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   Table of Contents - Current issue
January-March 2022
Volume 22 | Issue 1
Page Nos. 1-103

Online since Thursday, January 27, 2022

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Editorial p. 1
V Anand Kumar
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The soft tissue esthetic outcome with and without immediate provisionalization in immediate implants: A systematic review and meta-analysis p. 2
Priyanka Vaibhav Sutariya, Shruti Parthiv Mehta, Hemil Hitesh Upadhyay, Mansoorkhan Rafikahmed Pathan, Surbhi Ravi Patel, Yashpreetsingh Amarjitsingh Bhatia
Aim: This systematic review and meta-analysis aimed at checking influences of immediate provisionalization on the primary esthetic outcome by Pink Esthetic Score (PES) as well as other secondary soft tissue outcomes such as bleeding on probing, probing depth, plaque index, mesial papillary recession, distal papillary recession, and midfacial mucosal recession of the peri-implant mucosa around immediately placed implants in the anterior maxilla. Setting and Design: This systematic review and meta-analysis was evaluated using the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Materials and Methods: The relevant studies were found in the databases such as MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, Science Direct, and Google Scholar. The search was restricted to studies published in English only, with no time constraints. A second hand search was conducted on individual journals and study reference lists. The Evidence Project risk-of-bias tool was used to assess the risk of bias in included studies. The level of evidence was determined using the GRADEpro GDT: GRADEpro Guideline Development Tool (software). McMaster University, 2020 (developed by Evidence Prime, Inc.,) Statistical Analysis Used: The statistical meta-analysis was conducted by using Review Manager (RevMan) (Computer Program). Version 5.4. Copenhagen: The Nordic Cochrane Centre, the Cochrane Collaboration, 2020. Results: Nine studies were finalized. Seven studies were selected out of nine in the meta-analysis for PES. The results of the current meta-analysis for primary outcome observed that immediate implant placement (IIP) followed by immediate provisionalization improves the esthetic outcome, with forest plot favoring immediate provisionalization and demonstrating a statistically significant difference (mean difference [MD] =1.54, [95% confidence interval (CI): 0.82–2.27], P < 0.0001). Statistically insignificant result was observed for secondary outcomes; bleeding on probing (MD = 4.00, [95% CI: −1.15–9.15], P = 0.13), probing depth (MD = 0.17, [95% CI: −0.13–0.48], P = 0.26), plaque index (MD = −1.00, [95% CI: −7.56–5.56], P = 0.77), mesial papillary recession (MD = −0.10, [95% CI: −0.31–0.10], P = 0.33), midfacial mucosal recession (MD = −0.47, [95% CI: −1.01–0.07], P = 0.09). However, for distal papillary recession (MD = −0.32, [95% CI: −0.50–−0.13], P = 0.0007), the result was statistically significant with forest plot favoring immediate provisionalization. Conclusion: When the implant is placed in the esthetic zone, IIP with immediate provisionalization provides the best gingival (pink) esthetics.
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Current scenario on adhesion to zirconia; surface pretreatments and resin cements: A systematic review p. 13
Nirmalya Chatterjee, Amrita Ghosh
Several methods have been proposed to increase bonding of zirconia with resin. However, we are still to find the Holy Grail. A systematic literature review was performed through PubMed on international literature from January 2000 to May 2021 with relevant Medical Subject Headings terms. 56 articles were found to be relevant. Of all the different methods proposed, mechanochemical pretreatment of zirconia surface with alumina oxide and use of 10-methacryloyloxydecyl dihydrogen phosphate were found to be most effective as per majority of studies. New methods that require further research also surfaced.
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A comparative clinical trial for evaluating the posterior palatal seal developed from the conventional method and a novel functional swallow method p. 21
Sweekriti Mishra, Ravishankar Krishna, Rashmi Badakka Mandokar, Shobhit Agarwal, Anoop Sharma, Misty Shaw
Aims: The aim of this in vivo study was to compare the influence of posterior palatal seal (PPS) developed from the conventional method and a novel functional swallow method on the retention of custom tray and heat cure denture base. Settings and Design: This was a nonrandomized crossover clinical trial. Materials and Methods: Twenty patients requiring maxillary complete dentures were selected. In Group 1, for all twenty patients, the PPS was developed with the conventional functional method during border molding and a conventional cast scoring was performed before processing the denture base. In Group 2, for all the twenty patients, the PPS was developed with a novel functional swallow method and the master cast was “not” scored before processing the denture base. The retention was objectively measured using a dynamometer after border molding and also after processing the denture base for both groups. Statistical Analysis Used: Independent Student's t-test and paired t-test were used for analysis. Results: The mean retention value of Group 2 was significantly higher (P < 0.001) than Group 1 at border molding and after denture base processing. Within Group 1, the retention value significantly increased (P < 0.001) from border molding to the denture base stage, whereas within Group 2, there was no significant change (P > 0.001) between the stages. Conclusions: Within the limitations of the study, the novel functional swallow method of establishing the PPS demonstrated higher retention than the conventional method both during border molding and after processing the denture base.
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Evaluation of clinical and radiographic outcome of friction fit conical abutment system in implant-supported dental prostheses: An in vivo study p. 29
Vineet Sharma, Jyoti Paliwal, Sumit Bhansali, Kamal Kumar Meena, Neha Gupta, Ashish Dadarwal
Aim: The purpose of this clinical study was to analyze the clinical feasibility of friction fit conical abutment system in implant-supported fixed dental prostheses as an alternative to cement and screw retention. Settings and Design: This was an in vivo longitudinal study. Materials and Methods: A total of 10 prostheses were designed as 3- or 4-unit fixed dental prostheses supported by two implants. All the subjects selected were evaluated for pocket probing depth (PPD) and marginal bone loss at the time of implant placement (T1), at the time of placement of friction fit prostheses (T2), and 12 months after placement of friction fit prostheses (T3). Marginal bone loss at T2 and T3 was measured with respect to bone levels at T1 and T2, respectively. The patient satisfaction was assessed at T2 and T3 using FDI clinical criteria and scoring system (modified by Monaco et al.). Statistical Analysis Used: Shapiro–Wilk test was employed to test the normality of data. Paired sample t-test was performed for quantitative variables. Results: A total of twenty implants were inserted in ten partially edentulous spaces; the average patient age was 50.2 years. No significant difference was seen between T2 and T3 for PPD. Comparison of marginal bone loss using paired t-test showed a statistically highly significant difference at T2 and T3 with higher value at T2. No prostheses were dislodged during postprosthetic follow-up. The survival rate was 100% for both the abutments and implants. No change in surface luster was observed 12 months following prosthetic rehabilitation in any case. No prostheses or framework fracture was reported and all patients were satisfied with the prosthesis received. Conclusions: Friction fit conical abutment system can act as a novel approach for the retention of implant-supported fixed dental prostheses.
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A randomized controlled twelve month clinical study on the evaluation of success rate of endodontically treated teeth restored with metal poly-fiber posts and dentin posts p. 38
Sarvesh Shrikantbhai Patel, Rajesh Sethuraman
Settings and Design: Department of Prosthodontics, KMSDCH, SVDU, Randomised Controlled study. Materials and Methods: Thirty-six teeth that satisfied selection criteria were randomly allocated and treated in the two intervention groups – metal fiber post with composite core and dentin post with composite core. Patient characteristics with respect to gender, tooth guidance, type of tooth, and mobility amount of tooth structure left were recorded. The primary outcome of tooth loss and the secondary outcomes of recurrent caries detected at the crown margin, de-cementation of crown, and fracture of the core, post, and root were recorded at baseline, 3, 6, and 12 month follow up. Statistical Analysis Used: Chi Square test. Results: Thirty-six teeth in 17 patients (10 males and 7 females) were treated using metal fiber post (18 teeth) and dentin post (18 teeth). No loss of tooth was seen at the end of 3, 6, and 12 months. The secondary outcomes also showed no recurrent caries at margin and no fracture of core, post, and root in both the groups at the end of 3, 6, and 12 months. One case of de-cementation was observed in both the groups at the 12-month period. Periodontal and periapical conditions showed no clinical and radiographic signs at any of the follow-up periods in both the groups. Conclusion: This twelve month randomized controlled clinical study concluded a similar success rate for endodontically treated teeth restored with crowns on both metal fiber post with composite core and dentin post with composite core.
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Effect of multiple reuse of commonly used implant analogs on the changes in the distance between internal threads: An in vitro study p. 48
Ravi Shankar Yalavarthy, Jagadeesh Naidu Alla, Srinivas Kalluri, Shiva Shankar Mahadevan, Satyendra Kumar, Sunitha Ronanki
Aim: To assess the effect of multiple reuse of implant analogs of three different materials (SS, Ti, Al) on the changes in the distance between internal threads of implant analog by using two die materials at different time intervals (0, 3rd, 6th, 9th, and 12th). Settings and Design: An in vitro study. Materials and Methodology: Three commonly used implant analog materials (stainless steel, titanium, and aluminum) and two Type– IV die stone materials (Kalrock and Zhermack Elite) were used to make the samples. A total of sixty implant analogs (20 each), sixty corresponding abutments (20 each) and 720 screws (240 each) were taken, which includes stainless steel, titanium, and aluminum manufactured by Adin, Genesis, and Equinox/Myriad plus, respectively. In addition, silicone (light body consistency) was used to make an impression for the internal thread of implant analogs. The obtained samples were tested for changes in the internal threads of implant analogs while reusing the implant analogs at the interval of times (0, 3rd, 6th, 9th, and 12th) using a stereomicroscope at ×50. Here, the measured values at “0” interval were considered the control group. Statistical Analysis Used: The values obtained were statistically analyzed using One way ANOVA, independent t test, and dependent t test for multiple comparisons. Results: Based on the results obtained, the overall comparison of the mean distance between threads 1–2, 3–4, and 5–6 on the replica of internal threads of the stainless steel, titanium, and aluminum implant analog materials at 1–2 has more decrease in distance from 0 to 12th intervals, at 3–4 has less amount of decrease in distance than thread distance at 1–2 from 0 to 12th intervals, and at 5–6 has very less decrease in distance than thread distance at 1–2 and 3–4 from 0 to 12th intervals. On order the mean distance reduction between threads is more at 1–2, followed to that less reduction at 3–4 and very less reduction at 5–6. This infers that the amount of increase in the distance between the internal threads of implant analog at 1–2 has more followed by 3–4 and 5–6, respectively. Conclusion: From the study, the following inferences are drawn: That the aluminum implant analog internal threads have more amount of increase in the distance between threads followed by stainless steel and titanium. Hence, among the three materials, titanium implant analogs were most efficient for reuse.
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A comparative evaluation of stress distribution between an All-on-Four implant-supported prosthesis and the Trefoil implant-supported prosthesis: A three-dimensional finite element analysis study p. 56
Jaisudhaa Murugaian, Lambodaran Ganesan, M S Sathya Shankar, H Annapoorni
Aim: The primary aim of this study is to analyse the stress distribution between an ALL ON FOUR implant supported prosthesis and the TREFOIL implant supported prosthesis with 3D finite element models. Settings and Design: An in vitro perspective Materials and Methods: Two mandibular three-dimensional Finite Element Models were constructed by the CREO version 5 software, in which Model A depicts a mandible with ALL ON FOUR implant supported prost hesis and Model B will depict TREFOIL implant supported prosthesis. Model A contains four implants, two anterior straight and posterior tilted implants (30°), a bar and denture containing acrylic teeth. In Model B, it contains three straight implants and a prefabricated compensatory bar with standardised dimensions. To evaluate and compare the stress distribution between the bone and implant interface, one deleterious cantilever load of upto 300 N is applied on the second molar bilaterally and simultaneously. Another full bite biting load of 150 N is given bilaterally and simultaneously on the central groove of premolars and molars. Statistical Analysis Used: The results of the simulations obtained were analysed in terms of Von Mises equivalent stress levels at the bone -implant interface. Results: The results of loading 1 showed that the maximum Von Mises stress was recorded in the anterior implant region of the Trefoil system (Model B) when compared to All on four concept. The results of loading 2 showed that the maximum Von Mises stress were recorded in the anterior implant region Trefoil system (Model B) when compared to All on four concept. Conclusion: This invitro study concludes that All on Four implant supported prosthesis showed better stress distribution when compared to the Trefoil concept.
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Effectiveness of Vitamin D along with Splint therapy in the Vit D deficient patients with Temporomandibular disorder-A Randomized, double-blind, placebo-controlled clinical trial p. 65
Abhishek Kumar Gupta, Rekha Gupta, Shubhra Gill
Aim: The purpose of this study is to comparatively evaluate the Vitamin D supplementation and stabilization splint therapy in patients exhibiting temporomandibular disorders (TMD). Settings and Design The study design was double-blinded, parallel-group, randomized and placebo-controlled trial conducted in patients with low Vitamin D and TMDs, which were allocated to two groups, Study group S + D (Stabilization splint with Vitamin D supplementation) and Control Group S (Stabilization Splint with placebo drug). Subjects and Methods: Thirty-six participants of 18–45 years of age gap with Vitamin D deficiency and TMD were included in the study. Preoperative values of Vitamin D levels in ng/ml, comfort mouth opening (CMO) in mm, maximum mouth opening (MMO) in mm, temporomandibular joint (TMJ) tenderness (grading 0–3), Visual analog scale score (VAS Score 0–10 cm), and total energy (TE) integral values of both left and right TMJ's in Hertz (Hz) were recorded using joint vibration analysis All the values of CMO, MMO, TMJ Tenderness and VAS were recorded at each follow-up at 1st week, 1st month, 2nd month, and 3rd month, respectively. Postoperative Vitamin D levels and TE of both TMJs were recorded at end of 3 months. Statistical Analysis Used: For intergroup comparison, Mann–Whitney U-test and Pearson Chi-square tests were done. For Intragroup comparison, Wilcoxon signed rank test was used for comparison. Results: In Intergroup comparison, a significant difference was seen in CMO, VAS score and MMO (P < 0.05) but not among mean values of TE of right and left TMJ, and Vitamin D levels (P < 0.05). In both groups, there were significant statistical variations in CMO, VAS score, MMO, and TE integral before and after treatment in the right and left TMJs (P < 0.05). Conclusions: The study concludes centric stabilization splint helps in improving symptoms of TMD patients and Vitamin D supplementation provided faster relief in those cases.
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A randomized controlled trial for evaluation of bone density changes around immediate functionally and nonfunctionally loaded implants using three-dimensional cone-beam computed tomography p. 74
Kamleshwar Singh, Pooran Chand, Akhilanand Chaurasia, Neeti Solanki, Anupama Pathak
Aim: The aim of this study was to compare and assess bone density changes around immediate functionally and nonfunctionally loaded implants. Settings and design: In vivo comparative study Materials and Methods: Sixty participants selected based on the predetermined inclusion and exclusion criteria received single tooth implants in mandible under two implant loading protocols: Immediate functionally loaded (IFL) and immediate nonfunctionally loaded (INFL). Randomization was done by computer-aided simple randomization procedure. Self-tapering, aggressive SLA implants were placed in the single tooth edentulous sites of mandible in both the groups. Three-dimensional cone-beam computed tomography (3D CBCT) was taken at baseline, 3 and 6 months postimplant placement. Quantitative analysis of the bone density was performed using 3D CBCT in three areas around the implants at crestal, middle, and apical regions of implants. Statistical Analysis Used: Quantitative data were summarized as mean ± standard deviation. Statistical analyses were performed using the SPSS software version 21.0 (SPSS Inc., Chicago, IL, USA) by unpaired t-test. Results: Bone density changes after implant placement in IFL group from baseline to 3 months were; crestal region (314.18 ± 71.69), middle (278.23 ± 70.17), apical (274.70 ± 59.79) and changes from 3 to 6 months were; crestal (−105.55 ± 39.60), middle (−114.80 ± 41.46), apical (−141.88 ± 69.58). Bone density changes after implant placement in INFL group from baseline to 3 months were crestal region (199.42 ± 47.97), middle (56.91 ± 10.39), apical (200.98 ± 67.43) and changes from 3 to 6 months were; crestal (−194.38 ± 75.30), middle (−204.40 ± 63.75), apical (−191.28 ± 62.33). Conclusions: It was concluded that INFL implant group showed better bone density when compared to IFL implant group.
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Comparison of patient satisfaction between complete dentures fabricated using “conventional” and “cephalometric angular reconstruction” vertical dimension procedures: A multicenter randomized clinical trial p. 82
Dileep Nag Vinnakota, Nagaraj Edamadaka, P Sesha Reddy, Chalapathi Rao Duggineni
Aim: In Prosthodontics, during complete denture fabrication, conventional methods employed to determine occlusal vertical dimension require patient co-operation. Hence, the aim of the present study is to evaluate the clinical effectiveness of the 'cephalometric angular reconstruction' procedure in the calculation of these lost dimensions. Settings and Design: Multicentric randomised clinical trial conducted in four dental hospitals. Materials and Methods: Fully edentulous people who came to the hospitals for complete denture treatment were recruited into the study. Those who fulfilled the inclusion criteria were randomly assigned to two groups; Group 1: Dentures fabricated using a 'conventional' procedure and Group 2: Dentures fabricated using 'cephalometric angular reconstruction'. The patient's level of satisfaction was assessed on a scale of 1 to 5; 1-dissatisfaction to 5-excellent. The confounding factors that can influence the satisfaction were also recorded. Statistical Analysis Used: The distribution of patient's satisfaction was assessed using Chi-square test, whereas the difference between the two groups was evaluated using Mann–Whitney test. Results: There was no significant difference either in the vertical dimension determined (P = 0.465) or the patient's level of satisfaction (P = 0.943) between the two groups. There was no influence of confounding factors considered in the present study on the satisfaction levels. There was no difference in the distribution of satisfaction levels based on the dentist's quality assessment (P = 0.243). Conclusion: Complete dentures fabricated using cephalometric angular reconstruction procedure of vertical dimension determination were equivalent with respect to patient satisfaction, compared to those made using a conventional method. Hence, the new method can be clinically recommended during denture fabrication.
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Zygomatic implant-supported prosthetic rehabilitation of a patient with Brown et al. Class II c maxillary defect: A clinical report p. 92
Nitasha Gandhi, Sumir Gandhi, Harit Talwar, Kusha Dhawan
The genesis of acquired maxillary defects poses a significant challenge when it comes to rehabilitating a patient prosthetically. These defects lead to functional and esthetic impairment, affecting the quality of life of an individual. This clinical report describes a satisfactory zygomatic implant-supported overdenture rehabilitation of a patient who underwent subtotal bilateral maxillectomy after an industrial accident. The result shows zygomatic implant-supported overdenture as a viable, predictable, and economical treatment option for a patient with an extensive maxillary defect.
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Fixed screw-retained interim restorations with immediate implant placement in esthetic zone: A case series with six different techniques p. 97
Udatta Kher, Pravinkumar G Patil, Ali Tunkiwala, Smita Nimbalkar
Postextraction immediate implant placement in the esthetic zone is a common treatment modality. Immediate fixed interim restoration following immediate implant placement may provide excellent esthetic results to the patients and boost the clinicians' confidence. This paper demonstrates a series of six different techniques used to fabricate the customized screw-retained interim restorations following immediate implant placement with partial extraction therapy in the maxillary anterior esthetic zone. The techniques have utilized a putty index, polycarbonate shell crown, patients' existing crowns (prosthetic or natural), or laminate veneer, or fabricated in the laboratory based on the specific clinical situation. Advantages and limitations of each technique including alternative techniques or materials have been discussed. Excellent esthetic results were obtained with all six techniques using the screw-retained immediate interim restorations following partial extraction therapy and immediate implant placement.
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