Prashant Choudhary

Evaluation of the remineralization potential of amorphous calcium phosphate and fluoride containing pit and fissure sealants using scanning electron microscopy

AIM To evaluate the remineralization potential of Amorphous Calcium Phosphate (ACP) and Fluoride containing pit and Fissure Sealants using Scanning Electron Microscopy. MATERIALS AND METHODS Thirty maxillary first premolars were divided into three groups of ten each and were randomly selected for ACP containing (Aegis- Opaque White, Bosworth Co. Ltd.), Fluoride containing (Teethmate F1 Natural Clear, Kuraray Co. Ltd.), resin based (Concise- Opaque White, 3M ESPE Co. Ltd.) pit and fissure sealant applications. The Concise group served as a control. The teeth weresubjected to the pH-cycling regimen for a period of two weeks. After two weeks, the teeth were sectioned bucco-lingually into 4mm sections and were observed under Scanning Electron Microscope at 50X, 250X, 500X, 1000X and 1500X magnifications. The qualitative changes at the tooth surface and sealant interface were examined and presence of white zone at the interface was considered positive for remineralization. RESULTS Both ACP containing (Aegis) and Fluoride containing (Teethmate F1) group showed white zone at the tooth surface-sealant interface. The resin based group (Concise) showed regular interface between the sealant and the tooth structure, but no clear cut white zone was observed. CONCLUSION Both, Aegis and Teethmate F1 have the potential to remineralize. Release of Amorphous Calcium Phosphate molecules in Aegis group and formation of Fluoroapetite in Teethmate F1 group, were probably responsible for the remineralization.

Comparative evaluation of retention of prefabricated and conventional cast post: An in vitro study.

Background and Objectives: This study was conducted to evaluate the retention of various prefabricated posts and to compare them with that of the conventional cast post. Materials and Methods: A sample of 60 freshly extracted single-rooted human mandibular first premolars were sectioned horizontally, 1 mm coronal to the cemento-enamel junction and randomly divided into four groups consisting of carbon fiber posts, glass fiber posts, stainless steel posts and cast metal posts. Cast metal post was the control group. Each group contained 15 specimen. The post space of 9 mm depth was prepared using specific drill supplied by the manufacturer. Resin patterns of the prepared post spaces were fabricated for 15 specimen and were cast in nickel chromium base metal alloy. All the posts were cemented with self-adhesive resin cement and mounted in acrylic cylinders. The teeth were subjected to tensile pull-out test using a universal testing machine. The force required to dislodge each post from the teeth was recorded. The data was analyzed using one-way analysis of variance and Bonferroni test. Results: The bond strength of all the prefabricated posts was significantly lower than the conventional cast post. Among the prefabricated posts highest bond strength was obtained for prefabricated stainless steel post and lowest for carbon fiber posts. There was no significant difference in the mean bond strength obtained for stainless steel and glass fiber post. Conclusion: Though no single prefabricated post could achieve results close to the control group, most retentive among the experimental group were the stainless steel posts. However, conditions where nonmetallic posts are indicated most preferred type of post can be the glass fiber posts.

Efficacy of silver diamine fluoride as an antibacterial as well as antiplaque agent compared to fluoride varnish and acidulated phosphate fluoride gel: An in vivo study

BACKGROUND Silver diamine fluoride (SDF) is already proven as an antibacterial agent in vitro. Present study was formulated to compare the efficacy of SDF as an antibacterial as well as antiplaque agent in vivo with fluoride varnish and acidulated phosphate fluoride (APF) gel. STUDY DESIGN Total 123 children (male = 82, female = 41) were included in the study for a period of 18 months. Children were divided into three different groups-Group 1: SDF; Group 2: fluoride varnish; and Group 3: APF gel. All subjects were evaluated via plaque score at 6 th, 12 th, and 18 th months as well as Streptococcus mutans counts in saliva at 72 h, 6 th, 12 th, and 18 th months of follow-up. RESULTS Significant reduction was found in plaque score as well as S. mutans counts irrespective of group division. On intergroup comparison, no statistically significant difference was found in plaque score, but significant reduction in S. mutans counts was found in Group 1 as compared with Groups 2 and 3, while no significant difference was found between Groups 2 and 3. CONCLUSION In vivo application of SDF on enamel significantly decreases S. mutans counts as compared to fluoride varnish and APF gel.

Efficacy of silver diamine fluoride as a topical fluoride agent compared to fluoride varnish and acidulated phosphate fluoride gel: An in vivo study

Silver diamine fluoride (SDF) is already proven as an antibacterial agent in vitro. The present study was formulated to compare the efficacy of SDF as a topical fluoride agent in vivo with Fluoride Varnish and Acidulated phosphate fluoride (APF) Gel. A total of 123 children comprised of 82 boys and 41 girls were included in the study for a period of 18 months. Children were divided into three different groups - Group 1: SDF; Group 2: Fluoride Varnish; Group 3: APF Gel. All Subjects were evaluated through decayed, missing, and filled surface (dmfs) + DMFS index at 6 th , 12 th and 18 th months as well as fluoride content in enamel at 6 th month of follow-up. Significant increase in fluoride content of enamel was found in Group 1 when compared with Group 2 and 3, whereas no significant difference was found between Group 2 and 3. Reduction in dental caries found in all groups but inter group comparison shows no significant difference. In vivo application of SDF on enamel significantly increases fluoride content in enamel as compared to Fluoride Varnish and APF Gel and can be used effectively as topical fluoride agent.

Silver Diamine Fluoride: A Review and Current Applications

Although there has been a decrease in the prevalence and the severity of dental caries in children over the past few decades, still children from low socioeconomical status in many industrialized or developing countries are still suffering from ill-effects of dental caries. The antimicrobial effect of silver compounds has been proven by the 100-year-old application of silver compounds for the prevention and treatment of various infections. Although silver diamine fl uoride (SDF) had been used to arrest dental caries during 1970s in Japan, it was not exposed much to other parts of the world. Now in many countries a 38% (44,800 ppm fl uoride) SDF solution is commonly used to arrest caries and to reduce hypersensitivity in primary and permanent teeth. Application of SDF to arrest dental caries is a non-invasive procedure that is quick and simple to use. Reports of available studies found no severe pulpal damage after SDF application. However, it has drawbacks like black discoloration of the carious teeth and an unpleasant metallic taste. But, the low cost of SDF and its simplicity in application suggest that SDF is an appropriate therapeutic agent for use in community dental health projects. Thus, the availability of a safe, effective, effi cient, and equitable caries preventive agent like SDF appears to meet the criteria of both the WHO Millennium Goals and the US Institute of Medicine’s criteria for 21st century medical care.

Comparative evaluation of application of different fluoride varnishes on artificial early enamel lesion: An in vitro study

Introduction: In an attempt to manage noncavitated carious lesions noninvasively through remineralization, a range of novel fluoride varnishes with additional remineralizing agents have been made available for clinical application. Aim and Objectives: The aim of this study was to compare and evaluate the remineralization potential of three commercially available varnishes on artificial enamel lesions. Materials and Methods: This in vitro study involves eighty intact enamel specimens prepared from premolars extracted for orthodontic purposes. After specimen preparation, the eighty samples were divided randomly into two groups (n = 40) for measurement of baseline surface Vickers microhardness and baseline calcium/phosphorus ratio (% weight) through EDAX testing. Thereafter, the specimens were subjected to demineralization for 96 h to induce initial enamel lesions and the measurements were repeated. Following demineralization, each of the two groups was divided randomly into four subgroups (n = 10) from which one was used as the control group and the others three were allotted to each of the three test varnishes. After varnish application, all the specimens were subjected to a pH cycling regimen that included alternative demineralization (3 h) and remineralization (21 h) daily, for 5 consecutive days. The Vickers microhardness and EDAX measurements were then repeated. Results: One-way ANOVA and post hoc Tukey′s tests were conducted for multiple group comparison. All the three commercially available varnishes were capable of remineralizing initial enamel lesions that were induced artificially. No difference was noted in the remineralizing efficacy of the varnishes despite their different compositions. MI Varnish™ (casein phosphopeptide-amorphous calcium phosphate fluoride varnish) showed slightly better recovery in surface microhardness as compared to the other two varnishes. Conclusion: All the varnishes used in this in vitro study are capable of reversing early enamel lesions.

Prevalence and Characteristics of Chewing Habits of Areca Nut, Gutka & Tobacco among School Children of Rural Areas in and Around Gandhinagar District, Gujarat

Purpose: The aim of this study was to assess the prevalence and characteristic patterns of areca nut, gutka and tobacco chewing habits among school children. Materials and Methods: The study was carried out in the villages in and around Gandhinagar, Gujarat. All consenting school children of 1th to 8th class were interviewed individually by a pretested questionnaire about their chewing habits. After that thorough oral cavity examination for all students were carried out. Results: Of 1500 participants, 62% were boys and 38% were girls. Mean age of all the participants was 11.8 years. The prevalence of areca nut usage among boys and girls is seen to be 33.33% and 22.28% respectively, while it is 13.23% for gutka (contains tobacco) among boys. Majority of students started the chewing habit between 13 and 14 years. 49% of users were chewing these substances regularly for more than a year. Three-fourth of the participants was ignorant of associated health hazards or thought these substances to be harmless. About 39.5% of areca nut users were seen black staining of teeth. About 100 cases of oral submucous fi brosis were identifi ed among areca nut chewers. Conclusion: Awareness level of health hazards was very poor among the students. Health education and awareness against these substances at an early age may help in curbing this problem.

Evaluation of antimicrobial effect of azadirachtin plant extract (Soluneem ™) on commonly found root canal pathogenic microorganisms (viz. Enterococcus faecalis) in primary teeth: A microbiological study

Aim: The aim of this study is to evaluate the antimicrobial activity of Soluneem ™ when used as an irrigating solution along with other commonly used irrigating solution sodium hypochlorite (NaOCl) against Enterococcus faecalis. Materials and Methods: Microorganism used in this study was E. faecalis (Microbial Type Culture Collection 439). Test substance used was Soluneem ™, which was obtained from Vittal Mallya Scientific Research Foundation (VMSRF), Bengaluru. This study was conducted in a microbiology laboratory (Biocare Research India Pvt., Ltd. Laboratory, Ahmedabad, Gujarat) to evaluate the antimicrobial effect of Soluneem ™ (Azadirachtin) on E. faecalis. Antimicrobial activity testing was performed using the macrobroth dilution method according to the Clinical Laboratory Standards Institute guidelines. All determinations were performed thrice. Results: Minimum bactericidal concentration (MBC) was seen as 2.6% for Soluneem ™ while the same was seen at 0.1% for NaOCl. Independent sample t-test was carried out to compare the MBC of Soluneem ™ and NaOCl, which showed that there was no statistically significant difference between them, i.e., 2.6% Soluneem ™ was as effective as 0.1% NaOCl. Conclusion: Soluneem ™ showed antimicrobial activity against E. faecalis at various concentrations. It was also found that the efficacy of Soluneem ™ at 2.6% concentration and above was relatively similar to that of gold standard irrigating solution (NaOCl) on inhibition of E. faecalis.

Anatomical abnormalities in multiple permanent teeth.

A 12-year-old female patient had reported to Department of Pedodontics and Preventive Dentistry of College of Dental Sciences and Research Centre, Ahmedabad, India with the Chief complain of forwardly placed upper front teeth. On general examination, shape of head was Dolicocephalic and facial form was Oval and Symmetrical [Table/Fig-1,​,2].2]. There were no other significant pathological findings. On careful clinical examination, both permanent mandibular first molars revealed the presence of an extra cusp on lingual surface and there was presence of an accessory cusp on buccal surface of mandibular second premolars [Table/Fig-3]. Another striking feature was that both the permanent maxillary first molars were wider in the mesiodistal dimensions [Table/Fig-4] which is in contrast to the normal morphology. There was increased overjet as well as spacing was seen in anterior maxillary dentition [Table/Fig-5]. Molar relation was found to be Angles Class I on the left side [Table/Fig-6]. However, due to elongation of maxillary first permanent molar, a single tooth posterior cross bite was seen between 16 and 46 [Table/Fig-7]. Neither the siblings nor the parents had reported with such abnormalities. The intraoral periapical radiographs of all the first permanent molars were taken in order to assess for the root morphology. However, all the molars had normal root morphology. Then, Orthopantogram and Lateral Cephalogram were taken to assess the skeletal relationship, which appeared to be normal. Hence, the primary treatment carried out was scaling, fluoride application and pit and fissure sealants over all permanent molars. The correction of single tooth posterior crossbite was carried out using Quad Helix [Table/Fig-8,​,9].9]. The complete fixed orthodontic treatment has been planned for the correction of increased overjet in co-ordination with Department of Orthodontics and the patient is still under orthodontic treatment. [Table/Fig-1]: Patient’s frontal view [Table/Fig-2]: Patient’s profile view [Table/Fig-3]: Intraoral mandibular view showing bilateral 6 cusp 1st molar and accessory cusp on 2nd premolar [Table/Fig-4]: Intraoral maxillary view showing widened permanent 1st molar in mesiodistal dimension [Table/Fig-5]: Intraoral occlusal view showing single tooth posterior crossbite on right side [Table/Fig-6]: Intraoral occlusal view: left side showing normal occlusion [Table/Fig-7]: Intraoral occlusal view: Right side showing single tooth posterior cross bite between 16 and 46 [Table/Fig-8]: Intraoral placement of quad helix in maxillary arch [Table/Fig-9]: Two months follow up: quad helix Dental anthropology is the study of the origin and variations in the human dentitions. These structural variations are used to determine a population or a race. Tooth morphology may be an indicator of genetic disturbances between populations [1]. The etiology of extra cusp formation is unknown. Early school of thoughts for extra cusp formation was due to over activity of dental lamina. However, at present PAX and MSX genes are believed to be responsible for variation in shape of teeth [2]. The extra cusp develop during bell stage by abnormal proliferation and folding of portion of inner enamel epithelium (IEE) along with the adjacent ectomesenchyme cells of dental papilla into the stellate reticulum of enamel organ which results in either tubercle or supplemental solid elevation on crown surface [3]. Embryologically, the primary and secondary enamel knots direct the folding of IEE, which is responsible for the characteristic morphology of the crown. The development of primary enamel knot begins in cap stage of tooth development and location coincides with the presumptive apex of first forming cusp. Subsequently, the secondary enamel knots develop during bell stage and coincides with number and position of the other presumptive cusps [2]. Dahlberg presented evidence for a relationship between cusp number and tooth size. Sexual dimorphism in cusp number was evident in that females tend to have more cusps for the same crown diameter [4]. According to number of cusps [2], a tooth can be classified as follows One cusp - Protoconid Two cusps - Metaconid Three cusps - Hypoconid Four cusps - Entoconid Five cusps - hypoconulid Six cusps - entoconulid Variations in number and frequency of different patterns are more common with mandibular molars as compared to maxillary molars. In the present case, Y6 pattern is present where Y groove is present with six cusps in mandibular first molar. The frequency of +5 and +6 cusps is comparatively low and +4 patterns are seen in 0.6% only. No ethnic difference was found, but there is significant difference (0.005<p<0.0005), because males exhibit the six cusp pattern more frequently than females [5]. Commonly mandibular second premolar has one buccal and two lingual cusps [1] whereas in the present case it has two buccal cusps and one lingual cusp, which develop from five lobes (mesial, distal, mesiobuccal, distobuccal and lingual). These morphological abnormalities has certain clinical implications such as aesthetics due to peg lateral, plaque accumulation due to abnormal morphology of the fissures, caries due to presence of deep pits and fissure as well as plaque accumulation, occlusal disturbances due to abnormal location, difficulties in restorative, surgical and endodontic procedure. The presence of all these three different morphological abnormalities occurring together in a non-syndromic child is itself a unique and a rare finding. As a dentist we should be aware of such morphological variations observed during routine dental examination and one should not be very dogmatic about the standard morphological features of the teeth. Such morphological abnormalities may impose difficulties in several treatments such as banding; crown preparation and RCT. Proper documentation of these variations may help anthropologists in their study of a population.

Erosive potential of commonly used beverages, medicated syrup, and their effects on dental enamel with and without restoration: An in vitro study

Aim: This study evaluates erosive potential of commonly used beverages, medicated syrup, and their effects on dental enamel with and without restoration in vitro. Materials and Methods: Test medias used in this study included carbonated beverage, noncarbonated beverage, high-energy sports drink medicated cough syrup, distilled water as the control. A total of 110 previously extracted human premolar teeth were selected for the study. Teeth were randomly divided into two groups. Test specimens were randomly distributed to five beverages groups and comprised 12 specimens per group. Surface roughness (profilometer) readings were performed at baseline and again, following immersion for 14 days (24 h/day). Microleakage was evaluated. The results obtained were analyzed for statistical significance using SPSS-PC package using the multiple factor ANOVA at a significance level of P < 0.05. Paired t-test, Friedman test ranks, and Wilcoxon signed ranks test. Results: For surface roughness high-energy sports drink and noncarbonated beverage showed the highly significant difference with P values of 0.000 and 0.000, respectively compared to other test media. For microleakage high-energy sports drink had significant difference in comparison to noncarbonated beverage (P = 0.002), medicated syrup (P = 0.000), and distilled water (P = 0.000). Conclusion: High-energy sports drink showed highest surface roughness value and microleakage score among all test media and thus greater erosive potential to enamel while medicated syrup showed least surface roughness value and microleakage among all test media.