at 2nd and 4th weeks and 2, 4, 6, and 12 months (P < 0.05). Biological outcomes (mean marginal bone loss, implant stability), esthetic outcome (pink esthetic score and white esthetic score), and success and survival rate were evaluated. Statistical Analysis Used: Outcomes were compared using one-way ANOVA, while intragroup changes with baseline and follow up were assesed using repeated-measures ANOVA. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (SPSS Inc., Chicago, IL, USA). The level of significance was set at <.05. Results: Mean marginal bone loss was not significantly different in PF group and PRP group than the control group. PF group and PRP group showed significantly greater implant stability as compared to the control group. Pink and white esthetic scores were not significantly different among groups. Conclusion: Pretreatment of commercial dental implants with PF or PRP exhibited a statistically significant difference in implant stability but not with other outcomes.
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ORIGINAL ARTICLES Top

Comparative evaluation of occlusal splint therapy and muscle energy technique in the management of temporomandibular disorders: A randomized controlled clinical trial p. 356
Hardik K Ram, Darshana N Shah
DOI:10.4103/jips.jips_332_21  PMID:34810363
Background: Contradicting evidence regarding the effects of occlusal splint therapy in the management of Temporomandibular disorder (TMD) and promising results shown by muscle energy technique. Aim: To determine and compare the effects of occlusal splint therapy, muscle energy technique, and combined treatment with education for self-management and counseling in the management of TMD. Study Design and Settings: Randomized clinical trial. Methodology: A total of 160 participants diagnosed with TMD according to Diagnostic Criteria/TMD axis I were randomly allocated into four treatment groups with equal allocation ratio using random numbers table. The main inclusion criteria were the presence of pain in the preauricular area, TMJ and/or muscles of mastication and maximum mouth opening <40 mm. Group A participants received muscle energy technique, Group B participants received occlusal splint therapy, Group C participants received combined treatment, and Group D participants received education for self-management and counseling (control). Control group treatment was provided to all the trial participants. Statistical Analysis: Intragroup comparison was made using Friedman test and Wilcoxon test while intergroup comparison was done using Kruskal–Wallis test and Mann–Whitney U test. Results: Intensity of pain on a visual analog scale and maximum mouth opening were measured at baseline, at 1 week, at 2 weeks, at 1 month, and after 3 months. Conclusion: Muscle energy technique, occlusal splint therapy and combined treatment significantly reduce pain compared to controls and muscle energy and combined treatment are superior to other groups for mouth opening improvements in patients with TMD.
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Comparison of quality of bone and insertion torque values of early implants placed at 6 and 8 weeks in sockets preserved with advanced platelet-rich fibrin: A randomized controlled trial p. 366
Nukalamarri Om Brahma Prasad Chary, M Satyanarayana Raju, MC Suresh Sajjan, Sruthima NVS Gottumukkala, Ravikanth Manyam
DOI:10.4103/jips.jips_331_21  PMID:34810364
Aim: Successful functional and esthetic rehabilitation of edentulous jaws with implants depends on the optimal timing of placement, surgical protocol, materials used, cost-effectiveness, and satisfying patient needs. Increasing demand for shorter treatment times necessitates the immediate placement protocol. However, researchers have demonstrateda higher failure rate. A-PRF (Advanced platelet-rich fibrin) has exhibited accelerated bone regeneration potential. Early implant placement with a limited healing period, along with A-PRF, can be beneficial over conventional and immediate implant placement. Settings and Design: This prospective randomized clinical trial aims to assess the outcome of early implant placement in sockets preserved using A-PRF at six weeks and eight weeks of post-extraction. Two groups of 10 participantseach were formed. All patients underwent atraumatic extraction and socket preservation using A-PRF. Materials and Methods: A Partial-thickness pedicle graft was raised, and the extraction socket wasclosed. Implants wereplaced in at six and eight weeks of post-extraction in group A group B, respectively. The histomorphometric analysisassessedthe bone quality present at the timeof surgery. The insertion torque values were recorded during implant placement. Statistical Analysis Used: The obtained data were statistically analyzed using parametric tests, namely independent T-test for intergroup comparison. Results: T-test for torque values indicated a significantly higher torque value at eight weeks. The meanhistomorphometric value showeda significantly higher percentage of bone formation at eight weeks than at six weeks (P = 0.03). Conclusion: Within the study's limitations, early implant placement in extraction sockets preserved with A-PRF had significantly higher insertion torque values and predictable bone at eight weeks compared to six weeks.
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Oral health-related quality of life of patients using single or two-implant mandibular overdentures with immediate loading protocols: A randomized controlled trial p. 375
Pravinkumar G Patil, Liang Lin Seow
DOI:10.4103/jips.jips_328_21  PMID:34810365
Aim: Single implant-retained mandibular overdentures (1IMO) is a viable alternative to 2 implant-retained overdentures (2IMO) in edentulous patients. However, literature lacks in the quality of life (QoL) of these patients when treated with immediate loading protocols. The purpose of this study was to compare oral health-related QoL (OHRQoL) of patients using 1IMO or 2 IMO with immediate loading protocols at 1 month and 1 year. Settings and Design: Randomized Controlled Trial. Materials and Methods: Fifty-two edentulous participants treated with mandibular overdentures using either single implant (n = 26) or two implants (n = 26) with immediate loading protocol by a single operator. The low-profile stud-attachments (LOCATOR; Zest Anchors) were attached to the implants and female attachments were picked up within 0–7 days of implant placement. The OHRQoL was recorded using Oral Health Impact Profile-14 (OHIP-14) questionnaire either in English or in the Malay language before treatment and 1 month and 1 year after treatment. Statistical Analysis Used: Kruskal Wallis test was used to find out significant difference amongst 3 timepoints and 7 OHIP-14 domains and Mann-Whitney-U test to compare 1IMO or 2IMO groups. Results: Compared to baseline OHIP-14 scores, participants had a statistically significant decrease in total OHIP-14 at 1 month and 1 year after-treatment time points in both 1IMO and 2IMO groups (P < 0.05). The difference between 1 month and 1 year after-treatment total and subscale scores were also found to be statistically significant (P < 0.05). The overall QoL improvement was comparatively higher in 2IMO group than 1IMO group. The OHIP-14 scores were statistically different within seven domains (P < 0.05). Overall total scores between 1IMO and 2IMO groups were also found to be statistically significant (P < 0.05) at baseline and insignificant (P > 0.05) at 1 month and 1 year. Conclusions: Mandibular single and 2IMO improve the QoL of elderly edentulous Malaysian participants at 1 month of immediate loading and 1 year of recall. 1IMO may provide comparable QoL with the elderly patients using 2 implants.
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Evaluation of two computer-aided design software on the adaptation of digitally constructed maxillary complete denture p. 383
Eman G Abd El Galil, Shaimaa L Mohamed, Fardos N Rizk, Marwa E Sabet
DOI:10.4103/jips.jips_137_21  PMID:34810366
Aims: This study was conducted to evaluate the adaptation of maxillary complete denture designed by two different open computer-aided design software programs (3Shape and Exocad) using Geomagic surface matching software. Settings and Design: This was a nonrandomized crossover clinical trial. Materials and Methods: Twenty completely edentulous patients were selected in this study. Forty complete dentures were designed using two different software programs: twenty dentures were designed by 3Shape software and the other twenty dentures were designed by Exocad software. Maxillary dentures were evaluated regarding their adaptation by measuring the deviations that occurred between the fitting surface of the three-dimensional printed dentures, and the scanned master casts using Geomagic surface matching software. Statistical Analysis Used: An unpaired t-test was used for statistical analysis. Results: According to the positive average deviation value that represented pressure areas, 3Shape-designed maxillary dentures showed significantly lower mean deviation values (0.041115 ± 0.018165 mm) than Exocad-designed maxillary dentures (0.500665 ± 0.032619 mm). Regarding the negative average deviation values that represented the gap areas, Exocad-designed maxillary dentures showed significantly lower mean deviation values (0.161555 ± 0.007842 mm) than 3Shape-designed maxillary dentures (0.231350 ± 0.009146 mm). The results of the total average deviation values showed significantly lower mean deviation values (0.096950 ± 0.008868 mm) of 3Shape-designed maxillary dentures than Exocad-designed maxillary dentures (0.250755 ± 0.021154 mm). Conclusion: 3Shape and Exocad software programs produced acceptable maxillary dentures regarding denture adaptation. However, maxillary dentures designed by 3 Shape software showed better adaptation than maxillary dentures designed by Exocad software.
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A proportional appraisal of smile perception by laypersons, dental professionals, and a smile designing software: An in vivo study p. 391
Trushakumari Bhavanbhai Patel, Somilkumar Mathur, Snehal R Upadhyay, Takshil Devendra Shah
DOI:10.4103/jips.jips_152_21  PMID:34810367
Aim: To equivalence the perception of smile among laypersons, dental professionals and a commercially available popular smile designing software. Settings and Design: In vivo – comparative study. Materials and Methods: A total of 72 participants within age range of 18-30 years were randomly selected with a natural permanent dentition. All the subjects underwent extra oral and intra oral photographic evaluation as per the American Academy of Cosmetic Dentistry (AACD) guidelines. A total of 11 evaluators were selected for the study and were divided into four groups. The evaluation procedure comprised of assessment of patients' natural smile by laypersons, dental professionals and a smile designing software. A questionnaire was prepared for recording the responses which included a five-point Likert scale. Statistical Analysis Used: Data was statistically analysed using SPSS version 23. Frequencies and chi square test were done for intergroup comparison. Results: There was a statistically significant difference present in comparison across P < 0.05 all the groups. Conclusions: There was significant difference in the perception of smile among evaluators and a smile designing software. Smile designing software prefers to modify the smile as per in built criteria and is more inclined towards creating an ideal smile.
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Comparative evaluation of condylar guidance obtained by three different interocclusal recording materials in a semi-adjustable articulator and digital panoramic radiographic images in dentate patients: An in vivo study p. 397
SR Keerthana, HS Mohammed, A Hariprasad, M Anand, Syeda Ayesha
DOI:10.4103/jips.jips_239_21  PMID:34810368
Aim: The Aim of the study was to evaluate the reproducibility of condylar inclination values obtained using three different interocclusal recording materials in Hanau Wide-Vue semi-adjustable articulator and to compare those values of condylar inclination with panoramic radiographic images. Settings and Design: In Vivo Comparative study. Materials and Methods: The clinical trial was carried out in the Department of Prosthodontics, M. R Ambedkar Dental College and Hospital, Bengaluru. A total of 30 dentulous subjects aged between 20 and 40 years were selected, without any signs and symptoms of temporomandibular joint disorders. With the help of a custom-made protrusive guide, protrusive records for three materials were made. These records were used for programming the articulator and the respective horizontal condylar inclination (HCI) value, and panoramic radiographs were made. The values obtained were statistically analyzed. Statistical Analysis Used: Independent t-test, multiple comparisons using Bonferroni method followed by Analysis of variances (ANOVA) were used. Results: Among each pair of groups there exists a significant difference, i.e., the mean condylar inclination (degree) was found to be statistically significant between wax and polyvinyl siloxane (P < 0.01) as well as between wax and polyether (P < 0.01). No significant difference was observed between polyvinyl siloxane and polyether (P > 0.05). Conclusion: HCI values differed depending on the type of material employed. The study concluded that the protrusive condylar guidance angles obtained by panoramic radiograph can be used in programming the semi-adjustable articulator and among the materials polyether gave the highest Condylar Guidance values with less variability and wax gave lowest values with greater variation.
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Machine learning for identification of dental implant systems based on shape – A descriptive study p. 405
Veena Basappa Benakatti, Ramesh P Nayakar, Mallikarjun Anandhalli
DOI:10.4103/jips.jips_324_21  PMID:34810369
Aim: To evaluate the efficacy of machine learning in identification of dental implant systems from panoramic radiographs based on the shape. Settings and Design: In vitro–Descriptive study Materials and Methods: A Dataset of digital panoramic radiographs of three dental implant systems were obtained. The images were divided into two datasets: one for training and another for testing of the machine learning models. Machine learning algorithms namely, support vector machine, logistic regression, K Nearest neighbor and X boost classifiers were trained to classify implant systems from radiographs, based on the shape using Hu and Eigen values. Performance of algorithms was evaluated by its classification accuracy using the test dataset. Statistical Analysis Used: Accuracy and recover operating characteristic (ROC) curve were calculated to analyze the performance of the model. Results: The classifiers tested in the study were able to identify the implant systems with an average accuracy of 0.67. Of the classifiers trained, logistic regression showed best overall performance followed by SVM, KNN and X boost classifiers. Conclusions: Machine learning models tested in the study are proficient enough to identify dental implant systems; hence we are proposing machine learning as a method for implant identification and can be generalized with a larger dataset and more cross sectional studies.
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Assessment of different surface treatments and shear bond characteristics of poly-ether-ether-ketone: An in vitro SEM analysis p. 412
Umair Parkar, Ramandeep Dugal, Pallavi Madanshetty, Trupti Devadiga, Abid Sharifullah Khan, Aamir Godil
DOI:10.4103/jips.jips_199_21  PMID:34810370
Aim: The aim of this study is to assess the surface roughness and shear bond characteristics of pol-ether-ether-ketone after different surface treatments. Setting and Design: An in vitro, prospective. Materials and Methods: One hundred and twenty disc-shaped samples of 10 mm diameter and 2 mm thickness were milled and subjected to following surface treatments: 110 μm alumina particles, 98% concentrated sulfuric acid, and 10–20 μm synthetic diamond particles. Surface characteristics of treated sample were studied under SEM with ×500 and ×1000 magnification. Shear bond strength (SBS) with composite resin discs embedded in acrylic blocks after luting with self-etch resin cement and resin-modified glass ionomer cement (RMGIC) was evaluated using the universal testing machine (Instron®, Massachusetts U. S. A). Statistical Analysis Used: The data collected were evaluated using the Analysis of variance and Tukey's honest significant difference post hoc test. Results: Highest SBS and SR were noted with self-etch resin cement in the given order: 98% sulfuric acid (2.106 ± 0.186 μm), followed by alumina particles (1.706 ± 0.160 μm) and synthetic diamond particles (1.101 ± 0.167 μm). Conclusion: The SBS of self-etch resin cement was higher compared to RMGIC for all three surface treatments done on test samples. Hundred percent samples treated by all three surface treatment methods showed mixed type of failure.
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The effect of dynamic loading on bacterial microleakage of the dental implant fixture-abutment interface: An in vitro study p. 420
Mehrak Amjadi, Azadeh Khajavi, Navid Youssefi, Negar Barjini, Zahra Kazemi
DOI:10.4103/jips.jips_96_21  PMID:34810371
Aim: Bacterial micro leakage at implant-abutment interface under functional loading is an important factor, may lead to crestal bone loss and affect the long term success of dental implants. Due to the limited studies about the implant systems with a connection of Slip joint design, this study aimed to evaluate the effect of dynamic loading on bacterial leakage at the implant-abutment interface with slip joint connection. Settings and Design: In vitro- comparative study. Materials and Methods: A total of 20 implants and abutments with slip joint connections (Tapered Screw-Vent, 3.7 mm ×10 mm, Zimmer Dental, USA) was examined and depends on using functional loading were divided into two groups; loaded and unloaded. Initially, 10 μl of Brain Heart Infusion (BHI) culture broth was pipetted to the internal lumen of each implant, then the abutments were tightened to the fixtures and crowns were cemented. In the unloaded group, samples were immersed in E-Coli suspension for 5 days. In the loaded group, samples were immersed in microbial suspension under 500000 cycles using a cyclic load device. Following disconnection of fixtures and abutments, microbial samples were taken from the internal lumen of implants and colonies were counted. Data were analyzed using. Statistical Analysis Used: Mann-Whitney statistical test, SPSS version 24. Results: The mean rate of micro leakage in unloaded and loaded groups was 4000 CFU/ml and 27000 ± 31640 CFU/ml respectively. Bacterial colonies grew in 10% of unloaded samples and 50% of loaded samples. This difference was statistically significant. (P < 0.05) Conclusions: Microbial micro leakage at the implant-abutment interface with slip joint design increased significantly after functional loading.
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Development of fibre-reinforced composite disk for computer-aided design-computer-aided manufacturing milled posts; Experimental composite disk using e-glass fibre in different fibre direction p. 425
Warin Prachasujit, Somchai Urapepon
DOI:10.4103/jips.jips_135_21  PMID:34810372
Aims: To evaluate the flexural properties of computer-aided design-computer-aided manufacturing (CAD-CAM) milled posts fabricated from the experimental fibre-reinforced composite disks in different fibre direction, and to compare the flexural properties of the CAD-CAM milled posts to those of commercial prefabricated posts, RelyX and FRC PostecPlus. Settings and Design: In vitro comparative study. Materials and Methods: E-glass fibre was used to fabricate the CAD-CAM composite disks. The fibres were prepared in unidirectional and multidirectional arrangements into the epoxy resin, at 70% by weight. The disk was milled by the Cerec InLab CAD-CAM system to fabricate a post. Ten posts for each type of disk were prepared. Two types of commercial fibre posts, RelyX fibre post, and FRC PostecPlus were used as control. The three-point bending test was performed. Statistical Analysis Used: The data were analysed using one-way ANOVA and Game-Howell post-hoc test. Results: The results indicated that both commercial fibre posts had the highest flexural strength and flexural modulus. The unidirectional experimental post yielded significantly lower values in both flexural strengths (739.1 ± 24.1 MPa) and flexural modulus (21.0 ± 3.5 GPa) compared to the control posts, while the multidirectional experimental posts had extremely low flexural strength and flexural modulus. Conclusions: The direction of the fibres significantly influenced the mechanical properties of the posts. The experimental unidirectional fibre-reinforced composite disk showed the potential to be used as a CAD-CAM disk for post and core fabrication.
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CASE REPORT Top

Bilateral intraoral traumatic neuroma: Case report of a diagnostic challenge p. 430
Davis C Thomas, Rangarajan Vedantham, Nishanthini Annamalai, Priyanka Kodaganallur Pitchumani
DOI:10.4103/jips.jips_354_21  PMID:34810373
Oral traumatic neuromas (TrNs) are relatively rare lesions and they originate from a damaged nerve. They present a diagnostic challenge, due to the complex clinical features that may mimic odontogenic, musculoskeletal, and other neuropathic pain conditions. We describe an interesting and challenging case of painful bilateral intraoral lesions in a 56-year-old South Indian female patient who presented with clinical features consistent with TrN lesions bilaterally, in relation to different branches of the trigeminal nerve. The patient had undergone numerous aggressive dental treatments and interventions over the past three decades, with little or no pain relief. Topical treatment with lidocaine gel utilizing a custom-made neurosensory stent rendered the patient significant and sustained pain relief.
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