Dental Journal of Advance Studies

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Volume 12, Number 1, January-April 2024
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Bhagavandas Rai

Navigating the Future: Challenges and Strategies for Dentistry in India

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/djas-12-1-iv  |  Open Access | 



Shaimaa N Elshaboury, Yosra H Refai, Ghaliah S Almutairi, Eman Monier, Ahmad Alsaeed

Patient Awareness and Attitude toward Replacing Missing Teeth with Dental Implants

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:7] [Pages No:1 - 7]

Keywords: Awareness, Dental implant, Missing teeth

   DOI: 10.5005/djas-11014-0032  |  Open Access |  How to cite  | 


Aims and background: To assess the knowledge level and attitude of the Saudi population toward the use of a dental implant as alternative treatment for replacing missing teeth. Materials and methods: A questionnaire-based study will be performed on 100 patients, both male and female, ranging in age from 20 to 50 to assess the Saudi population's degree of attitude and expertise on replacing missing teeth with implants. Researchers conducted in-person interviews with respondents using questionnaires that are administered by researchers. A paper and pen version of the questionnaire will be provided. Results: The awareness of dental implants among the 100 participants increased between the ages of 20 and 30, additionally with high educational levels males and females. Social media and advice are sources of information for both sexes. The primary issue with implants, for both males and females, is their high cost. Conclusion: Adequate knowledge for patient and attitude toward dental implant as substitute for lost tooth. To ensure accurate scientific data, to ensure accurate scientific data, dentists should take an active role in educating and counseling potential implant patients. Study's significance: Dental implants are reorganized as a prosthetic treatment for partially and completely edentulous patients. The dentists play important role in this aspect and this can be achieved by conducting educational programmers for patients. Implications: Awareness of patients toward missing teeth and its sequence requires more emphasis, special efforts are needed to improve the knowledge of dental implants among the less educated population.



Iflah Javed, Rishika Thakur, Sameer Makkar, Shabnam Negi, Neha Menrai, Vanshish Sankhyan

Comparative Evaluation of ProTaper Gold, TruNatomy, and XP-endo Shaper Instruments on Dentinal Microcrack Formation: Scanning Electron Microscope Study

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:5] [Pages No:8 - 12]

Keywords: Dentin, Electron scanning microscopy, Endodontics, Nickel–titanium alloy, Root canal

   DOI: 10.5005/djas-11014-0036  |  Open Access |  How to cite  | 


Aim: The aim of this study was to compare dentinal crack formation in root canal walls after instrumentation with TruNatomy (TN), XP-endo Shaper (XP), and ProTaper Gold (PTG) files under a scanning electron microscope (SEM). Materials and methods: A total of 24 single-rooted teeth were selected. Teeth with any detectable fractures or cracks, calcifications, or previous root canal procedures were excluded. The teeth were randomly divided into three experimental groups (n = 8) as follows: Group A: TN, Group B: PTG, Group C: XP. Following root canal procedures, irrigation with water was used to section the roots at 3, 6, and 9 mm from the apex. To check for cracks, the pieces were examined under an SEM at a magnification of 100× in all directions. The data were analyzed using the Chi-square test. Results: ProTaper Gold produced a greater number of cracks than TN and XP files. There was a statistically significant difference in microcracks produced by PTG, XP-endo, and TN at coronal and apical levels (p = 0.001), while at middle level it was non-significant. Conclusion: All files produced dentin cracks, however, PTG produced the highest number of cracks, followed by TN and XP.



Gurkiran Kaur, Purshottam Jasuja, Shveta Munjal, Heena Khurana, Ekta Gakhar, Suman Sharma

Comparison of Fracture Resistance and Quality of Lateral Condensation Obturation in Traditional and Conservative Access Cavity Preparation: An In Vitro Study

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:8] [Pages No:13 - 20]

Keywords: Conservative endodontic cavity, Dye penetration, Fracture resistance, Lateral condensation, Radiovisiography, Stereomicroscope, Traditional endodontic cavity

   DOI: 10.5005/djas-11014-0041  |  Open Access |  How to cite  | 


Introduction: Access cavity preparation is indeed a pivotal step in successful endodontic treatment. It ensures efficient removal of diseased or infected tissue, facilitates thorough cleaning, and enables effective shaping and sealing of the root canal system, therefore eventually giving favorable results of the treatment. Conservative endodontic cavity (CEC) preparation aims to reduce the removal of tooth structure while still providing access to the root canal system. Unlike traditional endodontic cavity (TEC) preparation, where the roof of the pulpal chamber is detached, CEC focuses on preserving as much of the tooth architecture as possible, including pericervical dentin. The primary goal is to locate and access the canal orifices while maintaining the integrity of the tooth. Lateral compaction (LC) has been the most widely used root canal obturation technique. Thus, the study objective is to compare the fracture resistance by a universal testing machine (UTM) and to evaluate the compaction quality of lateral condensation (LC) obturation using radiovisiography (RVG) and stereomicroscope. Objectives: • Evaluation and correlation of fracture resistance of endodontically treated teeth with traditional vs conservative endodontic/access cavity preparation in permanent mandibular molars. • To analyze and compare compaction quality of LC obturation in teeth with Traditional vs Conservative endodontic/access cavity preparation in permanent mandibular molars. Materials and methods: Forty extracted permanent mandibular molars were gathered for the study. Through random allocation, they were split into two main groups, group I and group II, each comprising 20 teeth. These groups were then subdivided into two additional subgroups, denoted as group Ia, Ib, group IIa, and IIb, allowing for nuanced examination within the experimental framework. In group I, samples were prepared for determination of fracture resistance. In group Ia TEC was prepared and in group Ia CEC were prepared. Class II mesio-occlusal cavities were prepared for both group Ia and Ib. In group II, samples were prepared for the determination of the compaction quality of LC obturation. In group IIa TEC were made and in group IIb CEC were prepared. A UTM, was employed to test for fracturing for samples in group I, a constant compressive pressure was applied on the central fossa at a 15° angle in the lingual direction to the long axes of the teeth. The speed of pressure application was set at 1 mm/min using a 6 mm round-head tip as before the fracture. Those particular pressures that consequently resulted in concomitant fracture were noted down in Newton units. For compaction quality testing, in group II all samples were subjected to radiographic evaluation in both buccolingual (BL) and mesiodistal (MD) views for the quality of obturation using a four-point scale (Kersten et al. 1987) and then evaluated under stereomicroscope for apical dye penetration (microleakage evaluation) using (WP Saunders et al. 1993) criteria. The data collected was statistically analyzed. Results: In terms of fracture resistance, group Ib CEC showed higher fracture resistance as compared to group Ia TEC. Whereas, in terms of compaction quality of LC obturation, the group IIa TEC and group IIb CEC showed that, there were no noteworthy differences between compaction quality of LC obturation technique (both radiographic evaluation and microleakage evaluation). Conclusion: Due to pitfalls of aforesaid in vitro study, it may be summarized as: • The greater fracture resistance was recorded for CEC treated teeth, those made with the endodontic procedure when compared with teeth made by employing TEC preparative method. • A notable distinction in fracture resistance was observed between TEC and CEC endodontic cavity approaches. • There was no significant difference between the compaction quality of LC obturation technique of TEC and CEC procedures.



Suman Sharma, Purshottam Jasuja, Heena Khurana, Shveta Munjal, Ekta Gakhar, Gurkiran Kaur

Comparative Evaluation of Sealing Ability and Pushout Strength of Four Different Furcation Repair Materials: An In Vitro Study

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:8] [Pages No:21 - 28]

Keywords: Biodentine, Calcium-enriched material cement, Cention N, Dye extraction, Furcation repair, Perforation, Pushout strength, Spectrophotometer, Stereomicroscope

   DOI: 10.5005/djas-11014-0040  |  Open Access |  How to cite  | 


Introduction: In endodontic practice, technical accidents are commonly encountered such as furcation perforation. For everlasting success, furcation perforations shall be corrected rapidly with an ideal perforation sealing material. For an ideal perforation sealing material, the desirable properties include an adequate seal, minimal microleakage, good biocompatibility, high pushout strength, stability in blood-contaminated areas, bactericidal, induction of mineralization, osteogenesis, and cementogenesis, radio-opacity and ease of clinical manipulation. Mineral trioxide aggregate (MTA) is the commonly used furcation repair material, but it presents sundry clinical shortfalls for instance prolonged setting time, difficulty in handling, and tooth discoloration. To remodel the attributions of MTA, new materials have been introduced which include Biodentine, calcium-enriched material (CEM) cement, and Cention N (CN). Biodentine is used as a dentin substitute because of its excellent sealing potential, high compressive strength, high pushout strength, less setting time, good biocompatibility, and biomineralization properties. Calcium-enriched material cement is a water-based tooth-colored material that yields a biological glue, is biocompatible, and ability to induce osteogenesis and cementogenesis. Cention N is an “alkasite” restorative material, like compomer or ormocer materials. It is radiopaque and releases ions such as fluoride, calcium, and hydroxyl. Objectives: To evaluate and equate the sealing capability and pushout strength of ProRoot MTA, CEM cement, CN, and Biodentine as furcation perforation repair materials. Materials and methods: A total of 60 extracted permanent mandibular molars were collected, and furcation perforations were made between the roots in a standardized manner. Based on kind of perforation repair material, samples were arbitrarily categorized into four discrete groups having 15 teeth each. In group I, samples were restored with ProRoot MTA. In group II, samples were restored with CEM Cement. In group III, samples were repaired with CN, and in group IV, samples were revived with Biodentine. After which, five samples from each group were selected for sealing ability testing using the dye extraction method by spectrophotometer, five samples from each group were selected for microleakage testing using the dye infiltration method followed by sectioning and evaluation of the sectioned samples by stereomicroscope, and five samples from each group were selected for Pushout strength evaluation by embedding them in acrylic using polyvinyl chloride (PVC) molds and subjecting them to universal testing machine. The data collected was statistically analyzed. Results: The mean spectrophotometric dye absorbance was significantly higher in CN followed by CEM cement and dye absorbance was least in ProRoot MTA and Biodentine. Infiltration loss was significantly higher among ProRoot MTA and Biodentine compared to CEM cement and CN. The mean pushout strength was significantly higher in Biodentine followed by ProRoot MTA and CN and it was the least in CEM cement. Conclusion: Biodentine showed the best sealing ability and highest pushout strength among the four materials used, that is, MTA, CEM cement, and CN. Therefore, Biodentine can be used as a replacement for MTA, CEM cement, and CN as a furcation perforation repair material.



Nidhi Chandel, Ajay Mahajan, Kanwarjit S Asi, Monika S Walhe

Managing Periodontitis with Host Modulation Therapy: Current Concept and Future Perspective

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:5] [Pages No:29 - 33]

Keywords: Host modulating agents, Host modulation, Pathogenesis of periodontitis, Periodontology

   DOI: 10.5005/djas-11014-0035  |  Open Access |  How to cite  | 


As our basic knowledge of the etiopathogenesis of periodontitis has improved over the past years, it has become evident that the periodontal disease is multifactorial disease caused by the bacteria which establishes the immune reaction in the host. This initiation of the host response leads to destruction of the surrounding periodontium which ultimately results in tooth loss. An ever-increasing research in the field of pathogenesis of periodontitis has revealed that the initial breakdown in chronic inflammatory periodontal disease often involves a failure of resolution pathways in order to restore host's homeostasis. The practice of modulating the host response to control periodontal disease has been employed for many years not only for the periodontal disease but also for various medical conditions. As a result, the goal of this review is to provide an overview of existing findings on host modulation therapies (HMTs). In addition, to describe some of the recent advances made over the years in the field of HMTs and to determine some pertinent conclusions about its involvement in disease development and its use in clinical therapy. This will provide a chance for more detailed investigation in this particular field. As a result, the goal of this review is to describe the current findings available in the literature on HMT.



Nilam V Honaje, Nupur S Ninawe, Ritesh R Kalaskar, Avani R Doiphode, Shruti Balasubramanian, Suyash S Joshi

Clinical Effectiveness of Precooling Agent (Ice) and Topical Anesthetic Gel in Reduction of Pain Before the Intraoral Anesthetic Injection in Children—A Systematic Review and Meta-analysis

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:10] [Pages No:34 - 43]

Keywords: Benzocaine gel, Ice, Lignocaine gel, Precooling, Topical anesthetic gel

   DOI: 10.5005/djas-11014-0034  |  Open Access |  How to cite  | 


Aim: Clinical effectiveness of precooling agent (ice) and topical anesthetic gel in reduction of pain before the intraoral anesthetic injection in children—a systematic review and meta-analysis. Background: Topical anesthesia plays a crucial role in pediatric dentistry to mitigate the discomfort and anxiety associated with local anesthesia injections. Numerous strategies have been investigated to minimize pain perception during injections. In this systematic review, the focus is on comparing the efficacy of application of local anesthetic gel and cooling the injection site with ice. Materials and methods: Research question: Are precooling agent (ice) more effective than topical anesthetic gel (Benzocaine or lidocaine) in reduction of pain before the intraoral anesthetic injection in children? Research protocol: This systematic review followed the recommendation of PRISMA guideline 2020. Literature search: An electronic search of the databases was performed to find the effectiveness of precooling agent (ice) and topical anesthetic gel (benzocaine and lidocaine) in reduction of pain before the intraoral anesthetic injection in children aged between 5 and 10 years. Data extraction: Authors independently extracted the data from the eight included studies based on the inclusion criteria. Quality appraisal: The risk of bias was assessed using a tool developed by the Cochrane Collaboration for randomized clinical trial studies. Results and interpretation of results: After conducting a search, 305 published studies were identified. Following the elimination of duplicate studies and a thorough analysis of full-text articles, a total of eight studies were chosen for inclusion in the systematic review. Conclusion: Precooling the soft tissues with topical ice proved to be more effective in significantly reducing pain perception in children compared with the use of topical anesthetic gel. Clinical significance: It is important for pediatric dentist to know appropriate use of precooling agent. This paper gives an insight into appropriate use of precooling agent ice for reduction of pain during intraoral anesthetic injection in children.



Shaveta Sood, Monia Sharma, Shalini Gugnani, Sonia B Bhardwaj

Orofacial Manifestations in COVID-19 Patients, Health Challenges and Dental Practice Recommendations during COVID-19 Pandemic: A Clinical Update

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:5] [Pages No:44 - 48]

Keywords: Coronavirus disease-2019 pandemic, Oral manifestation, Severe acute respiratory syndrome coronavirus-2

   DOI: 10.5005/djas-11014-0042  |  Open Access |  How to cite  | 


The coronavirus disease-2019 (COVID-19) pandemic has posed a challenge to healthcare system globally; dentistry being no exception. As the duration of a pandemic is increasing and new strains of the virus are being detected in various parts of the world, the dentist should be familiar with the list of oral manifestations and implications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This will not only play an important role in diagnosing carriers but also equip the dental fraternity to deal with a surge of otherwise not-so-common oral diseases. Viruses are not new to the oral cavity, but here oral manifestations have importance in the detection of asymptomatic carriers of SARS-CoV-2. This article aims to compile available literature relevant to the oral health perspective in the era of COVID-19.



Arthi Marimuthu, Rathna Piriyanga, Geeth Deepika, Azhagu A Alagianambi

Gene Therapy and CRISPR/Cas Technology in Dentistry: A Review

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:6] [Pages No:49 - 54]

Keywords: CRISPR/Cas technology, Dentistry genome editing, Gene therapy, Oral health

   DOI: 10.5005/djas-11014-0033  |  Open Access |  How to cite  | 


Background: The evolution of gene therapy, conceptualized in the 1960s, reached a pivotal moment in 1989–1990 with the approval of the first human clinical studies. Gene therapy, as defined by the US Food and Drug Administration (FDA), involves the administration of genetic material via nucleic acids, viruses, or genetically engineered microorganisms. This review explores the historical development and current landscape of gene therapy, focusing on its applications in dentistry. Materials and methods: A comprehensive narrative literature search, utilizing PubMed, MEDLINE, Scopus, and Web of Science databases, was conducted. Keywords and MeSH terms related to gene therapy, CRISPR/Cas technology, and dentistry were employed. Inclusion criteria encompassed English-language publications from the last 10 years, specifically focusing on the gene therapy or CRISPR/Cas applications in dentistry. Data synthesis involved critical appraisal and extraction of relevant information. Results: Gene transfer, a cornerstone of gene therapy, involves modifying defective genes through the injection of genetically modified vectors into target cells, either in vivo or ex vivo. Various methods, including physical (electroporation, microinjection) and chemical (calcium phosphate, liposome) approaches, facilitate gene modification. Dentistry applications range from addressing diseases such as squamous cell carcinoma and Sjogren's syndrome to enhancing bone regeneration, implants, and managing chronic pain. Conclusion: The potential of gene therapy and CRISPR/Cas technology in dentistry is vast, offering innovative, personalized therapeutic interventions. However, challenges such as ethical considerations and the need for long-term efficacy studies must be addressed to ensure the transformative impact of these technologies on oral healthcare practices. The future promises a paradigm shift in dental care, with gene therapy leading the way towards more effective and targeted treatments.



Suyash Joshi, Nupur Ninawe, Hemraj Badhe, Shivani Bhadule, Karthika Krishnakumar, Nilam V Honaje

Evaluation of Casein Phosphopeptide–Amorphous Calcium Phosphate Effect on the Bond Strength of Self-etch Adhesives to Dentin: A Systematic Review

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:10] [Pages No:55 - 64]

Keywords: Dental bonding, Dental etching, Systematic review

   DOI: 10.5005/djas-11014-0038  |  Open Access |  How to cite  | 


Casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) is used as a remineralizing agent, ultimately reducing dental caries. The systematic review was performed as a review on the evaluation of CPP–ACP effect on the bond strength of self-etch adhesives to dentin. Medline (via PubMed) and Google Scholar were among the databases that were searched. Articles written exclusively in English and released up until 30 November 2021, were included. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria were followed in the conduct of this research. There were 479 published studies found in the search results. Thirteen studies were chosen following full-text analysis and the elimination of duplicate studies. Overall, the outcomes showed that CPP–ACP has positive impacts on the bond strength of self-etch adhesive to dentin. The search keywords were “CPP–ACP (Title/Abstract)” OR “tooth mousse (Title/Abstract)” OR “MI-paste (Title/Abstract)” AND “bond strength (Title/Abstract)” OR “tensile bond strength (Title/Abstract)” OR “microtensile bond strength (Title/Abstract)” OR “shear bond strength (Title/Abstract).” The bond-strength test is used to determine the ability of self-etch adhesives to remain in contact with the application of CPP–ACP as a remineralizing agent on the dentin while under stress. The impact of CPP–ACP application on dentin's bond strength to self-etch adhesives cannot be concluded due to the significant degree of variation among the included research.



Faheem Ahmed, Shilpi Tyagi, Shivani Sharma, Mamta Singh

Full-mouth Rehabilitation with Fixed Implant-supported Prosthesis: A Case Report

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:5] [Pages No:65 - 69]

Keywords: Case report, Implant, Periodontitis, Prosthesis, Rehabilitation

   DOI: 10.5005/djas-11014-0037  |  Open Access |  How to cite  | 


Restoration of the functions such as mastication, phonetics, and esthetics is the primary goal for patients with complete and partial edentulism. Several traditional treatment modalities have been proven to be efficient in fulfilling the same but with the changing demands of the patients and more focus on esthetics; implants have evolved as the ultimate choice. This case report presents a case of fabrication of maxillary and mandibular implant (CSM®implant, Daego, Korea)-supported prosthesis to rehabilitate a patient with severe periodontitis. Both traditional and advanced surgical methods have been undertaken according to the bone structure present. The surgeries for both the maxilla and mandible were performed and the patient was instructed to maintain oral hygiene. Postoperative results were satisfactory and resulted in complete rehabilitation of both the arches.



Satinderpal Kaur, Deepti Garg, Swati Gautam, Nishat Sankhyan

Pyogenic Granuloma with Calcification: An Enigmatic Case

[Year:2024] [Month:January-April] [Volume:12] [Number:1] [Pages:3] [Pages No:70 - 72]

Keywords: Case report, Gingiva, Peripheral ossifying fibroma, Pyogenic granuloma, Reactive lesions

   DOI: 10.5005/djas-11014-0039  |  Open Access |  How to cite  | 


Oral mucosa is one of the most common sites for reactive lesions as it is exposed to various internal and external stimuli. Pyogenic granuloma (PG) and peripheral ossifying fibroma (POF) are the most common reactive lesions associated with gingiva. Both lesions have similar clinical features and can be differentiated based on histopathology only. Pyogenic granuloma is a type of benign swelling and type of inflammatory hyperplasia that results in response to chronic irritation, trauma, and fluctuating hormones. Microscopically, ossification is a feature of POF and it is not seen in PG. This article aims to discuss the histopathology of PG in a young 18-year-old female patient, in which areas of ossification were seen that are not commonly encountered in this lesion.


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