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   Table of Contents - Current issue
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July-September 2020
Volume 20 | Issue 3
Page Nos. 225-334

Online since Friday, July 17, 2020

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EDITORIAL  

Deciphering the opinions in full mouth rehabilitation p. 225
N Gopi Chander
DOI:10.4103/jips.jips_280_20  
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REVIEWS Top

Effect of proton pump inhibitors on dental implants: A systematic review and meta-analysis p. 228
Dileep Nag Vinnakota, Rekhalakshmi Kamatham
DOI:10.4103/jips.jips_283_19  
Aim: The present systematic review aims to determine the evidence on the impact of proton pump inhibitors (PPIs) on dental implants. Settings and Design: This secondary qualitative and quantitative research was done using a pre-specified question and inclusion criteria. Materials and Methods: A systematic search was conducted in electronic databases such as PubMed, Ovid, and Cochrane. All the studies that assessed the effect of PPIs on dental implants were included, irrespective of the design. Literature review, letter to editors, short commentaries, and opinion articles were excluded. Results and Statistical Analysis Used: A total of three publications fulfilled the inclusion criteria. All these included articles were retrospective cohort studies; the methodological quality was assessed using Newcastle–Ottawa scale. A total of 452 implants were placed in 149 PPI users, whereas 6798 were positioned in 2241 nonusers. Of these, 43 and 212 implants failed in users and nonusers, respectively (odds ratio: 2.91, 95% confidence interval: 2.06–4.11). The meta-analysis was performed using the statistical software Review Manager, and a fixed-effect model was used to obtain the odds ratio. The success rate of implants based on age, gender, smoking, and bone augmentation could be combined only from two studies, which revealed a considerable effect of these factors. Conclusion: As far as the available evidence is considered, it seems as if the usage of PPI has a detrimental effect on the success of dental implants. This influence needs justification as none of the included studies segregated the data based on confounding factors. Hence, there is a need to conduct well-designed, prospective, randomized clinical trials with balanced confounding factors to derive a proper conclusion.
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Utility versus futility of facebow in the fabrication of complete dentures: A systematic review p. 237
Poonam Prakash, Kirandeep Singh, Rahul Bahri, SK Bhandari
DOI:10.4103/jips.jips_402_19  
Aim: The aim of this review was to investigate utility or futility of facebow for fabrication of complete denture prosthesis to maximise clinical efficiency and acceptability of complete dentures. Settings and Design: Systematic review following PRISMA guidelines. Materials and Methods: A study question was designed based on PICOT model which was used to evaluate whether facebow transfer is required or not for fabrication of complete denture prosthesis. An extensive search was carried out manually and using electronic databases such as PubMed-Medline, Cochrane, Google Scholar, and Clinicaltrials.gov. Parameters under review included patient satisfaction, masticatory efficiency, occlusal adjustments, clinician time, stability and retention. Boolean operators, MeSH terms and limiters were applied to develop the search and reach to conclusive studies pertaining to study design. Literature dated between 1950 and 2019 were selected. The data extraction and assessment of the studies was done by two independent investigators. Statistical Analysis Used: No meta-analysis was conducted due to heterogeneity of data obtained. Results: 13690 studies were shortlisted, 13672 were excluded based on title and abstract. By the end of search phase, 07 RCTs were considered relevant. 04 studies concluded comparable/ no differences in outcome with and without use of facebow for fabrication of complete denture prostheses, whereas 03 studies concluded better results without the use of facebow. Conclusion: The use of facebow results in fabrication of complete denture prostheses with similar results in terms of clinical efficiency and patient acceptability as compared to simplified techniques using anatomical landmarks. Variations in assessment criteria, non uniform distribution of sample size amongst different clinical trials and subjective questionnaire based criteria are the weaker links in the review. Extensive research and long term standardised studies with objective criteria for assessment are required for comprehensive and conclusive results to establish the need for change in clinical practice.
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Effect of nanoparticles on color stability and mechanical and biological properties of maxillofacial silicone elastomer: A systematic review p. 244
Nithin Kumar Sonnahalli, Ramesh Chowdhary
DOI:10.4103/jips.jips_429_19  
Aim: The aim of this systematic review was to evaluate the effect of addition of various nanoparticles into maxillofacial silicone elastomer on color stability and mechanical and biological properties of the silicone elastomer. Settings and Design: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines(PRISMA). Materials and Methods: The electronic database search in MEDLINE/PubMed was based on population (silicone elastomer), intervention (nanoparticles), comparison (unreinforced silicone elastomer with nanoparticle-reinforced silicone elastomer), outcome (color stability and mechanical, physical, and biological properties), i.e., PICO framework. The key words used are (”maxillofacial silicone” OR “silicone elastomer” OR “facial silicone”) AND (”nanoparticles” OR “Nano-oxides”) AND (”colour stability” OR “Hardness,” “tensile strength” OR “tear strength” OR “antifungal activity”). Results: The database search resulted in 2099 studies, of which 2066 articles were excluded as they were irrelevant, duplicates, and data were not available. The remaining 33 full-text articles were assessed for eligibility, out of which 2 articles were in Chinese language, 3 articles were thesis documents, and 8 were review articles. A total of 12 articles were excluded and the remaining 20 articles were included. One article was yielded by hand search of references of included studies. A total of 21 studies were included in the present systematic review. Conclusion: With the available evidence in the literature, it can be concluded that addition of nanoparticles at various concentrations may improve the physical and mechanical properties and color stability of the prosthesis made from the silicone elastomers.
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A systematic review and meta-analysis of the attachments used in implant-supported overdentures p. 255
Sachin Haribhau Chaware, Smruti Tushar Thakkar
DOI:10.4103/jips.jips_368_19  
Aim: To evaluate the survival rate, tissue response, and patient satisfaction of different attachments used in implant overdenture. Settings and Design: Systematic Review and Meta-analysis. Materials and Methods: Electronic search of peer-review articles published between 2001 and 2019 assessing the attachments used for implant-supported overdentures was done according to PRISMA Guidelies. The review evaluated sixteen articles related to survival of the attachments, the reaction of the soft and hard tissues along with repair and maintenance of the attachments, and overall performance of the overdenture attachments. Statistical Analysis Used: There is statistically significant heterogeneity (Q =374.7403, df = 15, and P < 0.0001). The statistics of fixed-effect model reported an MD of − 0.0880 (95% CI = −0.1536; 0.0225). Result: The review evaluated the 16 articles that met with the inclusion and search criteria. The studies were the combination of bar and ball attachments and their subtypes, magnetic and bar attachments, and locator in combination with other attachments. The meta-analysis of combined 16 studies reported acceptable heterogeneity among 16 studies (I 2 = 96%) and reported to be statistically significant (P < 0.01). Conclusion: The survival rate of attachments was in the range of 95.8%–97.5% for bar, 96.2%–100% for ball, 90%–92% for magnet and locator attachments were in the range of 97% after a mean follow-up period of 3 years. The bar attachments reported moderate tissue reaction in the form of mucosal changes, gingival inflammation, and bone resorption. The locator attachments require higher maintenance and repair. The magnetic attachments produce higher bone resorption and readily displace under functional force. Patient satisfaction and compliance was higher for ball, locator, and bar attachments as well as low for magnetic attachment. Thus, the ball and locator attachments excellently perform in terms of survival rate, tissue response, and patient satisfaction.
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Choosing the denture occlusion - A Systematic review p. 269
Ritika Bhambhani, Shubha Joshi, Santanu Sen Roy, Aditi Shinghvi
DOI:10.4103/jips.jips_409_19  
Aim: The aim of the study is to acquire evidence for the choice of occlusion with anatomic/modified anatomic teeth in complete denture prosthesis. Settings and Design: Systematic review following PRISMA guidelines. Materials and Methods: The study reviewed original articles on various occlusal schemes bilateral balance occlusion (BBO), lingual occlusion (LO), Canine guided occlusion (CG), posterior group function occlusion (PGFO) have been applied to the complete dentures and were analyzed for the objective or subjective or both evaluations. The data were collected in standard format with the needed information such as year of publication, type of study, occlusal schemes compared, test methodology used, sample size for experiment and control, assessment of retention, stability, and other factors which determine the quality of life and period of follow-up. The risk of bias was calculated using tools RoB2.0 and robvis. At all stages, the inclusion and exclusion of studies were discussed among the reviewers. Statistical Analysis used: Due to the heterogeneity in the data of the included studies no statistical analysis was used. Results: Of the 1896 articles screened only 17 studies were included in the systematic review. These were discussed amongst the reviewers regarding the various occlusion schemes used. The subjective and objective criteria used in the studies was tabulated separately. They were then analyzed for the risk of bias using the robvis 2 tool. Conclusion: No scheme is more superior to the other with the anatomic tooth forms. The use of alternative unbalanced schemes produces a similar satisfactory clinical outcome. The ridge classification also has a significant role to play in the preference for an occlusal scheme.
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Nonmetal clasp dentures: What is the evidence about their use? p. 278
Inti Mendoza-Carrasco, Juliana Hotta, Carolina Yoshi Campos Sugio, Andréa Lemos Falcao Procópio, Vanessa Migliorini Urban, Victor Mosquim, Gerson Aparecido Foratori-Junior, Simone Soares, Karin Hermana Neppelenbroek
DOI:10.4103/jips.jips_459_19  
The aim was to discuss the indications, contraindications, advantages, and disadvantages of Nonmetal clasp dentures (NMCDs), as well as the most relevant properties of its constituent materials. A search was conducted using the keywords: “nonmetal clasp dentures,” “thermoplastic resin,” “flexible resin removable partial denture,” “polyamide,” and “nylon” in databases PubMed/Medline, Lilacs, SciELO, and textbooks between 1955 and 2020. Theses and texts without reliable sources of publication were excluded. Once the analysis instruments were determined, the data were analyzed and discussed. NMCDs present high flexibility, easy adaptation to the abutments, color compatibility and biocompatibility with the oral mucosa, and absence of visible metal clasps. However, they need laboratory relining, grinding, and polishing, do not have criteria for its planning, become rougher and stained over time, and are able to traumatize supporting tissues. The association with metal components seems to be an alternative to increase the success of NMCDs by combining esthetics and biomechanical principles of conventional removable partial dentures. The lack of long-term clinical studies makes the professionals to rely solely on previous experiences or on the manufacturers' recommendations. It suggested that NMCDs must be indicated with caution when not used temporarily.
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ORIGINAL ARTICLES Top

Evaluation of flexural strength of Zirconia using three different connector designs: An in vitro study p. 285
Mohammed Samiuddin Ahmed, Kareti Mahendranadh Reddy, Y Mahadev Shastry, S Venkat Aditya, P Jayakrishna Babu
DOI:10.4103/jips.jips_68_20  
Aim: The aim of this study is to evaluate the flexural strength of zirconia using three different connector designs under vertical and oblique loads. Setting and Design: Invitro - analytical study. Materials and Methods: For simulating zirconia fixed partial prosthesis, a specimen with three octagonal cylinders connected with each other was designed. Each face of the octagon was 3.75 mm ± 0.1 mm, and the total width was 9 mm ± 0.1 mm with a standard connector area of 10 mm2 at cross-section. Three different connector designs, i.e., round, oval, and triangular were milled. Universal testing machine was used to test flexural strength with vertical and oblique forces. Statistical Analysis Used: Intergroup comparison of flexural strength was made using Descriptive statistics (1) one-way ANOVA, Bonferroni's post hoc test (2) Kruskal–Wallis test. The confidence interval was set at 95%, P < 0.05 was considered statistically significant for both the tests. Results: The highest flexural strength was observed in the triangle connector with vertical forces and lowest with oblique forces. Conclusions: Triangle connector design proved to be better than round and oval connectors on the application of vertical loads. Round connector design proved to be better than triangle and oval connector on application of oblique loads.
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Evaluation of oral stereognosis, masticatory efficiency, and salivary flow rate in complete denture wearers p. 290
K Manju Mary, Babu Cherian
DOI:10.4103/jips.jips_453_19  
Aim: The aim of the present study was to evaluate the improvement in oral stereognostic ability, masticatory efficiency, and difference in salivary flow rate in nonexperienced denture wearers, before, after, and 6 months after rehabilitation with complete dentures. Settings and Design: Invivo – Observational study. Materials and Methods: Seventy edentulous subjects were selected who came for rehabilitation with complete dentures for the first time. The study was conducted in three stages–before denture insertion, after denture insertion, and 6 months after denture insertion. Oral stereognostic ability was evaluated by asking the subjects to identify six heat cured acrylic resin samples by oral manipulation without seeing it. The unstimulated salivary flow rate was estimated by measuring the time taken to collect 5 ml of the whole saliva. Masticatory efficiency of the subjects was assessed with the help of preweighed chewing gums. The chewing gums were desiccated after the chewing strokes and weighed again. Statistical Analyses Used: Data were tabulated and analyzed statistically using pairedt-test, one-way ANOVA test, and the post hoc test. Results: Oral stereognostic ability increased immediately on insertion of complete dentures and was still higher 6 months post insertion of dentures. Comparison of the means of masticatory efficiency after denture insertion and 6 months after denture usage gave highly significant values (p<0.001). The salivary flow which increased immediately following denture insertion returned to almost normal 6 months after denture insertion. Conclusion: The study support the hypothesis that the presence of dentures improve oral sterognostic ability and masticatory efficiency.
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An evaluation of antimicrobial potential of irreversible hydrocolloid impression material incorporated with chitosan p. 297
Yenumula J. B Manikyamba, A V. Rama Raju, M C. Suresh Sajjan, P Arun Bhupathi, D Bheemalingeswara Rao, Jampana V. V. S. N Raju
DOI:10.4103/jips.jips_50_20  
Aim: To evaluate the antimicrobial potential of irreversible hydrocolloid impression material manipulated using chitosan impregnated solution at various time intervals. Setting and Design: Evaluative invivo study design. Materials and Methods: Maxillary impressions made for 20 dentulous volunteers using irreversible hydrocolloid impression material manipulated using distilled water as control and using 1% chitosan impregnated solution as test group using stock metal trays with one-week interval. Bacterial samples were collected using dry sterile cotton swab in the mid-palatal region at the time intervals of 0, 10, 20 minutes. Bacterial swabs were inoculated on nutrient agar media and incubated at 37° C for 24 hours. Bacterial colonies were counted with the aid of colony counter. Statistical Analysis Used: The resultant data was subjected to statistical analysis using repeated measures ANOVA and independent t test. Results: Adding water soluble chitosan to irreversible hydrocolloid impression material resulted in superior antimicrobial activity. With the passage of time there was a significant decrease in the microbial colony count upto 10min (p=0.016). However, the rate of decrease of microbial colony count was statistically insignificant between the samples collected at 10 and 20 min. Conclusion: Incorporation of water soluble chitosan to irreversible hydrocolloid impression material showed significant antimicrobial activity in 10 minutes.
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Socket preservation with demineralized freeze-dried bone allograft and platelet-rich fibrin for implant site development: A randomized controlled trial p. 304
Ridhima Dhamija, Vibha Shetty, K Vineeth, Rakesh Nagaraju, Roopa S Rao
DOI:10.4103/jips.jips_2_20  
Aim: This in vivo study compared clinical, histological, and radiological differences in bone formation in human extraction sockets grafted with demineralized freeze-dried bone allograft (DFDBA) and platelet-rich fibrin (PRF), with nongrafted sockets and bone–implant contact (BIC) at 3 and 6 months after implant placement. Settings and Design: Randomised controlled trial. Materials and Methods: The study comprised thirty posterior teeth sockets in either arch in patients ranging from 25 to 60 years. The patients were divided into two equal groups – Group I: control group wherein no graft was placed and the extraction socket was left to heal normally and Group II: test group in which DFDBA and PRF were placed after extraction. 12–16 weeks after extraction, a trephine biopsy was done just prior to implant placement, followed by implant placement. Cone-beam computed tomography (CBCT) at 3 and 6 months after implant placement was done to assess BIC. Statistical Analysis Used: Descriptive and Inferential statistical analysis was done. Parametric test: Independent t-test was used for intergroup analysis and dependent t-test for intra-group analysis. Results: Lower buccal bone levels were seen in the control group versus test group at all intervals though moderately significant. Lingual bone levels significantly reduced at all the three intervals for the control group as compared to the test group. Ridge width in both groups reduced in a time span of 6–7 months without any significant difference. Better bone conversion was noted in the preserved sockets. The preserved sockets also showed better BIC 3 months after implant placement and loading. Conclusion: Indigenously developed DFDBA material shows promising results as an osteoinductive material.
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Comparative evaluation of biting force and chewing efficiency of all-on-four treatment concept with other treatment modalities in completely edentulous individuals p. 312
Romesh Soni, Himanshi Yadav, Abhishek Pathak, Atul Bhatnagar, Vikram Kumar
DOI:10.4103/jips.jips_464_19  
Aim: To compare and evaluate biting force and chewing efficiency of all-on-four treatment concept, implant-supported overdenture, and conventional complete denture. Settings and Design: Invivo – comparative study. Materials and Methods: A total of 12 edentulous patients were included in the study and conventional complete dentures were fabricated. Patients were divided into two groups. In Group 1, complete dentures were replaced with implant-supported overdenture, and in Group 2, complete dentures were replaced with hybrid denture supported by all-on-four treatment concept. The biting force was assessed using a bite force sensor and electromyographic recordings were made by electromyogram for masticatory muscles when chewing three different consistencies of foods. Statistical Analysis Used: The data was statistically analyzed using software SPSS version 22.0. Paired t-test was used for intra-group comparison and unpaired t-test was used for intergroup comparison. Results: The difference in biting force and chewing efficiency for all-on-four treatment concept was statistically significant for overdenture and complete denture. The highest biting force and chewing efficiency were observed for all-on-four treatment concept, followed by implant-supported overdenture and complete denture. Conclusion: The study concluded that the completely edentulous individuals with atrophic posterior alveolar ridges can be rehabilitated successfully with improved biting force and chewing efficiency by All-on-four treatment concept.
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CASE REPORTS Top

Anchored guided rehabilitation p. 321
Minal Sanjay Kumthekar, Pronob Kumar Sanyal, Shivsagar Tewary
DOI:10.4103/jips.jips_311_19  
The loss of mandibular continuity leads to difficulty in swallowing, problems in mastication, altered mandibular movement, impaired speech articulation, and cosmetic disfigurement. Rehabilitation of such patients becomes more challenging in the case of complete edentulous maxillary and mandibular arches due to a lack of support and anchorage. This case report describes prosthetic rehabilitation of completely edentulous arches with segmental mandibulectomy. Hence, the anchorage was provided with the help of osseointegrated implants in both the maxillary and mandibular arches. Deviation of the mandible toward the unresected side during mastication and other functions was corrected using a palatal ramp. An attempt was made for prosthetic rehabilitation of mandibulectomy defect which required a multidisciplinary approach and which fulfilled the patient's requirement of mastication.
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Prosthetic management of a hemimandibulectomy patient using tilted implant protocol with 3-year follow-up p. 326
P Venkat Ratna Nag, Tejashree Bhagwatkar
DOI:10.4103/jips.jips_415_19  
Surgical resection of the mandible due to the presence of benign or malignant tumor commonly results in the deviation of the remaining mandible toward the defective side. Based on the location and extent (mandible), various surgical approaches such as marginal, segmental, and hemi or subtotal or total mandibulectomy can be executed. The restoration of normal form, function, and esthetic is often challenging in the prosthetic rehabilitation of patients with hemimandibulectomy. A 36-year-old male patient reported with a chief complaint of difficulty in eating and speech. Past dental history of the patient revealed ameloblastoma of the left mandibular alveolus, which was surgically operated 6 years back with a wide resection of the tumor with left-sided hemimandibulectomy without disarticulation and reconstruction with an osteocutaneous free fibula flap (from the right leg) fixed with a screw plate system. This case report suggests that the rehabilitation of surgically resected patients using tilted implant technique can reach a desirable prosthetic outcome. This clinical report describes prosthetic management (implant-supported fixed prosthesis) of a hemimandibulectomy patient using tilted implants and screw-retained prosthetic solutions using multiunit abutments. It improves speech, masticatory efficiency, and esthetics without any further deviation of the mandible with a 3-year follow-up.
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Graftless solution for multiple unfavorably placed implants using dynamic abutment® solutions: A case report with a 3-year follow-up p. 331
Chandrasekhar Nakka, Soujanya Kollipara, Kothuri Naga Ravalika
DOI:10.4103/jips.jips_362_19  
The employment of implant-supported crowns and bridges has become a well-established and preferred approach in replacing missing teeth. A favorable implant position is mandatory to obtain good esthetic results and ideal emergence of screw access hole. Usually, unfavorably placed implants are the result of insufficient bone volume which leads to implant trajectory in the available bone. Once placed, they are restored giving a cement-retained prosthesis to avoid labial/buccal screw access holes. A graftless solution for this scenario may be using an angulated screw channel technology which corrects the prosthetic screw access hole emergence in an alternative direction which is more esthetic and acceptable. Dynamic Abutment® Solutions system is unique and exclusive and can be used as a true alternative to titanium-angulated abutments or customized Ti abutments designed through computer-aided design and computer-aided manufacturing technologies. The Dynamic Abutment® solutions system rectifies angulation issues with millimetric precision up to 30° with full freedom of movement. This case report explains a case where a two-implant supported fixed partial denture was employed in the esthetic zone using Dynamic Abutment® Solutions system with angulation rectification by a graftless procedure.
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