Vivek Kumar Sharma

Shear bond strength of composite resin to dentin after application of cavity disinfectants - SEM study.

Aim: The aim was to evaluate the effect of different cavity disinfectants on dentin bond strengths of composite resin applied with two different adhesive systems. Materials and Methods: Two-hundred mandibular molars were sectioned parallel to the occlusal surface to expose dentin in the midcoronal one-third. The dentinal surfaces were polished with waterproof-polishing papers. The specimens were randomly divided into five groups of 40 teeth each as follows: group 1(control) -- specimens were not treated with any cavity disinfectants. Groups 2--5 (experimental groups) -- dentin surfaces were treated with the following cavity disinfectants, respectively; 2% chlorhexidine solution, 0.1% benzalkonium chloride-based disinfectant, 1% chlorhexidine gel, and an iodine potassium iodide/copper sulfate-based disinfectant. The specimens were then randomly divided into two subgroups including 20 teeth each to evaluate the effect of different bonding systems. Dentin bonding systems were applied to the dentin surfaces and the composite buildups were done. After the specimens were stored in an incubator for 24 hours, the shear bond strength was measured at a crosshead speed of 1 mm/min. The specimens were then statistically analyzed. Statistical Analysis Used: One way analysis of variance and Tukey-HSD tests were used. Results: There was no significant difference between chlorhexidine gel and control groups regardless of the type of the bonding agent used (P>0.05). On the other hand, pretreatment with benzalkonium chloride-based, iodine potassium iodide/copper sulfate-based disinfectants or chlorhexidine solutions had a negative effect on the shear bond strength of self-etching bonding systems. Conclusions: The findings of this study suggest that when benzalkonium chloride-based, iodine potassium iodide/copper sulfate-based disinfectants or chlorhexidine solutions are used as a cavity disinfectant, an etch-and-rinse bonding system should be preferred.

Determination of levels of nitric oxide in smoker and nonsmoker patients with chronic periodontitis

Purpose Cigarette smoking is a major risk factor in periodontal diseases. The pathogenesis of periodontal diseases may be affected by alterations of the inflammatory response by smoke. Nitric oxide (NO) is a gaseous, colorless, highly reactive, short-lived free radical with a pivotal role in the regulation of various physiological and pathological mechanisms in the body. It is important in host defense and homeostasis, on the one hand, whereas, on the other hand, it modulates the inflammatory response in periodontitis, leading to harmful effects. The aim of this study was to assess the levels of NO in both the serum and saliva of smokers and nonsmokers having chronic periodontitis and to compare them with periodontally healthy controls. Methods Sixty subjects participated in the study and were divided into three groups: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of twenty subjects. The biochemical estimation of NO in the collected serum and in the saliva was performed using the Griess colorimetric reaction. Results The results showed that the mean value of the salivary and serum NO was greater in group II than in group I, and also greater in group III than in group II. Conclusions NO appears to play an important and rather complex role in the immuno-inflammatory process and in the remodeling and maintenance of osseous structures. It is therefore logical that modulation of this mediator has potential for the treatment of a number of inflammatory conditions including periodontal disease.

Comparative evaluation of serum C-reactive protein levels in chronic and aggressive periodontitis patients and association with periodontal disease severity

Objective: C-reactive protein (CRP) is an acute-phase reactant and has been proved to be a significant predictor of future cardiovascular events. Recent studies have demonstrated a correlation between periodontitis and elevated CRP levels. However, most of the studies have focused on chronic periodontitis and very few studies are done in patients with aggressive periodontitis. The aim of this study was to determine and compare the relative levels of serum CRP in aggressive and chronic periodontitis patients. Materials and Methods: A total of 75 systemically healthy subjects were divided into three groups: Group I, nonperiodontitis subjects; group II, chronic generalized periodontitis patients and group III, generalized aggressive periodontitis patients. All participants were subjected to quantitative CRP analysis using enzyme-linked immunosorbent assay. Results: Mean CRP levels were significantly greater in both group II and III as compared to group I and group III having greater level than group II. Furthermore, CRP levels positively correlated with the amount of periodontal destruction as measured by probing depth and clinical attachment loss. Conclusion: The present study indicates a positive correlation between CRP and periodontal disease severity with particular concern in younger individuals that could be a possible underlying pathway in the association between periodontal disease and the observed higher risk for cardiovascular disease in periodontitis patients.

Endodontic management of nonvital permanent teeth having immature roots with one step apexification, using mineral trioxide aggregate apical plug and autogenous platelet-rich fibrin membrane as an internal matrix: Case series.

A tooth with blunderbuss canal and open apex can be an endodontic challenge because of difficulty in obtaining an apical seal, and existing thin radicular walls which are susceptible to fracture. To overcome the limitations of traditional long-term calcium hydroxide apexification procedures, nonsurgical one step apexification using an array of materials such as mineral trioxide aggregate (MTA) has been suggested. However, adequate compaction of MTA in teeth with wide open apices can be an arduous task, and an internal matrix is required for controlled placement of MTA against which obturating material can be condensed. Platelet-rich fibrin (PRF), a second generation platelet concentrate containing several growth factors that promotes hard and soft-tissue healing, has been used as an internal matrix to create an apical plug of MTA and hence prevent extrusion of filling materials. This case series presents the endodontic management of immature permanent teeth with open apices using internal matrix of autologous PRF membrane and one step apical barrier placement of MTA.

Ankyloglossia: Surgical management and functional rehabilitation of tongue

Ankyloglossia or “tongue-tie” is a rare congenital anomaly characterized by an abnormally short, thick, fibrosed lingual frenulum which may cause restriction in function of tongue including limitation in tongue movement. The lingual frenulum may be fibrous or muscular, and the tie may be complete or partial. Most often, ankyloglossia is seen as an isolated condition in an otherwise normal individual. This article reports the surgical management of a 20-year-old patient having ankyloglossia associated with restricted movement of tongue and difficulty in speech. The treatment involved is surgical removal of the lingual frenum followed by tongue training exercise and speech therapy to functionally rehabilitate the tongue. Six months postoperatively, the patient showed uneventful healing and was satisfied with the procedure.

Large Periapical or Cystic Lesions in Association with Roots Having Open Apices Managed Nonsurgically Using 1-step Apexification Based on Platelet-rich Fibrin Matrix and Biodentine Apical Barrier: A Case Series

&NA; Teeth having open apices in the absence of a natural apical constriction pose several challenges during conventional endodontic treatment, especially when establishing an apical seal. Treatment is further challenging when these teeth are associated with large periapical or cystic lesions having resulted in expansion and/or thinning of adjacent cortical plates. Although surgical intervention is commonly adopted in the management of such cases, a conservative treatment option offering equally good prognosis is always desirable. This case series describes 3 cases: a 39‐year‐old woman, a 45‐year‐old woman, and a 15‐year‐old boy having teeth with concomitant open apices and large periapical/cystic lesions managed conservatively by (1) following a strict intracanal disinfection protocol, (2) intracanal aspiration with digital decompression of associated swelling, and (3) 1‐step apexification for closure of the root apex by placing a preliminary barrier of platelet‐rich fibrin (PRF) and a secondary barrier of Biodentine (Septodont, Saint‐Maur‐des‐Fossés, France). In all 3 cases, the treatment outcomes, both clinical and radiographic, were highly satisfactory. PRF and Biodentine collectively rendered an apical plug that proved to be a suitable alternative to commonly used mineral trioxide aggregate in 1‐step apexification. Biodentine provides good interfacial adhesion and sealing with dentin attributed to its property of hydroxyapatite crystal deposition at the material‐dentin interface. Also, because of its bioactivity, it likely promotes the conversion of adjacent PRF into a calcific barrier, thus reinforcing the apical seal. Additionally, host‐modulating responses of PRF contribute in expediting the healing process. Reasonable osseous healing in the periapex could be appreciated as early as 3 months in all patients. The rapidity with which healing occurred may have been an incidental finding but definitely draws attention.

Translating discoveries of research into general practice: Need of the hour

We live in an era of information, innovation and change. There are a wide range of differences between what is known and what is practiced. Variation occurs due to gap between the time that basic and clinical research knowledge takes for transforming into reality of practice. As a result, there is delay between adopting new and useful information and discarding ineffective and harmful ones. The way to fill this gap is performing evaluations of findings available and by making them accessible to the clinician. It is of paramount importance that clinical decision regarding patient health care should incorporate the best available scientific evidence. Clinical decision making based on good quality evidence will lead to more effective and efficient treatments. Evidence alone is never sufficient to make a clinical decision. For effective care, the practitioner needs a more efficient and effective way to search for information as wells as skills to rapidly evaluate and sort out what is useful and relevant.