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   Table of Contents - Current issue
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April-June 2020
Volume 20 | Issue 2
Page Nos. 121-223

Online since Tuesday, April 7, 2020

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EDITORIAL  

An overview on 3D printing in prosthodontics p. 121
N Gopi Chander
DOI:10.4103/jips.jips_78_20  
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REVIEWS Top

Accuracy of marginal adaptation of posterior fixed dental prosthesis made from digital impression technique: A systematic review p. 123
Hanuman Chalapathi Kumar, Tannamala Pavan Kumar, Surapaneni Hemchand, Chinni Suneelkumar, Anirudhan Subha
DOI:10.4103/jips.jips_382_19  
Aim: The aim of this systematic review was to investigate the marginal adaptation of three or four unit fixed dental prosthesis (FDP) fabricated with digital impression techniques to those fabricated using any other impression technique. Settings and Design: Database/electronic searches were conducted till August 2019 in PUBMED-MEDLINE, SCOPUS, and Cochrane library. To identify published articles, multiple keywords were used to develop a search strategy in various combinations. Manual searching of articles was also done. Clinicaltrials.gov.in WHOICTRP and CTRI websites were also searched. Two independent reviewers (TP and VK) assessed eligibility for inclusion, extracted data, and assessed quality using the Cochrane risk of bias tool. Results: Database search identified 497 citations and four citations through manual search. After removing duplicates and going through abstracts, 23 articles were perused for full-text screening. Two articles met the inclusion criteria; characteristics were described qualitatively, with two studies having overall low risk of bias. Conclusions: Marginal adaptation of FDPs fabricated using the digital and conventional impressions method was within the clinically acceptable limits. However, more robust clinical trials need to be conducted with large sample size to validate the conclusions.
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Tooth shade analysis and selection in prosthodontics: A systematic review and meta-analysis p. 131
Siddhesh Borse, Sachin Haribhau Chaware
DOI:10.4103/jips.jips_399_19  
Aim: To evaluate the methods of the dental shade selection and provide a summary of different factors affecting the shade selection. Design and Setting: The systematic review and meta-analysis. Materials and Methods: The electronic search of the peer-review articles between 2002 and 2018 was carried out the by using the PRISMA guidelines. A total twenty-one studies related to the visual shade methods, instrumental shade methods, and the factors affecting the shade selections was evaluated. The search strategy was based on the PICOS framework. Statistical Analysis: There was statistically significant heterogeneity (Q = 1038.1518, df = 20, and P < 0.0001). The statistics of fixed-effect model reported an MD of − 0.0970 (95% CI = −0.1391, −0.0549). The random-effect model reported an MD of − 0.0862 (95% CI = −0.5866, 0.4142). Result: The review evaluated the 21 studies of tooth colour science that met with the inclusion criteria and search criteria. The meta-analysis of the 21 combined studies reported acceptable homogeneity (i2 = 98%) which indicates a statistically significant difference between the treatment and control groups. Conclusion: The VES spectrophotometer reported the highest accuracy, reliability, and repeatability in shade selection followed by photo colorimetric method. The Vita 3D master shows more consistent results in repetitive shade selection. Knowledge and training of the shade selection protocol are necessary for proper shade matching
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Assessment of intraoral scanning technology for multiple implant impressions – A systematic review and meta-analysis p. 141
Saloni Kachhara, Deepak Nallaswamy, Dhanraj M Ganapathy, Vinay Sivaswamy, Vaishnavi Rajaraman
DOI:10.4103/jips.jips_379_19  
Background: Intraoral scanner (IOS) is a medical device used for capturing direct optical impressions and composed of a handheld camera (hardware), a computer and software. Digital impressions by intraoral scanning have become an increasingly popular alternative to conventional impressions. The aim of this systematic review is to assess the studies regarding the various available technologies for IOS and evaluate the most accurate IOS system for cases with multiple implants and identify the factors that can influence its accuracy. Materials and Methods: A comprehensive electronic search was done in online databases, 'Pubmed', 'Google Scholar' and 'Cochrane' based on pre-determined eligibility criteria. In-vitro studies, In-vivo studies and Randomized controlled trials assessing the accuracy of intra-oral scanner technology were selected after thorough screening. The search strategy covered all studies published until February 2019 and yielded a total of 11 articles out of which 8 studies were determined to fulfil the inclusion criteria and were selected for this review. Data extraction from the included studies was conducted by the primary author and reviewed by the second author. Results: The information collected included sample size and population, study design, intervention, scanning methods, comparisons and outcome measures. 5 out of 8 included studies compared the distance deviation of the acquired scans from the true values while the remaining 3 studies gave trueness and precision values as the outcome variables. A forest plot on scanner precision displayed slightly higher precision levels in the TRIOS scanner compared to the other intraoral scanners. Conclusion: Despite the limitations this study, it can be concluded that active wavefront sampling is more accurate than the other intraoral scanning technology employed by commercial scanners.
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Role and influence of growth factors on early osseointegration in animal jaw bone: A meta-analysis p. 153
Modhupa Ghosh, Rekha Gupta, Radhika A Jain, Rashmi Mehra, Mahesh Verma
DOI:10.4103/jips.jips_385_19  
Aim: Growth factors (GFs) are polypeptides, which are intricately involved in the regulation of bone formation, preservation, and regeneration through gene expression. However, the role of these bioactive agents in osseointegration of dental implants has not been substantially proven. The objective of this systematic review (SR) and meta-analysis was to explore the effect of GFs on early osseointegration of dental implants in animal jaws. An attempt to decipher an adjunctive role of GFs in modulating predictable bone growth in peri-implant areas was done. Materials and Methods: An electronic and manual search of different databases was performed. Only randomized controlled trials (RCTs) were included and reviewed. The risk of bias (ROB) of the selected studies was assessed using the SR Centre for Laboratory Animal Experimentation (Cochrane) tool. A meta-analysis was also performed to evaluate the different study characteristics quantitatively. Statistical Analysis used: The total Weighted mean difference was evaluated using the Rev-Manv5.3 algorithm. Chi-square test and I2 test were done to assess the heterogeneity between the studies. ] Results: Seven RCTs were included in the study. These were associated with a high ROB. The total weighted mean difference (WMD) of the percentage of bone–implant contact was 3.25% (95% confidence interval [CI] = 1.49%–6.03%; P = 0.001; I2= 91%) between groups with and without exogenous application of GFs. The total WMD of the percentage of newly formed bone area was 4.48% (95% CI = 2.31%–5.90%; P < 0.00001, I2= 84%). A high level of heterogeneity (P < 0.001 for Chi-square test; I2>50 %) among comparable studies was observed. Conclusion: The ancillary application of external GFs exhibited evidence of early osseointegration, resulting in more predictable and faster results. However, a careful discernment of conclusions drawn from this SR is a must before conducting any human trials.
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A comparison of cost and cost-effectiveness analysis of two- implant-retained overdentures versus other removable prosthodontic treatment options for edentulous mandible: A systematic review p. 162
Shubhabrata Roy, Sourav Maji, Rahul Paul, Jayanta Bhattacharyya, Preeti Goel
DOI:10.4103/jips.jips_393_19  
Aim: The aim of this study was to examine systematically the data published on the cost and cost-effectiveness of mandibular two-implant-retained overdentures compared to other removable prosthodontic treatment options for edentulous mandible. Settings and Design: It is a systematic review which analyses the available data from the prospective and retrospective studies and randomized clinical trials to find out costs and cost effectiveness of different removable treatment modalities for completely edentulous mandible . The study protocol was decided according to PRISMA guidelines. Materials and Methods: The search was limited to English literature only and included an electronic search through PubMed Central, Cochrane Central Register of Controlled Trials, and complemented by hand-searching. All clinical trials published up to August 2019 were included (without any starting limit). Two independent investigators extracted the data and assessed the studies. Statistical Analysis Used: No meta-analysis was conducted because of the high heterogeneity of data. Results: Out of the initial 509 records, only nine studies were included. The risks of bias of individual studies were assessed. Six studies presented data on cost and cost analysis only. The rest three articles provided data on cost-effectiveness. The overall costs of implant overdentures were higher than the conventional complete dentures. However, implant overdentures were more cost-effective when compared to conventional complete dentures. Single-implant overdentures are also less expensive than two-implant overdentures. Overdentures supported by two or four mini-implants were also reported as more cost-effective than conventional two-implant-supported overdentures. Conclusions: Two-implant-retained overdentures are more expensive but cost-effective than the conventional complete dentures. Two- or four-mini-implant-retained overdentures are less expensive than two-implant-retained overdentures, but there is a lack of long-term data on aftercare cost and survival rate of mini-implants. Single-implant overdentures are also less expensive than the two-implant-retained overdentures. The differences of the aftercare costs of different attachment systems for implant overdentures were not significant. There is a need of further studies on comparative cost-effectiveness of different types of implant overdentures.
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ORIGINAL ARTICLES Top

The influence of Azadirachta indica, Melaleuca alternifolia, and Cocos nucifera on Candida albicans strain in tissue conditioner at varying time intervals p. 171
Preeti Satheesh Kumar
DOI:10.4103/jips.jips_366_19  
Aim: The search for alternative therapies for oral candidiasis is a necessity and the use of medicinal plants seems to be one such promising solutions. Incorporation of phytotherapeutic agents, Azadirachta indica (neem oil), Melaleuca alternifolia oil (tea tree oil), and Cocos nucifera oil (coconut oil), were tested for their efficacy as antifungal agents against Candida albicans. Next, the efficacy of these three antifungal agents when incorporated in a soft relining material at minimum inhibitory concentration (MIC) was evaluated. Settings and Design: Evaluative - In-vitro study design. Materials and Methods: The MIC against C. albicans ATCC 24433 was calculated for M. alternifolia oil, A. indica oil, and C. nucifera oil using the broth microdilution method. Based on the preliminary screening results for MIC, tissue conditioner samples were prepared to evaluate the zone of inhibition (ZOI) and MIC. Antifungal activity of the MIC of the three oils was assessed and compared by measuring the mean ZOI. Antifungal activity of the three oils was assessed using one-way analysis of variance (ANOVA) and post hoc test. Statistical Analysis Used: Oneway ANOVA and post hoc Tukey honestly significant difference test. Results: Inhibition against C. albicans was exhibited when 20% v/v, 25% v/v, and 15% v/v of C. nucifera oil, M. alternifolia oil, and A. indica oil were used, respectively. The results of ANOVA and post hoc test at the end of 48 h and 7 days suggested that all three oils were significantly different from each other (P = 0.000) and A. indica/neem oil with 15% concentration had the best antifungal activity at the end of 48 h and 7 days. Conclusion: The antimycotic activity of M. alternifolia, C. nucifera, and A. indica mixed with the Visco-gel tissue conditioner can be used as an alternative therapy for denture stomatitis.
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Tightening torque of implant abutment using hand drivers against torque wrench and its effect on the internal surface of implant p. 180
Y Sameera, Rathika Rai
DOI:10.4103/jips.jips_425_19  
Aim: The aim of this study was to compare the torque rendered by a handheld driver and a torque wrench and thereby evaluate its effect on the internal threads of implant. Setting and Design: An in-vitro comparison of implant abutment torque using a digital torque gauge. Materials and Methods: Thirty participants were randomly selected and were asked to torque two samples of mounted abutment analogs, one using a handheld driver and other with a torque wrench. The hex was then attached to the digital torque gauge to record the amount of torque generated and the recorded values were compared. Simultaneously, impressions of the internal threads of implant were taken using light body putty material before and after torque application. The samples were viewed under a stereomicroscope and the measurement of the initial four threads was compared. Statistical Analysis Used: The data was subjected to statistical analysis using SPSS version 20.0 software. The intergroup comparison was done using one sample t-test , and the internal threads were analyzed using ANOVA statistical analysis. Results: The results obtained showed that the torque generated using a handheld driver was higher (27–43 Ncm) than that of torque wrench (28–35 Ncm). Torque wrench values were within the manufacturer's recommendation. The mean of internal thread changes of the handheld driver and torque wrench was 861.033 mm and 864.350 mm, respectively, showing an insignificant difference. One-way ANOVA test showed P < 0.01 and difference of 11 mm for posttreatment hand torque and 14 mm for posttreatment torque wrench values. Conclusions: The mechanical torque instrument showed specified torque values as recommended by the manufacturer. Consequently, the internal threads of the implants did not undergo any significant change using hand tightening or using a torque wrench.
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An in vitro study to compare the surface roughness of glazed and chairside polished dental monolithic zirconia using two polishing systems p. 186
Sneha Harishchandra Gaonkar, Meena Ajay Aras, Vidya Chitre
DOI:10.4103/jips.jips_339_19  
Aim: To evaluate the efficiency of two commercially available polishing systems in reducing surface roughness of a monolithic zirconia after clinical adjustment and to compare them to glazed zirconia. Setting and Design: In vitro study. Material and Methods: This in vitro study was conducted on 25 discs (10mm in diameter and 2mm in thickness) using monolithic zirconia (Ceramill Zolid). From 25 specimens, 5 specimens were randomly selected as the positive control. The remaining discs were abraded for 15 secs with a red band diamond finishing bur using an air rotor handpiece. Then the specimens were randomly divided into 5 equal groups of 5 specimens each. Group 1: Roughened, unpolished and unglazed. Group 2 (Positive Control): Glazed without prior roughening,Group 3: Roughened and polished with eZr polishing kit, Group 4: Roughened and polished with Optra fine ceramic polishing kit and Group 5: Roughened and glazed. The surface roughness (Ra) values (μm) were measured quantitatively by a surface analyzer. The mean values were compared using one-way ANOVA and Post Hoc Test. One specimen of each group was evaluated qualitatively under a scanning electron microscope(SEM) for surface topography. Statistical Analysis Used: One-way ANOVA and Post Hoc Test. Results: The lowest Ra value was found in Group 4-Roughened and polished with Optrafine ceramic polishing kit (Ra=0.47μm) as compared to Group 3-Roughened and polished with eZr polishing kit (Ra=0.49μm) and Group 5-Roughened and glazed (Ra=0.59μm). There was no stastistically significant difference between two polishing systems. SEM analysis of surfaces polished with Optrafine polishing kit revealed smoother and regular morphology as compared to surfaces polished with eZr polishing kit. Conclusion: The Optrafine polishing kit created more smoother and uniform surfaces as compared to surfaces polished with eZr polishing kit both quantitatively and qualitatively. Also, lowest surface roughness values were produced by optrafine ceramic polishing kit on monolithic zirconia as compared to glazed monolithic zirconia after their clinical adjustments.Thus Optrafine ceramic polishing kit can be used as alternative to glazing.
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To evaluate and compare the accuracy of definitive casts using various splinting methods on implant level impressions in All-on-Four treatment: An in vitro study p. 193
S Daya Shankar, Santosh Doddamani
DOI:10.4103/jips.jips_210_19  
Aim: The aim of this study is to evaluate and compare the accuracy of master casts obtained by different splinting techniques for implant level impressions in All-on-Four implant treatment protocol using a coordinate measuring machine. Settings and Design: The study design involves an in vitro study. Materials and Methods: In this in vitro study, a reference clear acrylic resin (AR) model comprising four regular platform implant 3.6 mm × 10.0 mm (Dentium Implant India Pvt. Ltd, Bengaluru, India) which was placed following the All-on-Four implant protocol is prepared. Impressions were categorized into three different groups: Group 1 – impression copings were nonsplinted; Group 2 – impression copings were splinted using AR sectioned 17 min after setting and rewelded with the same resin; and Group 3 – impression copings were splinted by titanium bar using an intraoral welder. A total of 33 (n = 11 in each group) impressions were made to evaluate three different splinting techniques. Impressions were poured with Type 4 dental stone. A coordinate measuring machine was used to record the x, y, and z co-ordinates and angular displacement. The measurements were compared with those obtained from the reference model. Statistical Analysis Used: One-way ANOVA test was used as a test of significance. Results: There was less linear and rotational displacement for the metal-splinted group (P < 0.001) In the x-axis, nonsplinted group showed a statistically significant difference in straight implants (2 and 3 implants) (P = 0.001) of All-on-Four treatment protocol. Conclusion: The splinting methods have a direct effect on the accuracy of definitive casts. The metal-splinted direct technique produced the most accurate casts followed by AR-splinted direct technique and nonsplinted direct technique.
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In vitro fracture resistance of zirconia, glass-fiber, and cast metal posts with different lengths p. 202
Ashutosh B Palepwad, Rahul Shyamrao Kulkarni
DOI:10.4103/jips.jips_321_19  
Aim: Post-and-core restorations require sufficient length of the post for retention of the prosthesis and root strength. The effect of different lengths of prefabricated zirconia posts (ZPs) on the fracture strength of endodontically treated teeth needs evaluation. Hence, the aim of this study was to evaluate the in vitro fracture resistance of endodontically treated incisors restored with ZP, glass-fiber (GFP), and cast posts (CP) of different lengths. Settings and Design: Comparative in-vitro study. Materials and Methods: Sixty extracted incisors were endodontically treated, tooth preparations were carried out, and the impression of the coronal portion of each prepared tooth was made using polyvinyl siloxane impression material loaded in copper tubes. The coronal portion of each tooth was removed, maintaining a 2 mm ferrule. The teeth were restored with one of the three posts: CPs, GFP, or ZPs, with intraradicular lengths of either 6 or 8 mm (n = 10). The CP and core patterns were fabricated using post space impressions and core buildup and cast using Nickel–Chromium alloy. After composite resin core buildup of GFP and ZPs treated teeth using the previously made copper tube impressions, the teeth were loaded to fracture in an oblique direction in the universal testing machine. Statistical Analysis Used: Data were analyzed using two-way ANOVA and Tukey–Kramer tests (α = 0.05). Results: The highest and lowest values of fracture resistance were reported with ZP8 and GFP6 groups, respectively. There was no significant difference in fracture resistance between the posts of length 6 mm and 8 mm in CP, GFP, and ZP groups. There was no significant difference (P = 0.953) in fracture resistance between CP (284.8 N) and ZP (258.31 N) groups, while the GFP group (160.61 N) had a significantly lower value of fracture resistance than the CP and ZP groups. Two-way ANOVA test for fracture resistance of the post systems and post lengths showed that there was no significant correlation between the post systems and post length on the fracture resistance. There was a greater percentage of favorable fractures in GFP and ZP groups (65% each), than the CP group (20%). Conclusion: For the post systems tested, extending the post length does not significantly increase the fracture resistance of the restored teeth. The ZP represents a viable alternative to the cast metal post during the esthetic restoration of endodontically treated anterior teeth.
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A study to assess communication hindrances by the means of work authorization for fixed dental prosthesis: A survey p. 208
Sneha Harish Shetty, Karuna Gajanan Pawashe, Pronob Sanyal, R Sushma
DOI:10.4103/jips.jips_475_19  
Aim: The aim of the study was to assess the hindrances in communication between the prosthodontic office and the laboratory technicians through work authorization. Setting and Design: A questionnaire-based survey was carried out to assess communication gap between dentist and lab technicians through work authorization for FDPs. Materials and Methods: A total of 114 dental laboratory technicians were provided with a questionnaire regarding work authorization form via Google doc files. The survey focused questions pertaining to fulfilling the following areas of work authorization: patient's information, name of the prescribing dentist, material for the prosthesis, pontic design of the prosthesis, shade description, and date of completion of work. Statistical Analysis Used: The number of responses received was statistically evaluated using Fisher's t-test and nonparametric Spearman's correlation coefficient (P ≤ 0.05). Results: Eighty-five (74.5%) out of 114 laboratory technicians surveyed responded to the questionnaire. The patient's general information was satisfactorily filled in 75%–100% of the forms. Information regarding the pontic design, staining diagram, and preferred margin were on the lower side of the scale ranging between 25% and 50%. Conclusions: The survey concluded that areas of work authorization with respect to fixed dental prosthesis require attention and need to be adequately filled by the dentist. In addition, the study suggests that the foundation of communication skill training programs in work authorization should be laid from the undergraduate curriculum. The concerned authorized bodies/specialty organizations should formulate a standardized work authorization format which can bridge the wide gap between the crown and bridge office and laboratory.
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CASE REPORTS Top

Mechanically retained functional prosthetic rehabilitation of partial lip necrosis: A rare clinical report p. 214
Neetu Singh, Saumyendra Vikram Singh, Deeksha Arya
DOI:10.4103/jips.jips_301_19  
Prosthetic rehabilitation plays a crucial role in restoring patients with facial defects to normalcy. Although comprising a small proportion, lip defect plays a pivotal role in drastically diminishing the quality of life of the patient, both functionally and socially, with dwindling confidence and self-esteem. Patients may experience speech impairment, uncontrolled drooling, and unesthetic appearance. In addition, constant exposure of tissues to air leads to drying and crusting of lips. This rare case report of a patient with partial lip necrosis describes her functional, mechanically retained prosthetic rehabilitation, which improved phonetics, esthetics, and function without the need of additional retentive features, increasing convenience and ease of use by the patient and at the same time cutting down cost.
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A new approach for better anterior esthetic using platelet-rich fibrin as sole graft material combined with ovate design dental bridge p. 219
Muaiyed Mahmoud Buzayan, Haydar Majeed Mahdey, Chong Jun Ning
DOI:10.4103/jips.jips_264_19  
Alveolar ridge deficiency is considered a major esthetic limitation, especially in the maxillary anterior region. Several approaches have been developed to enhance and increase the soft-tissue volume. Among those approaches are connective tissue grafts, platelet-rich fibrin (PRF) membrane and implying the guided bone regeneration concept. The PRF grafting technique was employed in this clinical case to improve and enhance the anterior esthetic without the need for the bone graft and augmentation. This article describes the use of PRF as a sole grafting material for both socket and soft-tissue augmentation for a 23-year-old male, who had an accident 8 years ago while he was playing a basketball, which caused his upper front teeth to be intruded and discolored. The upper left central tooth suffered a major external root resorption; hence, it was extracted. PRF was prepared and packed in and extruded out of the socket. This was combined with ovate design provisional bridge. Ten days, 1 month, 3 months, and 6 months postoperative review showed a significantly well-progressed healing. According to the encouraging result obtained in this clinical case in regard to tissue healing and esthetic, the PRF can be a potential sole graft material for small anterior deficient areas. This may reduce the need of bone augmentation and graft in such selected cases.
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