Dental Journal

Post-hemimaxillectomy rehabilitation as a conservative prosthetic design to enhance functionality: A case report

Hazem Mofreh Dakhilallah AlTarawneh — 2024-07-15

Background: Oral rehabilitation through prosthetic management after cancer resection is a conservative and effective modality in improving patients’ oral health-related quality of life. However, it is challenging to obtain sufficient retention for hemimaxillectomy and edentulous cases without the use of Osseo-integrated implants. Purpose: This case aims to explain the oral rehabilitation management of post-hemimaxillectomy for edentulous patients using a hollow bulb obturator and long-term soft liner. Case: A 63-year-old female presented to the Universiti Malaya postgraduate dental clinic and complained of a loose obturator during speaking and eating and high resonance during speaking. Seven years ago, she underwent hemimaxillectomy surgery of the left hard palate for the removal of squamous cell carcinoma. Upon examination, she had an edentulous maxillary arch, with a large palatal defect; the lateral border of the defect was lined with a skin graft. The mandibular arch was partially dentate with three teeth remaining (33, 35, 43). Case Management: First, elective root canal treatment of the mandibular canines was done to use them as abutments for a mandibular overdenture. Next, a maxillary hollow bulb obturator and a mandibular overdenture were constructed. Then, after evaluating the airspace on the defect site, the lateral and posterior borders of the obturator were modified to be better utilized for retention. Conclusion: Oral rehabilitation of hemimaxillectomy cases with a hollow bulb obturator without the use of Osseo-integrated implants can be a viable option for improving patients’ mastication, and speech, after assessing the retention factors, including the seal, available undercuts, and occlusion.

Neglected zygomaticomaxillary complex fracture: Report of two cases during the COVID-19 pandemic

Nissia Ananda — 2024-07-15

Background: The COVID-19 pandemic spread rapidly worldwide, including in Indonesia. As a result, people developed a fear of visiting hospitals and a tendency to ignore symptoms unrelated to COVID-19. A zygomaticomaxillary complex bone fracture is one of the most frequent midface fractures and is often accompanied by infraorbital nerve paresthesia. Purpose: This article aims to report two cases of neglected zygomaticomaxillary complex bone fractures with persistent infraorbital nerve paresthesia caused by the patient’s fear of seeking medical care. Cases: The first case is a 19-year-old male with a history of trauma two weeks prior to hospital admission. He was diagnosed with a neglected zygomaticomaxillary complex bone fracture, which resulted in persistent infraorbital nerve paresthesia. This condition was due to the patient’s fear of visiting the hospital. The second case is a 21-year-old female who presented with a history of persistent numbness on the left cheek and upper lip for one month prior to hospital admission. The symptoms originated from an accident where the patient fell from a ladder measuring two meters in height. Case management: Surgical intervention—open reduction and internal fixation (ORIF)—was performed on both patients to promote nerve recovery. However, there is ongoing debate regarding the safety of elective oral maxillofacial surgery procedures during the COVID-19 pandemic. After a follow-up period, both patients experienced a recovery of sensory function in the infraorbital nerve. Conclusion: Infraorbital nerve sensory disturbance along with zygomaticomaxillary complex bone fracture found during the COVID-19 pandemic should be managed with ORIF to improve nerve recovery.

Enhancing pediatric endodontic treatment: Intraosseous anesthesia with computer-controlled delivery system

Khomsah Suciati — 2024-07-24

Background: Pain control during endodontic treatment is essential but challenging, particularly in pediatric dentistry. Intraosseous anesthesia (IO) ensures adequate areas are anesthetized for endodontic treatment of the primary tooth with only a single injection site and a small amount of anesthetic solution required. Anesthesia should be delivered slowly to enhance the success rate, minimize pain and, for the IO technique, minimize risk of osteonecrosis. The IO anesthesia delivery system that meets such criteria is computer-controlled local anesthetic delivery (CCLAD). Purpose: To describe the enhancement of pediatric endodontic treatment with minimum risk intraosseous anesthesia using CCLAD. Case: An 8-year-old male patient came to the Pediatric Dentistry Clinic at Padjadjaran University Dental Hospital reporting pain on the lower right second molar deciduous teeth, indicated for vital pulpectomy. Case Management: The procedure of vital pulpectomy was done under local anesthesia. Patient was given intraosseous injection with CCLAD prior to opening access. The point of injection was at two mm apical from distal interdental papillae of the lower right second molar deciduous teeth. The patient remained calm throughout the local injection and vital pulpectomy procedure. Conclusion: Intraosseous anesthesia is beneficial when used for pain control during pediatric endodontic therapy. The use of CCLAD gives comfort to the patient while lowering the risk of necrotizing alveolar bone.

The influence of peripheral-bone-removal protocol on bone augmentation in dental implant surgery: 5-year clinical retrospective study

Faaiz Alhamdani — 2024-07-15

Background: Bone augmentation aims to provide sufficient bone volume around dental implants. Available bone augmentation methods include autogenous bone grafts, xenografts, and alloplastic materials. All have their advantages and disadvantages. However, autogenous bone graft remains the gold standard for bone augmentation. Autogenous bone grafts are usually taken from the patient’s oral donor sites such as the chin and mandibular ramus. However, there is a newly developed implant preparation protocol, known as the peripheral-bone-removal (PBR) technique, which can provide bone augmentation from the dental implant site. Purpose: This study aims to determine the need for bone substitute materials in the PBR technique in dental implant surgery. Methods: This study included 130 patients who were treated for dental implants. These patients were treated between 7.1.2018 and 3.2.2023. Six dental implant systems were used. Five of these systems (ImplantKa®, DeTech®, NeoBiotech®, Easy Implant®, and Dentaurum® Implant) used a conventional method (sequential drilling technique). The sixth (IBS®) system used the PBR protocol. Both descriptive and Chi-Square Test statistics were used for data analysis. Results: The included patients were treated with a total of 198 dental implants. Seventy patients were treated with the PBR protocol, while 60 patients were treated with the sequential drilling protocol. For the PBR protocol, only 2 cases required bone substitute material, whereas 11 cases treated with the sequential drilling protocol required augmentation materials. This difference between both drilling protocols has been statistically confirmed (P=0.008). Conclusion: The PBR technique appears to be less traumatic and more cost-effective for cases that require horizontal bone augmentation.

Empowering adolescent cadres for promoting oral health behavior: A persuasive communication training pilot study in Indonesia

Arlette Suzy Setiawan — 2024-07-15

Background: Adolescents are considered good cadres to be able to socialize with this healthy dental behavior. Therefore, designing a dental health education program is necessary to prepare adolescents to socialize with dental health behavior. Purpose: This study evaluates the pilot training for trainers using persuasive communication to socialize dental health behavior. Methods: Thirty-five participants (13-16 years old) are trained by a persuasive communication coach and practice the skills with a simulated client”this one-day training has a two-phase structure; lectures and practicum. The evaluation is done through three out of four-level methods from Kirkpatrick (1959). The data analysis used for the reaction evaluation is descriptive statistics, calculating the average score per category of training support assessment items (curriculum, facilitator, accommodation, and overall score). The learning outcome analysis resulted from an analysis of the pre-post test results using the N-Gain value and paired T-test. Behavior outcomes were also analyzed descriptively by calculating the average score of all participants in every timeline (baseline and two weeks after the training). Results: evaluation of this training revealed that "reaction” has an average total score was 4.02, which shows that the participants were satisfied with the training, "learning” has an N-Gain acquisition of 48.28%, and "behavior” level shows a good outcome as an increased in points from 3.4 to 4.2. Conclusion: The training program produced thirty cadres ready to implement the program in the community.

Evaluation of physical properties of glass ionomer cement modified by ethanolic extract of propolis

Deviyanti Pratiwi — 2024-07-15

Background: Glass ionomer cement (GIC) is a dental material often used in clinical practice. However, its use is limited due to its drawbacks. Natural resources such as propolis have been used to mainly enhance GIC’s antibacterial properties, but other properties attributed to this enhancement also require evaluation. Purpose: The study aims to evaluate the surface hardness, the surface roughness, and the water absorption of GIC containing ethanolic extract of propolis (EEP) from Trigona spp. Methods: Samples in this study were divided into four groups: GIC (control group); GIC + 25% EEP; GIC + 30% EEP; and GIC + 35% EEP. Surface roughness was measured using a surface roughness tester. Surface hardness was measured using a micro-Vickers hardness tester. Water absorption was measured by weighing the samples before and after immersion in distilled water. Surface characterization was carried out using a scanning electron microscope (SEM). Data was statistically analyzed using the Shapiro–Wilk normality test and one-way variance analysis along with the post-hoc Tukey’s test to determine significant differences between all four samples. Results: The statistical test showed significant differences in surface hardness and surface roughness between the control group and the GIC + EEP group. However, the test demonstrated no significant differences in water absorption between the control group and the GIC + EEP group. Conclusion: The addition of EEP to conventional GIC can affect its physical properties.

Effect of 17% ethylenediaminetetraacetic acid and silver citrate on sealer resin penetration in the apical third

Iceu Estu Kurmaena — 2024-07-15

Background: Endodontic sealers limit bacteria growth and clean the smear layer of the root canal. Biocompatible irrigants silver citrate and ethylenediaminetetraacetic acid (EDTA) have a chelating agent that increases sealer penetration in dentinal tubules. Purpose: This study aims to investigate the final irrigation difference in epoxy resin and bioceramic sealer penetration into dentinal tubules at the apical third. Methods: A total of 30 extracted mandibular premolars were split into six groups; three received epoxy resin sealer and three received bioceramic resin with aquadest, silver citrate (BioAKT) or EDTA 17% irrigation. A confocal laser scanning microscope estimated sealer penetration in dentinal tubules. For quantitative data analysis, Olympus Fluoview ver.4.2a was used. Results: Silver citrate final irrigation with bioceramic resin sealer had the highest dentinal tubular penetration (24%; 1,431 µm), followed by EDTA 17% (20%; 1,202 µm), aquadest (16.3%; 969 µm), EDTA 17% with epoxy resin (15.8%; 938 µm, 14%; 803 µm), and distilled water (10%; 584 µm). Significant differences existed in all groups (p = 0.001). Epoxy resin sealer penetration into dentinal tubules was similar between final irrigants (p = 0.257) and bioceramic resin groups (p = 0.658). Conclusion: Silver citrate (BioAKT), a bioceramic resin sealer-based final irrigation solution, penetrates dentinal tubules better for endodontic therapy.

Optimizing examination of methylenetetrahydrofolate reductase gene promoter methylation in cleft lip with or without cleft palate non-syndromic patients using the pyrosequencing method

Ani Melani Maskoen — 2024-07-15

Background: Cleft lip with or without cleft palate (CL/P) is the most common congenital anomaly found in Indonesia. CL/P is caused by hereditary (genetic) and environmental factors. Environmental factors can result in methylation in the promoter of the methylenetetrahydrofolate reductase (MTHFR) gene, affecting its expression. Methylation takes place at the CpG site found at chromosome 1, coordinates 11,805,406–11,806,509. Pyrosequencing technology can detect the percentage methylation of a gene quickly, simply, and accurately. Purpose: The aim of the study is to optimize detection of methylation of the MTHFR gene using the pyrosequencing method. Methods: Methods used in this study were DNA extraction from blood, DNA bisulfite conversion, polymerase chain reaction (PCR), and methylation detection using CpG pyrosequencing assay. Samples were taken from 20 CL/P patients (C) and 44 normal patients (N). Results: The pyrosequencing method was successful in detecting methylation at three MTHFR gene sites at coordinates 11,805,507–11,805,529. The methylation level at the third site was higher in group C than in group N, while at the first and second positions, group C had a lower methylation level than group N. In general, the percentage of methylation for both groups was low or hypomethylated (less than 5%). Conclusion: The pyrosequencing method can be used to determine methylation levels in the MTHFR gene with the results presented as percentages (quantitative data). Hypomethylation occurs in groups C and N at the coordinates 11,805,507–11,805,529 of the MTHFR gene promoter.

Antibacterial assessment of Ziziphus mauritiana Lam on inhibition of the growth and biofilm of Streptococcus mutans

Dharli Syafriza — 2024-07-15

Background: Streptococcus mutans (S. mutans) causes dental caries. S. mutans biofilms are inhibited by the antibacterial properties of Ziziphus mauritiana Lam (Z. mauritiana Lam). Purpose: Evaluating the potential of Z. mauritiana Lam in inhibiting the growth and biofilm formation of S. mutans ATCC 25175 in vitro. Methods: This study used the ethanolic extract of Z. mauritiana Lam as the test material and S. mutans as the research subject. Spectrophotometry (620 nm) was used to assess the growth of S. mutans, the inhibition of S. mutans biofilm using a 1% crystal violet staining was measured by spectrophotometry (520 nm), and the visualization of the biofilm mass was conducted with an electric microscope (200x). Results: At all concentrations, Z. mauritiana Lam displayed excellent growth inhibition of S. mutans 0.04–0.09 (< 300 CFU/mL) and was able to inhibit the formation of S. mutans biofilm with a strong scale of optical density (OD) 0.4 at 24 hours incubation time. At the same time, the incubation time of 48 and 72 hours tended to have moderate-scale biofilm inhibition (OD 0.2–3.9). At a concentration of 25%, the biofilm mass decreased by a relatively small size, the same as the positive control group. At 50%, 12.5%, and 6.25%, it was seen that the S. mutans biofilm mass experienced a dominant loss. Conclusion: Z. mauritiana Lam can be bacteriostatic against the growth of S. mutans and can inhibit the formation of biofilms by degrading the structure and mass of S. mutans biofilms.

Effect of Ganoderma lucidum extract on tumor necrosis factor-alpha and prostaglandin E2 levels in periodontitis model Sprague Dawley rats

Restian Febi Andini — 2024-07-15

Background: Periodontitis is a chronic multifactorial disease caused by microorganisms such as G-anaerobes in the periodontal tissues. It activates host defense cells and releases inflammatory mediators such as tumor necrosis factor-alpha (TNF-α) and prostaglandin E2 (PGE2). Ganoderma lucidum is a traditional medicinal mushroom with anti-inflammatory effects against various diseases. Biologically, different levels of its active constituents, such as triterpenoids and phenolic compounds, reduce inflammation with various pathways. Furthermore, the constituents inhibit toll-like receptor 4, MyD88 receptors, and the activities of nuclear factor-kappa B, which synthesize TNF-α and PGE2. Purpose: This study aimed to analyze the extent to which G. lucidum extract can reduce TNF-α and PGE2 levels in periodontitis model Sprague Dawley rats. Methods: Thirty Sprague Dawley rats were randomly divided into six groups of five rats. Periodontitis inflammation was induced by the injection of Porphyromonas gingivalis bacteria into intrasulcular gingival incisors in the lower jaw labial section. Grouping was as follows: Group K1 (healthy control); Group K2 (negative control); Group K3 (positive control with doxycycline dose 0.27 mg/kg BW); Group P1 (G. lucidum extract dose 5 mg/kg BW); Group P2 (G. lucidum extract dose 10 mg/kg BW); and Group P3 (G. lucidum extract dose 20 mg/kg BW). Samples were taken from rat gingival tissue and the levels of TNF-α and PGE2 were examined using the enzyme-linked immunosorbent assay method. Data analysis was performed using one-way analysis of variance (ANOVA) with a confidence level of 95% (p < 0.05). Results: The levels of TNF-α and PGE2 were the highest in the K2 group and the lowest in the K1 group. One-way ANOVA showed no significant difference in TNF-α and PGE2 levels between P3 and K1 group. Conclusion: G. lucidum extract can reduce TNF-α and PGE2 levels in Sprague Dawley rats with periodontitis.

Comparison of the antibacterial effect of experimental primary tooth canal pastes containing octenidine dihydrochloride and calcium hydroxide: An in vitro study

Ayşegül Orhan — 2024-07-18

Background: Octenidine dihydrochloride (OCT) has been used as a canal irrigation agent. However, no research has been done on its use as a primary root canal paste mixed with calcium hydroxide in primary teeth. Purpose: This study aims to determine the in vitro antibacterial effect of an experimental canal sealer prepared using OCT and calcium hydroxide (CaOH) on primary root canal pathogens and compare them to zinc oxide eugenol (ZOE) and iodoform paste (IP). Methods: Staphylococcus aureus (S. aureus), Streprococcus mutans (S. mutans) and Enteroccus faecalis (E. faecalis) were used as microorganisms to determine their antibacterial effect. A disc diffusion test was applied to the strains of impregnated discs with canal sealer. The number of bacteria was standardized and incubated into the Mueller–Hinton growth medium. At the end of the incubation period, the inhibition zones around the discs were measured in millimeters and recorded. Results: When the diameters of the inhibition zones were compared, the experimental canal paste obtained by mixing OCT and CaOH at a ratio of 2:1 was found to have the highest antibacterial effect against S. aureus, S. mutans and E. faecalis, and the primary tooth canal paste containing iodoform, which is used routinely in clinical practice, had the lowest antibacterial effect. Conclusion: As a result of this study, the antibacterial effect of experimental canal sealer containing OCT–CaOH on S. mutans, S. aureus and E. faecalis was found to be considerably higher than the root canal sealer containing eugenol and iodoform.

Changes in denture teeth location in three different flasking techniques

Ahmed Asim Al-Ali — 2024-07-18

Background: Artificial tooth movement may compromise the occlusion of complete (or implant-supported complete) over-dentures. This movement can lead to traumatic occlusion that may need to be corrected because the planned harmonious occlusion is lost, mainly when anatomic artificial teeth are utilized. Purpose: The study was conducted to evaluate the effect of the combination of gypsum plaster and laboratory silicon on the artificial teeth movement during the flasking procedure using radiographic imaging of intra-flask changes. Methods: In the current study, 90 identical mandibular complete dentures were fabricated and divided into two groups according to the acrylic material used. Stainless-steel pieces (0.5×0.5) were placed in the (buccal and mesiobuccal) cusp tips of the first premolar and first molar on both sides. Each group was subdivided into three subgroups (n=15) representing different techniques of flasking. Radiographs were taken at three phases of the flasking procedure, before and after the second investment layer and after curing the acrylic. The anteroposterior and mediolateral factors were calculated, and the data were analyzed by the one-way analysis of variance (ANOVA) and Duncan’s post hoc tests at P˂0.05. Results: The anteroposterior factors of the groups had insignificant differences at all phases, and the mediolateral factors showed significant differences in the gypsum samples and total silicon samples. Conclusion: Anteroposterior movement of the artificial teeth was not changed due to bracing between the teeth, and a mixed silicon and plaster investing layer had the smallest teeth location changes during the packing and curing phases.