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   2018| October-December  | Volume 18 | Issue 4  
    Online since October 3, 2018

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Comparison of the effect of monolithic and layered zirconia on natural teeth wear: An in vitro study
Yamini Gundugollu, Ravi Shankar Yalavarthy, M Hari Krishna, Srinivas Kalluri, Shameen Kumar Pydi, Satyendra Kumar Tedlapu
October-December 2018, 18(4):336-342
Aim: The aim of this study is to compare wear of the natural teeth against monolithic zirconia and layered zirconia with different surface finishing procedures such as unpolished unglazed, polished unglazed, and polished glazed. Materials and Methods: The two-bodied wear test was carried out in a custom-made oral wear simulator with a sample size of 60 zirconia specimen opposing natural teeth. Zirconia specimen was divided into two groups layered and monolithic which further subdivided into unpolished unglazed, polished unglazed, and polished glazed groups (n = 10). The amount of enamel wear occurred for 250,000 cycles when opposed by monolithic and layered zirconia with different surface finishing methods was measured by loss of height of each tooth using three-dimensional scanning and loss of weight using sensitive balance at specified time intervals of 50,000 cycles during masticatory test considering baseline measurement as control. The data were statistically analyzed to compare the enamel wear against layered and monolithic zirconia with different surface finishing protocols by repeated ANOVA test. Results: Monolithic polished unglazed zirconia showed least tooth wear followed by monolithic polished glazed zirconia, monolithic unpolished unglazed zirconia, and layered unpolished unglazed zirconia showed highest tooth wear in terms of both height loss and weight loss (P < 0.01). Conclusion: Within the limitations of the study, monolithic polished unglazed zirconia is wear-friendly to the opposing natural teeth, and polished surfaces in both the groups showed less tooth wear compared to the glazed surface of zirconia specimen.
  3,728 310 -
A comparative evaluation of vertical marginal fit of provisional crowns fabricated by computer-aided design/computer-aided manufacturing technique and direct (intraoral technique) and flexural strength of the materials: An in vitro study
Ishita Dureja, Bhupender Yadav, Puja Malhotra, Nupur Dabas, Akshay Bhargava, Ripul Pahwa
October-December 2018, 18(4):314-320
Background: With the advent of new provisional crown materials, it has become imperative to evaluate their marginal fit and strength to select the ideal provisional crown material. Aim: The purpose of this in vitro study was to evaluate and compare the vertical marginal fit and flexural strength of provisional crowns prepared using computer-aided design-computer-aided manufacturing (CAD-CAM) temporary material versus those fabricated using bis-acrylic composite-based autopolymerizing resin material. Materials and Methods: Eighty samples were divided into two equal Groups (I and II). Group I consisted of forty samples that were evaluated for flexural strength and Group II consisted of forty samples that were evaluated for their vertical marginal fit. Group I was subdivided as Group IA, i.e., bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) blocks and Group IB, i.e., CAD/CAM provisional material blocks. Similarly, Group II was subdivided as Group IIA, i.e., bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) crowns and Group IIB, i.e., CAD/CAM provisional material crowns. Marginal adaptation was evaluated using stereomicroscope and image analyzing software to measure the amount of marginal gap. For flexural strength, all specimens were subjected to a standard compression load in the universal testing machine until fracture occurred. Data were analyzed using Student's t-test (P = 0.001). Results: CAD/CAM provisional crowns showed better marginal adaptation (34.34 μm) as compared to bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) crowns (63.42 μm) (P < 0.001). The flexural strength of CAD/CAM blocks (94.06 megapascals [MPa]) was not statistically different from bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4) blocks (101.41 MPa) (P > 0.001). Conclusion: Protemp™ 4 and CAD/CAM provisional materials have comparable flexural strength. However, the marginal fit of temporary crowns fabricated by CAD/CAM was found to be superior to the ones fabricated using bis-acrylic composite-based autopolymerizing resin material (Protemp™ 4).
  3,162 331 -
Computer-aided design finite element modeling of different approaches to rehabilitate endodontically treated teeth
Gabriela Fernandes da Fonseca, Guilherme Schmitt de Andrade, Amanda Maria de Oliveira Dal Piva, Joao Paulo Mendes Tribst, Alexandre Luiz Souto Borges
October-December 2018, 18(4):329-335
Background: Carious lesions and dental fractures cause weakening in the dental structure. In these situations, endodontic treatment and prosthetic rehabilitation using an intraradicular post are indicated. However, the postspace preparation of the root canal further weakens the dental remnant, especially if there is no ferrule present. This study aimed to evaluate the stress distribution in endodontically treated upper premolars treated with different rehabilitation approaches. Materials and Methods: An endodontically treated first upper premolar was modeled for finite element analysis. Three different approaches were carried out on this model: rehabilitation with fiberglass post (FCP), endocrown (ECW), or buildup. The models were exported in STEP format to the analysis software (ANSYS 17.2, ANSYS Inc., Houston, TX, USA). The solids were considered isotropic, homogeneous, and linearly elastic. A mechanical, structural static analysis was used as the criterion of maximum principal stress to show regions under tensile stress to evaluate the stress distribution in the restoration, cementation line, and root. A load of 400 N (90°) was applied to the lingual triangular ridge. The values of maximum principal stress in MPa were evaluated through colorimetric graphs. Results: Similar stress concentration was observed for all groups. However, the ECW group presented higher values in the restoration/cement interface and root dentin. Conclusions: All the treatment modalities had favorable mechanical behavior to support the masticatory loads; nevertheless, the ECW group presented a higher risk of detachment failure.
  2,848 309 -
An in vitro study to evaluate and compare the surface roughness in heat-cured denture-based resin and injection-molded resin system as affected by two commercially available denture cleansers
Pankaj Tripathi, Sumit Singh Phukela, Bhupender Yadav, Puja Malhotra
October-December 2018, 18(4):291-298
Background: Denture hygiene is of utmost importance to maintain the dentures as well as the underlying tissues in appropriate health. Various denture cleansers as well as denture-based materials have evolved in the market; however, the effect of denture cleansers on different types of denture-based materials has not been very well documented. Aim: The purpose of this in vitro study was to evaluate and compare the surface roughness in heat-cured denture-based resin and injection-molded resin system as affected by two commercially available denture cleansers for a period of 15, 30, and 45 days. Methodology: A standardized metal die was fabricated to make 120 denture-based resin discs of uniform dimensions. The samples of heat-cured denture-based resin and injection-molded thermoplastic denture-based resin were immersed in the two denture cleansing solutions for a period of 15, 30, and 45 days, respectively. The surface roughness was evaluated by surface profilometer TR200. The data were subjected to statistical analysis and the comparison of quantitative data was done using unpaired t-test and repeated-measures ANOVA test. Results: The surface roughness values (Ra) of heat cured denture base resin samples when immersed in two denture cleansers were 0.22 μm at 0 days, 0.27 and 0.29 μm at 15 days, 0.29 and 0.31 μm at 30 days, 0.30 and 0.31 μm at 45 days whereas for injection moulded samples surface roughness values were 1.31 & 1.27 μm at 0 days, 1.46 & 1.66 μm at 15 days, 1.50 & 1.69 μm at 30 days, and 1.50 & 1.69 μm at 45 days. Conclusion: The surface roughness (Ra) increased significantly in injection-molded polyamide denture-based resin samples when immersed in both the denture cleansers. Whereas, heat-cured denture-based resin samples did not reveal any significant surface changes at the various time intervals. Hence, the use of denture cleansers is questionable in thermoplastic resins.
  2,354 233 -
A cephalometric analysis to establish a correlation of different ridge relations to three levels of camper's line in edentulous patients: An in vivo study
D R V Kumar, Shrikar Sandeep Mehta, Sumit Deshpande, Arun Gupta, Manish Chadha, Chetna Kumar
October-December 2018, 18(4):299-304
Aim: This study was undertaken with an aim to establish a relationship between normognathic (Class I), retrognathic (Class II), and prognathic (Class III) ridge relation and superior, middle, and inferior levels of the ala-tragus line in edentulous individuals, by utilizing arbitrary and cephalometric methods. Methodology: Ninety edentulous male patients were selected for the study, and after establishing tentative jaw relation, radiopaque ball bearings were attached on three levels of the tragus and inferior part of the ala of the nose. Furthermore, orthodontic wire was attached to maxillary occlusal rims. Lateral cephalometric radiographs were taken, and tracings were carried out to compare and to evaluate the cephalometrically derived ridge relations with that of the visually analyzed ridge relations based on the mounted casts in relation to the ala-tragus line. The results obtained were statistically analyzed using one-way ANOVA test, and multiple comparisons were carried out using the Bonferroni tests. The interoperator variability for obtaining ridge relations using visual analysis and the cephalometrically obtained ridge relations were analyzed using the Kappa statistics. Results: The result obtained states that 78 participants out of 90 participants are in total agreement with the Kappa value of 0.8. Conclusion: The study concluded that for Class I and Class III, the inferior part of the tragus forming the ala-tragus line, and for Class II, the middle part of the tragus should be considered for establishing the occlusal plane.
  2,242 202 -
Cone beam computerized tomography evaluation of incisive canal and anterior maxillary bone thickness for placement of immediate implants
Mousumi Panda, Thatapudi Shankar, Anjana Raut, Shruti Dev, Aswini Kumar Kar, Sadanand Hota
October-December 2018, 18(4):356-363
Purpose: Variation of dimensions of the nasopalatine canal and anterior maxillary bone thickness vary in relation to age, gender, edentulism, and ethnicity; thorough knowledge with regard to these landmarks is of vital importance prior to surgical procedures such as implant placement and local anesthesia in the anterior maxilla. Cone beam computerized tomography (CBCT) aids in accurate treatment planning in such situations. Subjects and Methods: A total of 300 participants were selected by the inclusion and exclusion criteria. CBCT was performed with Hyperion X9 CBCT Scanner. Images were reconstructed from the CBCT data using NNT image reconstruction software and visualized using multi-planar resolution screen. The dimensions of the nasopalatine foramen (NPF), the incisive canal (IC) and foramen, and anterior maxillary bone thickness were measured. Results: The mean diameter of NPF was found to be 3.27 mm, incisive foramen (IF) was 3.62 mm, IC was 2.12 mm. The average length of the IC was 10.66 mm. The IF was located at a mean distance of 13.81 mm away from the most anteroinferior point of the cortical plate of the labial bone of the maxilla. The anterior maxillary bone was the thickest at the nasal spine level (10.94 mm), and was the narrowest at lower labial alveolus (7.16 mm). The average anterior maxillary bone thickness was found to be 8.36 mm. Conclusion: Within the limitations of the study, it was found that found that gender and age are important factors that affected the characteristics of the IC and the amount of bone anterior to it.
  2,174 194 -
Presentation of cysticercosis of the lateral pterygoid muscle as temporomandibular disorder: A diagnostic and therapeutic challenge
Mythili Kalladka, Anuradha Navaneetham, Eli Eliav, Junad Khan, Gary Heir, Mel Mupparapu
October-December 2018, 18(4):377-383
Orofacial pain can often be the chief complaint of many systemic disorders. Cysticercosis involving the lateral pterygoids may cause limitation of mouth opening and may mimic clinical symptoms of a temporomandibular disorder. A 37-year-old female presented with 1-month-old complaint of limited mandibular range of motion. She reported a similar episode a year earlier and was diagnosed with a temporomandibular joint disorder by her primary dentist. Comprehensive intra- and extra-oral examinations were performed, which revealed a limitation of mouth opening accompanied by mild limitation of contralateral excursion. A magnetic resonance imaging revealed a ring-enhancing lesion within the left pterygoid muscle suggestive of cysticercosis. The patient was referred to her primary care physician for further treatment and given physical therapy (stretching exercises) to improve mouth opening. One week later, she developed lesions in the arm and trunk. Further ultrasound imaging of the abdomen and the forearms confirmed the diagnosis of cysticercosis. She was treated with albendazole, physiotherapy, joint stabilization appliance, and had eventual complete recovery. This case emphasizes the importance of diagnosis of a systemic condition that may have serious implications, if untreated, and the importance of a comprehensive evaluation, workup, and multidisciplinary management.
  2,142 111 -
Effect of the simulated Indian and Mediterranean climates on the Shore A hardness of maxillofacial silicone
Amanda Ferreira, Meena Aras, Vidya Chitre, Ivy Coutinho, Praveen Rajagopal
October-December 2018, 18(4):305-313
Purpose: The purpose of this study was to assess and compare the effect of the simulated Indian and Mediterranean climates on the Shore A hardness of a commercially available nonpigmented room temperature vulcanizing maxillofacial silicone. Materials and Methods: Sixty specimens were fabricated from A-2000 silicone material (Factor II), using a stainless steel mold of dimension 20 mm × 2 mm. The initial Shore A hardness was noted using a digital durometer. Thirty samples were subjected to the simulated Mediterranean climate (Group I), and the remaining thirty samples were subjected to the Indian tropical climate (Group II) in an accelerated weather chamber to simulate 1 year of clinical use. Final Shore A hardness was noted. A one-way ANOVA and Bonferroni post hoc tests were performed for the Shore A hardness at P < 0.05. Results: The mean initial Shore A hardness for both the groups was 24.9833. After accelerated weathering, Group I showed mean Shore A hardness of 33.0000 whereas Group II showed mean Shore A hardness of 38.0000. Conclusions: The Shore A hardness of Factor II, before and after accelerated artificial weathering, was statistically significant at 0.05 level (P < 0.05).The change in Shore A hardness was greater in the simulated tropical climate group (Group II) as compared to the simulated Mediterranean climate group (Group I) but within clinical limits.
  2,037 124 -
Determination of the center of anteroposterior curve of occlusion in a selected local population: A cross-sectional cephalometric study
Sudiksha Jaiswal, Tulsi Subramaniam, Amit Gharpure, Neel Bhatavadekar
October-December 2018, 18(4):321-328
Objective: The objective of this paper was to cephalometrically determine the center of the anteroposterior curve of occlusion, and its relation to standardized landmarks, to establish a suitable occlusal curve for the restoration of maxillary and mandibular arches in a selected local population. To the best of the authors' knowledge, this was the first cephalometric study identifying variations occurring in the anteroposterior curve in this population. Materials and Methods: A total of 80 patients (40 males and 40 females) with Angle's Class I occlusion and normal growth pattern were selected. Landmarks were established following tracings on standardized lateral cephalograms. The center of the occlusal curve was determined, and its distance from the nasion, lachryma, and orbitale was statistically compared using ANOVA, post hoc and proximal matrix tests in males and females. In addition, a relationship between the depth of occlusal curve and the condyle was established. Results: The mean distances of the center from nasion, lachryma, and orbitale (statistically significant) were 11.15 mm ± 5.65 mm, 18.68 mm ± 8.6 mm and 33.10 mm ± 10.13 mm for females (P < 0.001) and 9.7 mm ± 4.69 mm, 16.80 mm ± 6.45 mm and 31.22 mm ± 8.51 mm (P < 0.001) for males, respectively. Depth of the curve and distance from the condyle had an inverse corelation. Conclusion: Nasion is closest to the center of the curve of occlusion in both females and males followed by lachryma and orbitale. Hence, nasion can be considered as a point of reference clinically while determining anteroposterior curve of occlusion.
  1,954 132 -
A study on the evaluation of bite force, prosthetic and nutritional status in adult cleft patients in Kolkata
Alak Kumar Bera, Samiran Das, Jayanta Bhattacharyya, Sayan Majumdar, Saumitra Ghosh, Preeti Goel
October-December 2018, 18(4):343-355
Context: Altered orofacial morphology and poor dental status affects the dietary intake of cleft patient, making susceptible to nutritional imbalance. Oral health care planning for this population is impossible without the evaluation of stomatognathic functional status as well as prosthetic and nutritional status and need. Aims: The aim of this study was to evaluate prosthetic status and prosthetic treatment need, bite force and nutritional status, in adult cleft patients and to compare them with the adult noncleft population of similar definition. Settings and Design: Cleft (n = 250) and noncleft (n = 250) individuals of either sex, aged 18 years or above, excluding severe medically compromised and differently abled, were examined and individual biteforce was measured after obtaining written consent and ethical clearance from the two institutions in Kolkata. Subjects and Methods: A “raw data sheet” was prepared according to the parameters of the “Oral Health Surveys: Basic methods,” World Health Organization (1997) for evaluation of prosthetic status and need, dentition status and Mini-Nutritional Assessment, Nestlé (1994) for the evaluation nutritional status. A Gnathodynamometer was used to record bite force. Statistical Analysis Used: Statistical analysis was performed using SPSS 20.0.1, Graph Pad Prism version 5, Student's t-test, and Chi-square test. Results: The mean bite force of frontal area in cleft group (3.4356 ± 0.9457 kgf) was found to be significantly lower (P < 0.0001) than in noncleft (22.8749 ± 5.3644 kgf) group. The difference of mean bite force in the right side (2.4576 ± 0.6131 kgf) and left side (1.2708 ± 0.1036 kgf) in cleft group was found to be statistically significant (P < 0.0001). Prosthetic need in maxillary arch was found to be significantly (χ2: 490.0000; P < 0.0001) higher in cleft than in noncleft group. Nutritional status was observed to be significantly (χ2: 179.4049; P < 0.0001) higher “at risk” in cleft than in noncleft group. Conclusions: Lack of adequate Government concern leading to significantly higher prosthetic need and lower prosthetic status, hence lower bite force resulting lower nutritional status in adult cleft patients in Kolkata.
  1,815 115 -
Prosthodontic rehabilitation of combined oronasal defect in patients with non-Hodgkin's lymphoma using two different attachments: Two case reports
Kirti Bansal, Paras Rawat, Gunjan Pruthi, Veena Jain
October-December 2018, 18(4):370-376
Debridement of affected parts in patients with non-Hodgkin's lymphoma leads to large mid facial defects leading to poor quality of life due to cosmetic disfigurement and various functional comorbidities. Therefore, a surgeon should refer the patients to a prosthodontist for replacement of lost tissues to improve their function and esthetics. Two cases have been presented here with a history of non-Hodgkin's lymphoma having large, continuous defects involving nose, cheeks, and maxilla. Retaining large facial prosthesis and intraoral obturator was a challenge as supporting hard and soft tissues were less. Two-piece lightweight prostheses were fabricated and retained with the use of very economical titch buttons used (used in clothes) in case 1 due to financial constraints and slightly expensive iron boron neodymium magnets in case 2. Functional and esthetic rehabilitation was successfully achieved with intraoral and facial prostheses attached to each other.
  1,746 134 -
Characterization of dental materials
N Gopi Chander
October-December 2018, 18(4):289-290
  1,588 137 -
Prosthetic rehabilitation of resected orbit in a case of mucormycosis
Harsimran Kaur, Aditi Nanda, Mahesh Verma, Parul Mutneja, Dheeraj Koli, Smiti Bhardwaj
October-December 2018, 18(4):364-369
The design of orbital prosthesis to rehabilitate patients with orbital exenteration depends on the underlying clinical condition, material chosen for prosthesis, method of retention of the prosthesis, and and preference of the patient. Rehabilitation of a patient with orbital exenteration due to mucormycosis has been described by fabricating a prosthesis that used polymethyl methacrylate (to fabricate a conformer) and silicone material (to fabricate prosthetic superstructure). The two-component prosthesis was designed to attain dual mechanical retention using an anatomic undercut (conformer) and manually created mechanical undercut (prosthetic superstructure). The objective was to maintain the biological health of the underlying postsurgical tissue, longevity of the prosthesis, optimal esthetics, and adequate retention.
  1,528 132 -