Air management techniques in dental office in post COVID era: A Literature Review / Técnicas de gerenciamento de ar em consultório odontológico na era pós COVID

The neoteric coronavirus outburst has jeopardised the health care system globally. As a result, practising dentistry has severe constraints due to production of aerosols and splatter in a large quantity. Air management gains foremost importance in reducing the transmission of SARS-COV-2 in a dental operatory. A variety of air filtration techniques have been put forth to optimize the air quality by removing the pollutants and pathogens. Amidst the blowing wave of information accessible online and on social media, it is puzzling to identify dependable research data and guidance to equip the operatory to minimize the risk of disease by aerosol, droplet and contact transmission. This paper presents comprehensive review on the different air purification technologies, their mechanism and utility in reducing viral load with the aim of providing information in regards to setting up a dental operatory with reduced risk of disease transmission in the post COVID-19 era (AU).

A explosão neotérica de coronavírus colocou em risco o sistema de saúde global. Como um dos resultados, a prática odontológica passou a ter restrições severas devido à sua grande produção de aerossóis e respingos. O gerenciamento de ar ganhou uma importância ainda maior na redução da transmissão do SARS-COV-2 em um procedimento odontológico. Uma variedade de técnicas de filtração de ar tem sido colocada para otimizar a qualidade do ar através da remoção de poluentes e patógenos. Em meio à onda de informações disponíveis online e na mídia social, é difícil identificar dados de pesquisas confiáveis e orientações para equipar os operadores a minimizarem os riscos de doenças transmissíveis por aerossóis, gotículas e contato. Este artigo apresenta uma compreensível revisão das diferentes tecnologias de purificação de ar, seus mecanismos e utilidades na redução da carga viral com o objetivo de prover informação quanto à prática odontológica com redução de riscos de transmissão de doenças na era pós COVID-19 (AU)

Effect of preconditioning the fractured coronal fragments with remineralizing agents on fracture resistance of re-attached teeth

Background: Fragment re-attachment has been considered as one of the treatment modalities for the management of fractured anterior teeth. Hydration of fractured fragments aids in inhibiting the loss of ions and maintains vitality and esthetics. Aim: The study aimed to evaluate the effect of preconditioning the fractured fragments with remineralizing agents on fracture resistance of re-attached teeth. Settings and Design: This was an in vitro study. Materials and Methods: Sixty freshly extracted noncarious human permanent maxillary central and lateral incisors were randomly allocated into three Groups of 20 each: Group 1: 2% sodium fluoride (2%NaF), Group 2: casein phosphopeptide–amorphous calcium phosphate (CPP-ACP), and Group 3: self-assembling peptide P11-4 (SAP). These were further divided into two subgroups of 10 teeth each, based on contact time with remineralizing agents, i.e., 30 min and 2 h. Fractured fragments were treated with remineralizing agents for a specified contact time and then re-attached with flowable composite resin. Force required to fracture the re-attached tooth was recorded in Newtons using universal testing machine. Statistical Analysis: Unpaired t-test, one-way analysis of variance test, and post hoc Tukey test were used for the statistical analysis. Results: A higher fracture resistance was noticed in fragments treated with 2% NaF (30 min- 215.6 N, 2 h- 188.5 N) compared to CPP-ACP (30 min- 141.3 N, 2 h- 111.1 N) and SAP (30 min- 134.8 N, 2 h- 149.5 N). At 30 min interval, it was found to be more in 2% NaF and CPP-ACP groups compared to 2 h. However, it increased with time in the SAP group. A statistically significant difference was found between the groups at both time intervals (P = 0.007 and 0.017). Conclusion: Preconditioning of fractured coronal fragments with 2% NaF showed higher fracture resistance compared to CPP-ACP and self-assembling peptide P11-4. Samples treated with SAP P11-4 exhibited good fracture resistance at 2 h contact time.

Transitional Dental implant in Adolescent Patient – A Narrative Review

Aim: This article aims to review the literature available on transitional implants and elaborates on the same through a case report with a follow-up of 5 years. Material and Method: PubMed, Medline, Google Scholar, and Web of Science databases were screened for literature. Articles other than those in English language were excluded. For the review, the complete texts of 49 papers were acquired, with 34 of them being included in the review. Conclusion: Transitional implant placement could be considered as an alternative to removable or fixed resin bonded dental prosthesis in adolescents with a regular follow-up. In such patients, a detailed assessment of growth pattern and a prediction of growth completion has to be done before considering implant as a treatment option.

Evaluation of the average pulp cavity volume of primary second molar and canine for obturation of a single primary tooth A preliminary cone-beam computed tomographic study

Objective: Metapex/Vitapex is one of the most commonly used obturating materials in pediatric dental practice in recent times. It is available in a premixed syringe which poses numerous practical difficulties. This study aimed to calculate the root canal volume of maxillary and mandibular canine and second molar using cone-beam computed tomography (CBCT) to determine the quantity/grams of obturation material to obturate a single tooth (mass = density × volume). Materials and Method: This nonrandomized clinical trial is comprised of two parts. The first part involved calculation of average root canal volume using CBCT which was used to calculate the quantity/grams of obturating material. This predetermined quantity was used to obturate primary mandibular second molars and canines, and the quality of obturation was assessed. Results: Assessment of quality of obturation showed optimum length obturation in 53.33% primary second molars and 66.66% primary canines. Conclusion: It can be inferred that even with the use of exact predetermined quantity/grams of obturating material, optimum quality obturation could be achieved, thus avoiding wastage, preventing cross contamination, and simultaneously offering good clinical results. Hence, this study opens further gateways to device ampules containing predetermined mass of obturating material for a single use for obturation of a single primary tooth.

Appraisal of Awareness and Attitude of School Teachers towards Emergency Management of Dental Trauma and Tooth Avulsion Replantation

Health education is an essential aspect for prevention of oral health problems in school children. Dental trauma can result in damaging the tooth, periodontal ligaments, and sometimes even alveolar bone and gingiva. These traumatic injuries to the anterior teeth in young children are tragic but are an ignored problem. They can result in aesthetic and functional problem with possible impact on child’s quality of life as anterior teeth are essential for phonetics, mastication, integrity of supporting tissue and also mental and psychological wellbeing of children. This dental emergency can be best handled by the school teachers and the staff members when it happens in a school. So, the study was conducted to assess the knowledge and attitude of the school teachers regarding the emergency management of dental trauma and sensitize them on the subject. METHODSThis is a pre- and post-test study performed using self - designed questionnaire provided to the school-teachers of Wardha district. RESULTSKnowledge of 98 % teachers increased after the activity whereas knowledge of 2 % of school teachers was the same as earlier. CONCLUSIONSSensitization of the school teachers improved their awareness and attitude to manage the dental trauma and avulsion injury of teeth in school.

Probiotic Bacteriotherapy and Its Oral Health Perspective.

As health professionals, we prescribe wide range of chemotherapeutics to the patients to control or to prevent the disease. When there is excessive use of antibiotics, it leads to imbalance between the beneficial and harmful microorganisms, making our body more susceptible to infections. Probiotics are living microorganisms which when administered in adequate amounts confer a health benefit on the host. They are living microorganisms added to food which beneficially affect the host by improving its intestinal microbial balance. Intestine’s microbial colonization is determined by the maternal intestinal flora and surroundings. Oral cavity is a complex ecosystem which has rich and diverse microbiota. The change in environment may be due to illness, debility, behaviour, diet or medications. So, an obvious fact is that changes in this ecology may give rise to dental diseases. A slight change in environment promotes the potential pathogens gain competitive advantage under appropriate conditions. Then, the pathogens increase in great numbers to predispose a site to disease. In order to cure the disease, probiotic approach, may be used. In probiotic method, whole bacteria replacement therapy is given which may be very effective in eliminating the dangerous pathogens from the oral cavity. Different probiotics are provided in products such as in medicines, beverages, milk-based foods, dietary supplements, etc. This review highlights the effectiveness of probiotics in improving the oral health.

A Comparative Evaluation between Propolis and Mineral Trioxide Aggregate as Pulpotomy Medicaments in Primary Molars.

Pulpotomy is defined as the complete removal of coronal portion of dental pulp followed by placement of a suitable dressing or medicament that will promote healing and preserve the vitality of the tooth.1 This treatment helps to maintain the primary tooth in the arch and to fulfil its function in primary and mixed dentition period.2 Since its introduction by Sweet (1932), Formocresol (FC) has been a popular pulpotomy medicament in the primary dentition for the past 80 years.3 However, it has many disadvantages like cytotoxicity, pulpal inflammation and necrosis, systemic disturbances, mutagenic and carcinogenic potential and immunologic responses.4METHODS40 carious primary molars selected from 32 children aged between 4-9 years were included in the study. The selected teeth were randomly divided into 2 groups. Group A: 20 primary molars to be pulpotomised with MTA. Group B: 20 primary molars were treated with 15% Propolis tincture. The children were recalled at 3, 6- and 12-months interval for clinical and radiographical evaluation.RESULTSThere was also absence of periapical radiolucency in propolis group at 3 months whereas in the MTA group periapical radiolucency was present in 1 (5.6%) tooth at 3 months. There was absence of sinus/ fistula in MTA group, while one (5.9%) tooth developed sinus/ fistula in propolis group at 6 months. There was also absence of sinus/ fistula in MTA group, while two (11.1%) teeth developed sinus/ fistula in propolis group at 12 months. At 12 months success rate was higher in MTA group (6 months- 100% and 12 months – 94.4%) as compared to Propolis (6 months- 88.2% and 12 months – 88.9%).CONCLUSIONSClinical outcome of Propolis is comparable to that of MTA at both 6 and 12 months follow up period. Hence, Propolis seems to be a promising and a reliable medicament for pulpotomy.

Antimicrobial efficacy of a new tri-antibiotic combination against resistant endodontic pathogens: an in-vitro study / Eficácia antimicrobiana de uma nova combinação tripla de antibióticos contra patógenos endodônticos resistentes: um estudo in vitro

Antecedentes: A remoção de todas as bactérias patogênicas do sistema de canais radiculares é de primordial importância para o sucesso da terapia endodôntica. Objetivo: O estudo teve como objetivo determinar a eficácia antimicrobiana de três antibióticos e sua nova combinação contra patógenos endodônticos selecionados. Métodos: Neste estudo in vitro, foram utilizadas cepas bacterianas associadas à condição endodôntica refratária e determinado CIM e MBC de Clindamicina (C), Metronidazol (M), Doxiciclina (D), bem como sua combinação de DMC. Cultivamos Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans em meios de cultura seletivos. Analisamos os dados usando o teste 't' emparelhado, ANOVA unidirecional e o teste post hoc HSD de Tuckey. Resultados: A clindamicina inibiu significativamente o crescimento de C. Albicans (90%) e S. Mutans (90%) e P. Aeruginosa, E. Coli, E. Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitans eram resistentes a ele. O metronidazol não inibiu nenhuma das bactérias. A doxiciclina inibiu significativamente C. Albicans (90%),P. Aeruginosa (90%) e S. Mutans (90%), enquanto E.Coli, E. Faecalis, B. Subtilis e A. Actinomycetemcomitanseram resistentes a ela. A combinação de CMD inibiu significativamente todos os micróbios. Entretanto, em concentrações bactericidas de CMD, E. Faecalis (p = 0,024),B. Subtilis (p = 0,021) e A. Actinomycetemcomitans (p =0,041) foram eliminados significativamente, enquanto C.Albicans (p = 0,164), P. Aeruginosa (p = 0,489), E. Coli (p= 0,106) e S. Mutans (p = 0,121) apresentaram resistência. Conclusão: O CMD combinado pode ser usado contra patógenos endodônticos resistentes para obter resultados endodônticos previsíveis. (AU)

Background: Removal of all the pathogenic bacteria from the root canal system is of prime importance for the success of endodontic therapy. Objective: The study aimed to determine the antimicrobial efficacy of three antibiotics and their new combination against selected endodontic pathogens. Methods: In this in-vitro study, we used bacterial strains associated with the refractory endodontic condition and determined MIC and MBC of Clindamycin (C), Metronidazole (M), Doxycycline (D) as well as their combination CMD. We cultured Candida Albicans, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecalis, Streptococcus Mutans, Bacillus Subtilis subsp. spizizenii, Actinomyces Actinomycetemcomitans on selective culture media. We analyzed the data using paired 't' test, one-way ANOVA, and Tuckey's HSD post hoc test. Results: Clindamycininhibited the growth of C. Albicans (90%) and S. Mutans (90%) significantly and P. Aeruginosa, E. Coli, E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistantto it. Metronidazole did not inhibit any of the bacteria. Doxycycline inhibited C. Albicans (90%), P. Aeruginosa(90%), and S. Mutans (90%) significantly while E. Coli,E. Faecalis, B. Subtilis, and A. Actinomycetemcomitans were resistant to it. The combination of CMD inhibited all the microbes significantly. However, at bactericidal concentrations of CMD, E. Faecalis (p = 0.024), B. Subtilis (p = 0.021) and A. Actinomycetemcomitans(p = 0.041) were eliminated significantly, while C. Albicans (p = 0.164), P. Aeruginosa (p = 0.489), E. Coli (p = 0.106) and S. Mutans (p = 0.121) showed resistance. Conclusion: Combination CMD can be used against resistant endodontic pathogens to achieve predictable endodontic results. (AU)

A digital volumetric tomography (DVT) study in the mandibular molar region for miniscrew placement during mixed dentition

OBJECTIVE: To assess bone thickness for miniscrew placement in the mandible during mixed dentition by using digital volumetric tomograph (DVT). MATERIAL AND METHODS: A total of 15 healthy patients aged 8-10 years old, with early exfoliated mandibular second deciduous molar, were included. DVT images of one quadrant of the mandible were obtained using Kodak extraoral imaging systems and analyzed by Kodak dental imaging software. The error of the method (EM) was calculated using Dahlberg's formula. Mean and standard deviation were calculated at 6 and 8 mm from the cementoenamel junction (CEJ).Paired t-test was used to analyze the measurements. RESULTS: Buccal cortical bone thickness, mesiodistal width and buccolingual bone depth at 6 mm were found to be 1.73 + 0.41, 2.15 + 0.49 and 13.18 + 1.22 mm, respectively; while at 8 mm measurements were 2.42 + 0.34, 2.48 + 0.33 and 13.65 + 1.25 mm, respectively. EM for buccal cortical bone thickness, mesiodistal width and buccolingual bone depth was 0.58, 0.40 and 0.48, respectively. The difference in measurement at 6 and 8 mm for buccal cortical plate thickness (P < 0.05) and buccolingual bone thickness (P < 0.05) was found to be significant, whereas for mesiodistal width it was insignificant (P > 0.05). CONCLUSION: Bone thickness measurement has shown promising evidence for safe placement of miniscrews in the mandible during mixed dentition. The use of miniscrew is the best alternative, even in younger patients. .

OBJETIVO: avaliar, por meio de tomografia volumétrica digital (TVD), a espessura óssea necessária para a instalação de mini-implante na arcada inferior durante a fase de dentição mista. MÉTODOS: um total de 15 pacientes saudáveis, com idades entre 8 e 10 anos, com segundo molar inferior decíduo irrompido recentemente, foram incluídos no presente estudo. Imagens de TVD da hemiarcada inferior foram obtidas utilizando sistemas de imagens extrabucais Kodak. As imagens foram analisadas por meio do programa de imagens Kodak. O erro do método (EM) foi calculado utilizando a fórmula de Dahlberg. Médias e desvios-padrão foram calculados de 6 a 8mm aquém da junção amelocementária. O teste t foi utilizado para a análise das medidas. RESULTADOS: a espessura do osso cortical vestibular, largura mesiodistal e profundidade óssea vestibulolingual, a 6mm, foram de 1,73 + 0,41; 2,15 + 0,49; e 13,18 + 1,22 mm, respectivamente. Já a 8mm, os valores foram de 2,42 + 0,34; 2,48 + 0,33; e 13,65 + 1,25mm. O EM para a espessura do osso cortical vestibular, largura mesiodistal e profundidade óssea vestibulolingual foi de 0,58, 0,40 e 0,48mm, respectivamente. A diferença entre as medidas a 6 e 8mm para a espessura do osso cortical vestibular (p < 0,05) e a espessura óssea vestibulolingual (p < 0,05) foi significativa, embora não tenha sido significativa para a largura mesiodistal (p < 0,05). CONCLUSÃO: a mensuração da espessura óssea demonstra evidências promissoras para a segura instalação de mini-implantes na arcada inferior e na fase de dentição mista. O uso de mini-implantes tem se mostrado a melhor alternativa, mesmo nos casos de pacientes mais jovens. .

Digital radiograph of the middle phalanx of the third finger (MP3) region as a tool for skeletal maturity assessment.

Objective: To evaluate the reliability of the digital radiograph of the middle phalanx of the third finger (MP3) in skeletal maturity assessment Study Design: Fifty children (24 girls and 26 boys) belonging to the circumpubertal age-group were selected for the study. Two radiographs - lateral cephalogram and digital radiograph of the MP3 region - were taken in each child. Age assessment was based on the changes in shape of the cervical vertebrae and the epiphysis of the middle phalanx of the third finger of the left hand. The radiographs were assessed by three examiners. The inter- and intraexaminer variability were determined by the Wilcoxon rank sign test and the Kruskal-Wallis test and were found to be nonsignificant. Examiner 3 showed the best intraexaminer agreement and was selected to evaluate the radiographs for the entire study. Results: The correlation determined between the MP3 stages and cervical vertebrae maturity index (CVMI) stages, the peak-wise distribution of the MP3 stages, and the correlation between the MP3 stages and the chronological age were found to be highly significant. Conclusions: Digital radiograph of the MP3 region is definitely a simple, reliable, cost-effective, and time-saving technique for the assessment of skeletal maturity.