Dental Journal

An intraoral approach to minimize morbidity in a pediatric trauma case

Bima Baskara — 2025-01-15

Background: Maxillofacial fractures are rare in children. The treatment of fractures in children differs from that of adults due to the growth process of the jaw and dental development. The intraoral approach does not result in facial scars or nerve injury. Furthermore, it allows direct visualization of occlusion confirmation during the plate placement. Purpose: This case report describes a pediatric comminuted mandibular fracture that underwent open reduction with an intraoral approach. Case: A 13-year-old boy with a mandibular fracture was referred by the neurosurgery department. Clinical examination found a hematoma in the left submental region and discontinuity of the mandibular symphysis without a wound in the extraoral region. Coleman's sign and a vertical step between teeth 41 and 31 and teeth 33 and 34 with anterior open bite were found intraorally. A CT scan disclosed more than two fracture lines that involved the mandibular symphysis and a basal triangle fracture. The patient was diagnosed with a symphysis mandibular comminuted fracture with open bite malocclusion. Case management: Open reduction and reconstruction plate placement with an intraoral approach was performed under general anesthesia. The patient had no complaints during the two-month evaluation, and the plate was planned for removal in the third month postoperatively. Conclusion: In this case, open reduction with an intraoral approach was able to restore bone architecture without functional or aesthetic complications. This may be because the patient could be treated like an adult, as he had almost reached skeletal maturity due to his age. However, periodic observation is necessary to evaluate jaw growth.

Improperly diagnosed odontogenic myxoma in a 23-year-old female: A radiographic analysis

Gabriel Maria Ferdilia Sugianto — 2025-01-15

Background: Misdiagnosis can occur due to various radiographic alterations linked to odontogenic myxoma (OM). Regular examination can detect abnormalities early on, but not all practitioners are aware that these lesions exist. Purpose: This case report aims to describe and discuss an OM case from the perspective of oral radiology on panoramic radiographs and cone-beam computed tomography (CBCT). Case: A 23-year-old female went to her first dentist for orthodontic treatment with no prior radiographic evaluation. On January 7^th, 2022, the second dentist extracted teeth 38 and 48 using the panoramic radiograph without identifying lesions. Concerned about swelling on her lower right gingiva, which had gradually grown, the patient went to an oral and maxillofacial surgeon on November 15^th, 2022. The clinical examination revealed facial asymmetry with a thick, palpable, firm mass with an ambiguous boundary. Despite the evident movement of tooth 47, the gingiva exhibited no noticeable change in coloration. Case management: From the panoramic examination, multilocular radiolucency with radiopaque septa and aggressive mass characteristics were found. Advanced imaging CBCT was used to investigate further and correlate histology findings for treatment. Conclusion: Odontogenic myxoma is difficult to distinguish from other benign and malignant neoplasms due to the wide variations of radiological patterns. Cone-beam computed tomography provides a thorough and broad range of data that can be used to make a precise diagnosis and develop an effective treatment strategy. This highlights the critical need for a trained expert to thoroughly examine CBCT scans.

Pharmacological and low-level laser therapy in radiation-induced oral mucositis in patients with head and neck cancer

Imme Kris Wicaksono — 2025-01-15

Background: Oral mucositis (OM) is common in people undergoing radiotherapy, chemotherapy, or a combination of both. Pharmacological and low-level laser therapy (LLLT) are potential treatments to reduce pain and accelerate the healing process. Purpose: The aim of this case report is to describe the effectiveness of combining pharmacological therapy and LLLT for OM. Case: A 54-year-old man with post-hemi glossectomy diagnosed with tongue cancer was referred from the radio-oncology department with complaints of painful sores all over the oral cavity after receiving radiotherapy. The canker sores worsened when eating but felt more comfortable when drinking cold water. Intraoral examination revealed erythematous lesions accompanied by fibrinous pseudomembranes and yellowish-white plaques, which could be scraped off, leaving erythematous areas with pain. These lesions were present on the upper and lower labial mucosa and the right and left buccal mucosa. The diagnosis was grade-3 OM, according to the World Health Organization (WHO) criteria. Case management: Pharmacological therapy included 0.025% hyaluronic acid gargles three times a day and the use of LLLT with a wavelength of 976 nm. Conclusion: The combination of pharmacological therapy with LLLT was effective in maintaining and improving the condition of the oral mucosa by reducing pain and ultimately improving the patient’s quality of life.

Hemisection with socket preservation using alloplastic bone graft and platelet-rich fibrin

Kun Ismiyatin — 2025-01-15

Background: The developments in endodontics have created opportunities for patients to maintain functional teeth for longer. Surgical endodontic treatment, such as hemisection, has become a more conservative treatment than complex treatments, such as removable or fixed partial dentures or implants. Purpose: The aim of this treatment is to preserve the remaining tooth structure through a hemisection procedure and socket preservation using an alloplastic bone graft and platelet-rich fibrin (PRF). Case: A female patient presented with mastication pain and a large carious tooth in the right mandibular first molar and wanted to save the tooth. Examination showed deep caries and perforation in the bifurcation area of the tooth with loss of the distal crown. However, the mesial root could be preserved, thus hemisection was proposed. Case management: A root canal treatment was performed on the mesial root, followed by separation of the mesial and distal roots, and, finally, distal root extraction. A mixture of PRF and bone graft was used for socket preservation. The tooth was restored with a splinted zirconia crown. Conclusion: Hemisection with socket preservation using alloplastic bone graft and PRF represents a more conservative treatment option for molar teeth with extensive caries. This approach exhibits a good long-term prognosis and enhances the bone healing process.

Various methods affect the flexural strength of repairing the denture base

Ibrahim H. Alfahdawi — 2025-01-13

Background: The assembly of replacement teeth to mimic natural ones remains a challenge for dentists, particularly regarding the surface characteristics of prosthetic teeth. Purpose: To evaluate various surface mechanical techniques that affect the flexural stress of a repaired denture base. Methods: Six sets (n = 10) of sixty heat-polymerized acrylic resin bar-shaped samples have been produced. Samples were divided into halves to give a 1-mm clearance, with the exception of the group under positive control (group PC). Also taken into account was a negative control group (group NC) that received no skin treatment. Other groups received a variety of surface treatments, including group Er:YAG laser therapy, group abrasion by airborne particles (APA), group APA + Laser, and group Bur grinding. All sectioned samples were repaired by auto-polymerizing acrylic resin, which was then thermocycled after surface roughness was measured with a profilometer. A global testing device conducted a three-point bending test. Results: The mean surface roughness of all study groups was considerably greater than group NC's (P<0.05). With the exception of group Bur, group PC's flexural strength was considerably greater than that of all other groups (P=0.999). The bending strength of groups Bur and Laser among all surface-treated groups was significantly greater than that of group NC (P=0.001 and P=0.015, respectively). Conclusion: All surface treatments enhanced surface roughness in comparison to the untreated group, but bur grinding and Er:YAG laser exposure also significantly raised the flexural strength of the sectioned groups. Sectioned polymethyl methacrylate’s flexural strength was significantly increased by bur grinding.

Histological evaluation of the effect of Nigella sativa on the healing of created bony defect in the animal jaw

Ali Idrees Al-Niaimi — 2025-01-13

Background: The bone healing process is a complicated and highly specific action that includes deposition, resorption, and remodeling phases occurring in a tidy and overlapping schedule. Herbal medicine has improved substantially in the last decade, and herbal products have spread widely to prevent or treat various problems and diseases. Nowadays, different herbs are employed to heal soft or hard tissue in humans. Purpose: This study aims to evaluate the effect of topically applying Nigella sativa oil in healing bony defects. Methods: Fifteen rabbits were used in this study. Two round holes were created on the buccal side of the mandible: the anterior hole was filled with black seed oil, while the other was left unfilled as the control group. Animals were sacrificed after 1 week, 2 weeks, and 4 weeks, respectively, and sent for histopathological examination. Results: During the first week of bone healing, the experimental group showed substantially fewer inflammatory reactions than the control group. Granulation tissue formation increased considerably in the experimental group compared with the control group. The experimental group also showed higher bone tissue formation, with more mature woven bone compared with the control group. Conclusion: Nigella sativa has an anti-inflammatory effect and can positively influence bone healing by increasing bone cell production and bone tissue development in the bone defect.

Dental students’ perception of a self-preference musical mobile app used as a relaxing tool in the clinical setting

Nur Irdina Nasmi Zarudin — 2025-01-13

Background: Diverse music activities may reduce stress and enhance well-being. However, using a musical mobile health application (app) as an intervention during dental treatment has not yet been established. Hence, a self-preference musical mobile app (ACOU@PLAY) has been created for use in clinical settings. Purpose: This study aims to assess the quality of the ACOU@PLAY app as a relaxing tool for dental students and compare the results with patients’ opinions. Methods: A total of 53% (n = 38) dental students and 47% (n = 35) patients were recruited to use the self-preference musical mobile app (ACOU@PLAY) for 10 minutes and watch a 5-minute pre-recorded video. Then, an evaluation was performed using a validated tool, the modified user version Mobile App Rating Skill (uMARS), which included a demographic survey. The uMARS questionnaire consists of five domains (engagement, functionality, aesthetics, information, and app subjective quality) using a 5-point Likert scale. Results: The average quality score of the app was 3.96 ± 0.509. The app received its highest rating for the information domains, with a mean score of 4.14 ± 0.577, and its lowest for subjective quality, with a mean score of 3.63 ± 0.565. Notable differences were observed in the ratings for engagement (p = 0.008) and aesthetics (p = 0.035) between dental students and patients, as well as significant differences in ratings based on gender in the domains of engagement (p = 0.007), functionality (p = 0.018), and aesthetics (p = 0.021). Conclusion: The self-preference musical mobile app (ACOU@PLAY) is well accepted by dental students and favored by patients with adequate qualities to be used in clinical settings.

Degradation rate and weight loss analysis for freeze-dried, decellularized, and deproteinized bovine bone scaffolds

Ramadhan Pramudya Vidarta — 2025-01-13

Background: Mandibular defects, often caused by trauma, tumors, infections, and congenital issues, are commonly treated with bone grafts. Tissue engineering plays a crucial role in bone reconstruction, with scaffolds such as deproteinized bovine bone matrix (DBBM), freeze-dried bovine bone (FDBB), and decellularized FDBB (Dc-FDBB) being studied for their efficacy. Decellularization reduces the antigenic potential of FDBB. These scaffolds are designed to degrade within the body. Purpose: To analyze the weight loss and degradation rates of FDBB and Dc-FDBB materials, using DBBM as a control. Methods: This in vitro experimental study, conducted over 2 months, employed a cross-sectional approach to analyze the weight loss and degradation rates of FDBB, Dc-FDBB, and DBBM scaffolds in a simulated body fluid (SBF) solution. Results: Under dynamic immersion conditions, DBBM exhibited the highest daily weight loss at 0.741% and a degradation rate of 0.466 mg/cm²/day, followed by Dc-FDBB at 0.568% and 0.418 mg/cm²/day and FDBB at 0.525% and 0.385 mg/cm²/day. Under static immersion conditions, DBBM also showed the highest weight loss at 0.255%, with a degradation rate of 0.165 mg/cm²/day, followed by Dc-FDBB at 0.245% and 0.163 mg/cm²/day, and FDBB at 0.168% with a degradation rate of 0.126 mg/cm²/day. Significant differences were observed between scaffold groups (p = 0.000). Conclusion: DBBM, Dc-FDBB, and FDBB scaffolds meet the optimal requirements for tissue engineering materials based on their weight loss and degradation rates. DBBM demonstrated the highest values among the scaffolds analyzed.

The Effect of cocoa pod husk (Theobroma cacao L.) extract on alveolar socket post tooth extraction

Yani Corvianindya Rahayu — 2025-01-13

Background: Cocoa pod husk (CPH) of Theobroma cacao L. contains tannins, alkaloids, saponins, and flavonoids triterpenoids that have antibacterial, anti-inflammatory, and antioxidant activities that can accelerate wound healing and alveolar bone regeneration. Purpose: This study aimed to analyze the effect of CPH extract gel on the number of fibroblasts, osteoblasts, and osteoclasts in Wistar rats’ sockets after tooth extraction. Methods: The samples used were 36 male Wistar rats divided into three groups: the negative control group (placebo gel), the positive control group (Alveogyl; Septodont, UK), and the treatment group (100 mg/ml CPH extract gel), which in each application was given for three, seven, and fourteen days on the mandibular first molar post-extraction socket. The samples were sacrificed and tissue was processed on days 4, 8, and 15. The amount of fibroblasts, osteoblasts, and osteoclasts was identified and determined by the Image J software. Results: The Mann-Whitney U analysis showed significant differences (p<0.05) between groups. Fibroblasts and osteoblasts in the treatment group were significantly higher than the control groups. Osteoclasts in the treatment group were significantly lower than the control group. Conclusion: Ethanol extract gel of CPH significantly increased fibroblasts on days 3 and 5 and osteoblasts on days 7 and 14 and decreased osteoclasts on day 14 in post-extraction socket of Wistar rats.

Dental students' knowledge level regarding the use of antibiotics in endodontic infections in pediatric patients

Gizem Karagoz Dogan — 2025-01-13

Background: Endodontic infections frequently occur in children and stand out as dental issues where antibiotics are widely favored. However, the recent overuse of antibiotics has resulted in the development of antimicrobial resistance in children. The awareness and understanding dental students have regarding the application of antibiotics for treating endodontic infections in pediatric patients have been explored in limited studies. Purpose: This study aims to evaluate the understanding of fourth- and fifth-year dentistry students—who are actively involved in patient care during their internships and will soon become medical professionals—about prescribing antibiotics to treat endodontic infections. Methods: This study was conducted using the Google Form electronic survey method on intern students at three different faculties of dentistry who have started their clinical internships. Results: Data were obtained from 468 participants who responded to the survey within the scope of the study. Statistically significant differences were observed in terms of knowledge level between those who were informed and those who were not about general antibiotic knowledge, prescription awareness, pediatric antibiotics dose calculations, and parenteral antibiotic applications, as well as between the places where they were informed; the same difference was observed between those who considered the information they received sufficient and those who did not (p < 0.05). Conclusion: The results of the study indicate that dental students have inadequate knowledge about the use of antibiotics in children with endodontic infections. Nevertheless, the study concludes that the knowledge level of the students can be improved through various training and educational programs.

Cervical vertebral maturation stage and Demirjian index for assessment of skeletal and dental maturation for children’s growth stages

Seno Pradopo — 2025-01-15

Background: Determining age is essential in various fields, particularly pediatric dentistry. A reliable method for assessing an individual's growth and development involves evaluating their chronological and biological age. Biological age can be determined by examining skeletal or dental maturation. Accurately assessing growth potential and timing of growth spurts is crucial for several clinical situations, especially in the planning and outcomes of treatments like orthodontic therapy. Purpose: This study uses common radiographic ortho-diagnosis techniques to analyze the accuracy of cervical vertebral maturation stages (CVMS) and the Demirjian index methods in evaluating children's growth and development stages. Methods: The CVMS assessment on cephalometric radiography was conducted using the Bacetti method, which includes six stages. In addition, the mandibular second molars' calcification stages were evaluated using the Demirjian index method, which encompasses stages A to H on panoramic radiography. Following this, skeletal and dental maturation accuracy was analyzed using the Statistical Package for Social Sciences application. Results: This study revealed differences in the chronological age corresponding to each stage of calcification of the mandibular second molars and the CVMS. Additionally, CVMS was found to be the most accurate method for assessing age in children. Furthermore, the right side was generally preferred over the left at the calcification stages of the mandibular second molars. Conclusion: Using CVMS to assess skeletal maturation provides a more accurate determination of growth and developmental stages in children than the Demirjian index.

Fungistatic effect of Gracilaria verrucosa on phospholipase enzymes and the cell surface hydrophobicity of Candida albicans

Basri A. Gani — 2025-01-13

Background: Candida albicans (C. albicans) was reported as a primary cause of oral candidiasis. Phospholipase enzymes and cell surface hydrophobicity (CSH) are involved in the pathogenesis of its infection. Gracilaria verrucosa (G. verrucosa) is reported to contain flavonoids, tannins, and phenolic compounds, which can inhibit the development of C. albicans. Purpose: The study analyzed the effect of the ethanol extract of G. verrucosa on the inhibition of the phospholipase enzyme and CSH of C. albicans. Methods: The G. verrucosa chemical compounds were examined by phytochemical tests and phospholipase enzyme-inhibiting egg yolk media, and a CSH assay was conducted using xylene. Results: Gracilaria verrucosa contains steroids, terpenoids, tannins/phenolics, and flavonoids. The 25%–100% concentrations inhibit the phospholipase enzyme of C. albicans more strongly at 48 hours than at 12 hours and 24 hours (p < 0.05). Furthermore, the 100% and 75% concentrations substantially affect the inhibition of CSH of C. albicans, with a strong relationship. Conclusion: Gracilaria verrucosa has a more substantial inhibitory effect in suppressing the phospholipase enzyme and CSH of C. albicans.

Comparative effect of different types of artificial teeth and the effect of different surface treatments on the shear bond strength to CAD/CAM denture base

Hajar M. Saleh — 2025-01-15

Background: Complete tooth loss reduces a patient’s quality of life. The most suitable treatment option is complete denture fabrication, which provides an acrylic-based removable prosthesis as a substitute for all dentition and related structures. Purpose: This study aims to evaluate the shear bond strength (SBS) of three types of artificial teeth—acrylic, composite, and computer-aided design and computer-aided manufacturing (CAD/CAM) milled denture teeth—and the effects of three surface treatments: bur roughening, air abrasion (AB), and dichloromethane (DCM). Methods: Milled CAD/CAM denture base resin was used to test three types of denture teeth: acrylic, composite, and milled CAD/CAM. A total of 120 maxillary right central incisors were used, with 40 of each tooth type. Each type was divided into four groups based on the treatment surface: control (no treatment), AB, bur roughening, and DCM. Universal testing equipment was used to measure SBS. Data were statistically analyzed using ANOVA, and Duncan’s multiple range test was applied to compare mean values among groups. Results: Acrylic and CAD/CAM milled teeth demonstrated higher SBS compared with composite teeth. Teeth treated with AB and DCM surface treatments exhibited increased SBS across all tooth types compared with the control groups. Conclusion: Acrylic and CAD/CAM milled teeth show superior SBS compared with composite teeth. AB and DCM treatments effectively enhance SBS in all types of teeth.