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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 19 | Issue 4
Page Nos. 281-383

Online since Thursday, October 10, 2019

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EDITORIAL  

Augmented reality in prosthodontics p. 281
N Gopi Chander
DOI:10.4103/jips.jips_324_19  
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ORIGINAL ARTICLES Top

Evaluation of peri-implant condition in periodontally compromised patients p. 283
Guilherme Da Rocha Scalzer Lopes, Alfredo Carlos Rodrigues Feitosa, Fabricia Ferreira Suaid, Jefferson David Melo De Matos, John Eversong Lucena De Vasconcelos, Sergio Lins De Azevedo Vaz, Valdir Cabral Andrade, Renato Sussumu Nishioka, Selva Maria Gonçalves Guerra
DOI:10.4103/jips.jips_197_19  
Aims: The aim of the study is to evaluate the profile of peri-implant tissues in periodontally compromised patients. Settings and Design: In vivo – cross sectional study design. Materials and Methods: Fifty-eight implants were evaluated, clinically and radiographically, installed in seven individuals treated by the same team of professionals, during the years 1997 and 2005 in a private dental clinic in Vitória, ES, Brazil; that time of data collection, all implants were at least 10 years of functional loading. The variables related to the dental implants evaluated were: visible Plaque Index, Gingival Bleeding Index (GBI), probing pocket depth, bleeding on probing, and bone level, to relate them to the classification of dental implants. Statistical Analysis Used: The Chi-square and Kruskal–Wallis test were adopted. Results: The total of 58 implants were classified: 11 (18.9%) as healthy and 12 (20.7%) as clinically stable. The other 35 implants (60.4%) had some type of peri-implant inflammation, 20 of them (34.5%) were diagnosed with peri-implant mucositis and 15 (25.9%) with peri-implantitis. Among the variables studied, the results showed statistically significant differences for implant location (P = 0.001) and GBI (P = 0.03). Most of the maxillary implants (85.7%) were classified for some type of peri-implant disease. For the implants which resulted in Score 1 for GBI, most of them (75.0%) were also classified for some type of peri-implant disease. Conclusions: Dental implants placed in periodontally compromised patients may have high long-term survival rates. However, most implants were classified with some type of peri-implant inflammation.
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A clinical comparative study to assess the efficacy of a new centric registration technique with a conventional technique p. 290
R Sushma, Malvika Suresh Roy, Pronob Kumar Sanyal, Anand Joshi, Aaditee Vande, Abhijeet Ramachandra Kore
DOI:10.4103/jips.jips_126_19  
Aim: The aim and objectives of this study were to assess and compare the efficacy of a new copyrighted technique (wax ball technique, L-77997/2018) and design (denture base design for the wax ball technique, L-78006/2018) for recording centric relation (CR). Settings and Designs: In vivo – comparative study. Materials and Methods: This study was conducted on sixty consented edentulous patients. The study participants were divided into Group I and Group II. CR in Group I patients was recorded using Dawson's bimanual technique (technique 1). For participants in Group II, CR was recorded using the authors' copyrighted technique (technique 2). Time taken and accuracy of CR records by both the techniques were evaluated. Statistical Analysis Used: Descriptive statistics such as frequency and percentage were calculated for categorical variables, mean and standard deviation were calculated for quantitative variables. Independent t-test was used to compare the time taken to record the CR between the two groups. The accuracy of both the techniques was assessed by Mann–Whitney U-test. Results: The mean time taken for technique 1 was 56.47 s, whereas for technique 2, it was 5.97 s, with an overall mean difference of 50.5 s between the two techniques. Both techniques were found to be accurate, as the CR recorded during jaw relation matched with CR during trial in all the cases in both the groups (frequency 30 (N) and cumulative percentage 100%). Conclusion: From the study, it was found that, time taken for technique 2 was statistically less compared to that of technique 1, and both the techniques were found to be equally accurate.
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Hard and soft-tissue evaluation of bar-clip, ball-socket, and kerator attachments in mandibular implant overdenture treatment: An in vivo study p. 296
Nitish Varshney, Sakshi Gupta, Sumit Aggarwal, Shalabh Kumar, M Sadish, Mohsin Khan
DOI:10.4103/jips.jips_143_19  
Aim: The aim of this in vivo study was to evaluate and compare the soft and hard tissue changes in implant supported mandibular overdenture with three different attachment system. Settings and Design: In vivo – observation study. Materials and Methods: After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The crestal bone loss, modified sulcular bleeding index, plaque index values were evaluate with the attachments at baseline and after 6 months was measured in a standardised way. Statistical Analysis Used: Oneway ANOVA test and post hoc Bonferroni multiple test. Results: At the end of six months modified sulcular bleeding index and plaque index values was higher in Group 2 (bar and clip attachment) as compared to Group 1 (ball and socket attachment) and Group 3 (Kerator attachment) and crestal bone loss was equal in groups 1, 2 and 3. Analysis of variance with repeated measures showed significant differences in modified sulcular bleeding index and plaque index among the three attachment types. Conclusion: (1) Group 2 (bar-and-clip attachment) exhibited higher Modified Sulcular Bleeding Index and Plaque Index values than Group 1 (ball-and-socket attachment) and Group 3 (kerator attachment). (2) Crestal bone loss was equal in Group 1 (ball-and-socket attachment), Group 2 (bar-and-clip attachment), and Group 3 (kerator attachment).
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Complete denture fracture – A proposed classification system and its incidence in National Capital Region population: A survey p. 307
Shweta Choudhary
DOI:10.4103/jips.jips_312_18  
Aim: The complete denture fracture of denture may ruin the routine life of an edentulous patient. The aim of the present study was to propose and evaluate a new classification system for denture fractures. Settings and Design: Cross sectional -Survey. Materials and Methods: Ten dental laboratories in Delhi and the National Capital Region participated in the study for 2 years. The accurate assessment of fractured dentures received in the laboratories for repairs was done. A questionnaire with complete information along with photographs was used to classify the denture fracture. Statistical Analysis Used: Percentage (proportion) statistical test. Results: Out of 620 dentures, 164 (94 maxillary and 70 mandibular) were found with previous repair, soft liners, metal frame, or wire reinforcements which were excluded from the study. In the present study, 456 dentures were considered (256 maxillary and 200 mandibular). Class I fracture (midline) was the most common in both maxillary and mandibular dentures (46.87% in maxillary and 61% in mandibular) with high significance (P < 0.001). Class II and Class V were the second most common pattern of fracture in mandibular and maxillary dentures, respectively. There was no single case of Class III fracture for the mandibular dentures, and Class IV was the least common among the maxillary dentures. Conclusions: This study encourages further clinical studies for validation and reliability evaluation of proposed new classification system.
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A comparative evaluation of amount of gingival displacement produced by four different gingival displacement agents – Anin vivo study p. 313
Zainab Ilyas Kesari, Jyoti Tipin Karani, Saloni Sharad Mistry, Ashutosh Ramesh Pai
DOI:10.4103/jips.jips_288_19  
Aim: The aim of this study was to compare and evaluate the efficacy of ViscoStat clear, Vasozine, and Racegel (with and without cord) with respect to the amount of lateral gingival displacement produced by them. Settings and Design: Comparative - In vivo study. Material and Methods: Thirty consented volunteers were selected in the age group of 18–22 years. Maxillary right first premolar and lateral incisor and maxillary left central incisor and canine were selected for each individual. A composite resin standard reference point was made two millimeters below the gingival margin on the midsection of the labial surface of each tooth. By simple random sampling, the agents (ViscoStat clear, Vasozine, and Racegel with cord and Racegel without cord) were used for gingival displacement on each of the selected teeth. Pre- and postgingival displacement impressions were made with medium-body polyvinyl siloxane impression material. Three-millimeter thick buccolingual slice sections were obtained of the models and measured under a stereo microscope (×20 magnification), and the amount of displacement was calculated. Statistical Analysis used: The Kruskal–Wallis test and the Mann–Whitney U-test were used for comparison between the amounts of gingival displacement produced by them. Results: Mean displacement produced (in mm2) by Racegel with cord, tetrahydrozoline, ViscoStat clear, and Racegel is 0.2256, 0.2158, 0.2069, and 0.1414, respectively. Conclusions: The largest mean gingival displacement was produced by Racegel with cord (0.2256 mm2) and lowest by Racegel without cord (0.1414 mm2). There was no significant statistical difference in the amount of gingival displacement produced between the four agents.
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Comparison of expectation and satisfaction among new and existing denture wearers and correlation of duration of previous denture-wearing experience to satisfaction in completely edentulous patients: A pilot study p. 324
Deepa Subramanian, Raj Tilak Govindarajulu, Vinod Narayanan, Nandhini Devi Kalimuthu
DOI:10.4103/jips.jips_165_19  
Aim: The aim of the study was to evaluate the patients' expectation and satisfaction with complete dentures before and after the treatment concerning retention, mastication, phonetics, esthetics, and comfort among the first-time denture wearers and already denture wearers and to find the correlation between duration of denture-wearing experience and satisfaction. Settings and Design: Cross sectional survey . Materials and Methods: A questionnaire was given to the patient before the onset of the treatment, and ratings were given by the patient for expectation regarding retention, mastication, phonetics, esthetics, and comfort. Patient-related variables regarding previous denture experience and duration of wearing were also recorded. After the treatment was completed, the patient was asked to complete the same questionnaire to assess the satisfaction. Statistical Analysis Used: Descriptive statistics, frequency and percentage analysis, Wilcoxon signed- rank test, Mann–Whitney U-test. Results: Expectation and satisfaction were met for all the variables except mastication (P = 0.004) for first-time wearers and except mastication (P = 0.001) and comfort (P = 0.007) among existing denture wearers. However, no significant correlation was elicited between patient expectation and satisfaction in both these groups as the overall mean satisfaction percentage was similar. A clinical significance of P = 0.037 was seen with respect to the duration of denture-wearing experience among existing wearers. Regression model analysis showed a decreased satisfaction with increased duration of wearing (r = 0.396). Conclusions: Satisfaction and expectation were found to be almost the same irrespective of whether they are first-time wearers or existing wearers. With the increase in the duration of denture-wearing experience, the satisfaction of the patients decreased.
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Evaluation of cytotoxicity levels of poly vinyl ether silicone, polyether, and poly vinyl siloxane impression materials: An in vitro study p. 332
N Vivek Rajasimhan, Srinivasan Jayaraman, Doulathunnisa Jaffar Ali, Balanehru Subramanian
DOI:10.4103/jips.jips_261_19  
Aim: To assess the cytotoxicity level of newly introduced poly vinyl ether silicone (PVES) compared to poly vinyl siloxane (PVS) and polyether (PE) elastomeric impression materials. Settings and Design: Comparative -Invitro study design. Materials and Methods: Mouse cell line NIH/3T3 was grown in Dulbecco's modified Eagle's medium. Samples of three elastomers were dissolved in dimethyl sulfoxide and were tested at various concentrations. Twenty-four well plates with NIH/3T3 cells with different concentrations of elastomeric solutions were incubated at 37°C. 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide assay was performed on day 1, 3, and 7, with a time interval of 15 min, 30 min, 60 min, and 24th h to estimate the cytotoxicity for all three elastomers. Statistical Analysis Used: Kruskal–Wallis ANOVA test and the period effect within the subjects, repeated-measure ANOVA was done using the Greenhouse–Geisser correction method. Results: The mean cell viability (survival rate) of NIH 3T3 cells at the concentrations tested was measured. A repeated-measure Kruskal–Wallis ANOVA determined the mean survival concentration on day 1, 3, and 7. PVES showed significant decrease in the survival rate on day 1 than PVS and PE, while PVS and PE had significant decrease in the survival rates of cells on day 3 and 7 which were statistically significant (P < 0.001). Conclusion: PVES shows early cytotoxic signs as compared to PVS and PE, and cell viability for PVS was the highest among all. When making impression with PVES and PE, it is always better to evaluate the impression and gingival sulcus carefully with magnification to prevent adverse reaction, if any material is left inadvertently for longer period of time.
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A comparative evaluation of the effect of liners on the shear bond strength of veneered zirconia block: An in vitro study p. 338
Pooja Yadav, Nupur Dabas, Sumit Singh Phukela, Puja Malhotra, Shefali Drall, Pankaj Kumar Ritwal
DOI:10.4103/jips.jips_103_19  
Aim: This study aims to evaluate the effect of lithium disilicate glass–ceramic liner, silicon dioxide based liner, and glass–ceramic interlayer on the shear bond strength (SBS) of a commercially available veneered zirconia block and to study fractographic behavior of the samples using universal testing machine, scanning electron microscope (SEM). Setting and Design: In vivo – comparative study. Materials and Methods: 60 samples were fabricated from VITA (vita zahnfabrik. Bad sackingen, Germany) zirconia discs. Samples were divided into 4 groups with 15 samples each. First is the control group, second is lithium disilicate glass–ceramic liner group, third is silicon dioxide based liner, and fourth is glass–ceramic interlayer group. SBS of samples was recorded using universal testing machine. Samples were further analyzed for fractographic behavior using SEM. Statistical Analysis Used: One Way ANOVA test, and Chi-Square test. Results: The intergroup comparison of mean SBS (Mpa) was done using the post hoc Bonferroni test. The mean SBS (Mpa) was significantly more among lithium disilicate and glass–ceramic interlayer groups in comparison to silicon dioxide-based liner group. Fractographic analysis was done using the Chi-square test. Conclusion: It was concluded that maximum SBS was obtained for lithium disilicate liner. Maximum adhesive failures were found with lithium disilicate liner, and silicon dioxide-based liner group showed cohesive failures.
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Comparative evaluation of elastic recovery of three different elastomeric impression materials on chemical disinfection and autoclaving: An in vitro study p. 345
Garima Gothwal, Sudhir Meena, U Narendra Padiyar, Hemant Kumar Sharma, Pragati Kaurani, Devendra Pal Singh
DOI:10.4103/jips.jips_277_19  
Aim: The aim of the study was to investigate the effect of disinfection and steam autoclaving on the elastic recovery of three different elastomeric impression materials. Settings and Design:In vivo - comparative study. Materials and Methods: Ninety dumbbell-shaped specimens of commercially available two addition-cured silicones (AFFINIS and AQUASIL) and one condensation-cured silicone (SPEEDEX) impression materials were prepared and treated with chemical disinfectant and steam autoclaving. Specimens were seal packed and sent to laboratory for testing elastic recovery. After the specimen had been pulled to failure, the broken parts were fitted back together, and the distance between the marks was measured using an electronic Vernier caliper. Statistical Analysis Used: one-way analysis of variance test and Tukey post hoc test for multiple comparisons. Results: The result showed significant difference in elastic recovery of AFFINIS when it was disinfected and steam autoclaved whereas elastic recovery showed no significant difference when SPEEDEX and AQUASIL were disinfected and steam autoclaved. Similarly, results were alike when AFFINIS, SPEEDEX, and AQUASIL were compared on disinfection. However, significant difference was noted on steam autoclaving, highest being the mean value of AFFINIS. Conclusion: Within the limitations of this in vitro study, conclusion was made that the elastic recovery of AFFINIS was the least which improved with disinfection and autoclaving. Elastic recovery of SPEEDEX and AQUASIL was similar. However, all the three materials used in the study can be safely sterilized after clinical use and before being sent to the laboratory without significantly affecting their elastic recovery.
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Correlation between abutment angulation and off-axial stresses on biomechanical behavior of titanium and zirconium implants in the anterior maxilla: A three-dimensional finite element analysis study p. 353
Harilal Guguloth, Chalapathi Rao Duggineni, Ravi Kumar Chitturi, M Sujesh, T Ravvali, Roja Roshan Amiti
DOI:10.4103/jips.jips_268_19  
Aim: The aim of the present study was to evaluate the stress distribution around the titanium and zirconium implant with different abutment angulations in the anterior maxilla to off-axial load. Setting and Design: In vitro – Comparative study. Materials and Methods: Two models of titanium and zirconium implants (4 mm × 13 mm) and abutment with at 0°, 15°, 25° angulations were modeled to replace missing right central incisor using three-dimensional finite element analysis. A bite force of 178 N was applied on the lingual fossa of crowns at an angle of 120° off-axial to the long axis of implant. Statistical Analysis Used: Nil. Results: Von Misses stresses observed are as follows: (1) at the implant–bone interface Ti 0 (8.31 MPa), Zr 0 (8.57 MPa), Ti 15 (83.59 MPa), Zr 15 (98.07 MPa), Ti 25 (197.8 MPa), and Zr 25 (265.77 MPa); (2) at the implant–abutment interface Ti 0 (5.90 MPa), Zr 0 (6.45 MPa), Ti 15 (19.13 MPa), Zr 15 (19.32 MPa), Ti 25 (38.65 MPa), and Zr 25 (38.26 MPa); and (3) within superstructure Ti 0 (3.11 MPa), Zr 0 (5.02 MPa), Ti 15 (6.17 MPa), Zr 15 (5.02 MPa), Ti 25 (8.15 MPa), and Zr 25 (6.131 Mpa). Conclusion: Stress behavior of titanium and zirconium implant with tested abutment angulation at implant–abutment interface and within the superstructure was similar, except at implant–bone interface.
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Comparing two intraoral porcelain repair systems for shear bond strength in repaired cohesive and adhesive fractures, for porcelain-fused-to-metal restorations: An in vitro study p. 362
Jaiveer Singh Yadav, Nupur Dabas, Akshay Bhargava, Puja Malhotra, Bhupender Yadav, Manoti Sehgal
DOI:10.4103/jips.jips_120_19  
Aim: The objective of research was to evaluate the shear bond strength of two commercially available intraoral porcelain repair systems, Clearfil repair system (Kuraray) and P and R repair system (Shofu) for repairing cohesive and adhesive fracture in metal-ceramic restorations. Settings and Design: In vivo – comparative study. Materials and Methods: Ninety samples of Nickel–Chromium metal discs were fabricated. Each disc was veneered with 2 mm thickness of ceramic material using custom made metal jig. Samples were divided into control (Group I n = 10) and two test groups (Group II n = 40 and Group III n = 40). Adhesive and cohesive fractures were created in test group samples, Group II (Ceramic substrate or cohesive defect) and Group III (metal substrate or adhesive defect). The samples of ceramic substrate (Group II) and metal substrate (Group III) were further subdivided into A and B containing 20 samples each according to the repair material used (A; Clearfil porcelain repair system and B; P and R porcelain repair system). All specimens were subjected to a standard shear load in the UTM until fracture occurred. Data were analyzed using one-way analysis of variance and post hoc Bonferroni test. Statistical Analysis used: One-way analysis of variance (ANOVA) and post hoc Bonferroni test. Results: Clearfil repair system showed significantly higher shear bond strength value (29.16 Mpa) as compared to P and R repair system (27.23 Mpa) for cohesive fractures. Whereas if compared for repairing adhesive fractures P and R repair system had significantly higher shear bond strength values (26.59 Mpa) than Clearfil repair system (25.74 Mpa). Conclusions: From the present study, it was be concluded that for cohesive fracture Clearfil repair system is a better material and for adhesive fractures P and R repair material gives better results.
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CASE REPORTS Top

Implant supported prosthesis on edentulous mandible with multiple impacted teeth - a case report with 5 year follow up p. 369
Annapoorni Hariharan, Siva Prakash Dhanaraj
DOI:10.4103/jips.jips_375_18  
Multiple impacted teeth are quite often syndromically related, which could be hormonal or metabolic. It may be also due to infection, cyst, or trauma. A number of idiopathic multiple impacted teeth cases have been reported in the literature. In most of these situations, the impacted teeth are few in number. Here, we present a case with all mandibular teeth impacted. The number of reports in the literature of rehabilitation of such a clinical situation is very less. Impacted teeth can significantly complicate the rehabilitation of an otherwise straight forward case. When all teeth are impacted, the situation becomes even more complex. This case report illustrates prosthodontic rehabilitation of mandibular arch of a 24-year-old, asyndromic patient with implant-retained dentures following the surgical removal of impacted teeth. The objective of presenting this clinical report is primarily to increase the awareness, with which, the rehabilitation can be handled in a similar situation and also for the fact that such a report is a rarity.
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A low-profile universal attachment system with housing welded to metal reinforcement framework to retain mandibular implant overdenture: A clinical report p. 374
Paresh Vasant Gandhi, Bhagyashree Gurunath Kalsekar, Abhijit Ashok Patil, Nikita Shirish Kandi
DOI:10.4103/jips.jips_129_19  
Literature has proved that implant-retained overdenture is one of the best prosthetic options in the rehabilitation of complete edentulism. Tissue-supported implant-retained overdentures have been an appropriate treatment modality for atrophic mandibular ridges. In this case report, the patient presented with Class I maxillomandibular relationship and Class II Prosthodontic Diagnostic Index. The patient was concerned about esthetics as well as the retention of the lower denture. Taking into consideration the above concerns, an implant-retained mandibular overdenture was the chosen treatment modality. There are numerous attachment systems that have been used to improve the retention, stability, and support of implant-retained overdenture. Every attachment system has its own set of advantages. The OT Equator is a new line of low-profile attachment which is a radically modified OT-CAP Normo. The rationale for using this attachment is that it is considered the smallest attachment system available with the least overall dimension. It is a resilient and self-aligning attachment system which can be used in limited inter-arch space situation. OT equator derives its name from the OT Dental Laboratory (Bologna, Italy) used as a brand name. Considering these advantages, this was the chosen attachment and proved beneficial in terms of both patient satisfaction and the overall success of the treatment.
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A multidisciplinary approach for the management of temporomandibular joint disc displacement without reduction p. 379
Rashmi Kishor Jaggad, Ina Bhupesh Patel, Ronak Hemant Choksi, Khyati Bhavik Gosai
DOI:10.4103/jips.jips_284_19  
The temporomandibular joint (TMJ) is one of the primary components of the complex masticatory system. Any disturbance in the joint due to congenital or acquired causes such as trauma, pathology, or functional disturbance affects the masticatory system. This case report highlights the management of condylar hypoplasia due to trauma by forceps delivery which led to TMJ dysfunction and chronic disc displacement without reduction. A combination of stabilization appliance and arthrocentesis using platelet-rich plasma along with patient education has been proved effective for the conservative management of patients with chronic disc displacement and TMJ dysfunction.
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