Volume 22 – Issue 2 (April – June 2013)

Journal of The Pakistan Dental Association

Title Abbreviation: J Pak Dent Assoc

ISSN (Print): 1680-2292
ISSN (Online): 2306-5885

Table of Contents

Volume 22, Issue 2  (April - June 2013)

Open Access

ORIGINAL ARTICLE
Patients’92 Knowledge And Awareness Levels For Implant-supported Dental Prostheses At A Teaching Dental Hospital.
Fazal Ghani , Faisal Moeen , Saleha Nisar
(Pages 78 - 83)
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Abstract
OBJECTIVE:

To assess knowledge and awareness levels fordental implant-supported prostheses (ISPs) as optionsfor replacing teeth, amongst patients ata Teaching Dental Hospital in Islamabad. Study Design, Place & Duration: Questionnaire based, Cross-sectional, Prosthodontics Department, Islamic International Dental College, Hospital, Islamabad ,1st Dec 2011-30th Mar 2012.

METHODOLOGY:

Withconvenience sampling, 210 patients participated in the study. The method of direct interview and a pre-structured questionnaire with nine questionswere used for collecting data of each patient including knowledge,level of awareness, acceptance and perceived cost of ISPs. SPSS version 17.0, was used to analyze data.

RESULTS:

Only 35 (16.6%) patientshad prior knowledge of ISPs.Majority (83.4%) did not know about ISPs. Of the 35 patients having prior knowledge and awareness, only one had actually received ISP. Of the 175 out of 210(83.4%) patients having no prior knowledge of ISPs, 161 (92%) showed interest after receiving explanation and information aboutthem. Many patients (N=196, 93.3%) indicated interest in ISPs upon knowing about them. Many patients (N=188, 89.5%) rejected conventional removable prosthesis.Those who believed ISPas the best choice for replacing missing teeth were 115 (54.7%) but 85% of themindicated their high cost as a barrier to having ISPs.

CONCLUSION:

Patients’ knowledge and awareness about ISPs was found poor. However,upon introduction about ISPs, many showed interest in them. Many would still refrain from getting ISPs because of their high cost. Dental practitioners should include information about ISPswhen explaining prosthodonticoptions for replacing missing teeth.

KEY WORDS:

Implant-supported prostheses, Awareness to dental implant prostheses, Options for replacing missing teeth, Informed consent .Prosthodontictreatment.

ORIGINAL ARTICLE
Biopsy Audit At Government University Oral Health Facility
Salik Rasool , Farhat Bashir , Sara Gardezi
(Pages 84 - 88)
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Abstract
OBJECTIVE:

The present study signifies the pattern of Oral mucosal lesions at Oral Pathology Department of Dr.Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi.

METHODOLOGY:

Study is designed as retrospective cross sectional. Two hundred and fifty six case biopsies were selected from patientsattending the out patient department of the dental college. Biopsied oral lesions at (DIKIOHS) were from July 2007- to-December 2011.

RESULTS:

Out of a total of 256 lesions 111 were benign and 145 malignant. Oral squamous cell carcinoma was the most prevalent pathology amongst 121 cases. The other lesions were 38 pyogenic granulomas, 25 salivary gland lesions, 23 connective tissue lesions of which 11 were hemangiomas, 10 were non specific inflammations and 1 lymphangioma. Seventeen were diagnosed as epithelial dysplasias, 3 each as osteomyelitis, tuberculosis, candidiasis, while one case each of plasmacytoma, and actinomycosis. Bone pathology were 2 ossifying fibromas, and 1 fibrous dysplasia. Cystic lesions comprised of 1 radicular cyst, epidermoid cyst each, verrucous neoplasm, ameloblastoma, and adenomatoid odontogenic tumor. Buccal mucosa showed 52% positivity for all lesions, amongst (33%) male and (19%) female positives respectively. Salivary gland and alveolus had 10% site predilection each, while palate had 9.4%, gingiva 8.2%, tongue 7.4%, floor of the mouth 1% each.

CONCLUSION:

It is concluded that connective tissue disorders were more prevalent in younger age group, whereas the most common pathology reported was oral squamous cell carcinoma, reported in adolescence and elderly presented most frequently on the buccal mucosa.

KEY WORDS:

Biopsy, Oral Mucosal lesions, Audit, Pakistan

ORIGINAL ARTICLE
Occupational Bloodborne Exposure Incident Survey & Management Of Exposure Incidents In A Dental Teaching Environment
Nabila A. Sedky
(Pages 89 - 97)
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Abstract
OBJECTIVES:

The objectiveof this study was to investigatethe prevalence of occupational exposure incidents among undergraduate dental students and the factors associated with it inthe educational dental clinics atPharos University in Alexandria – Egypt, and to measure the commitment with applying infection control policy in the form of compliance with post-exposure management protocol and reporting exposure incidents.

METHODOLOGY:

An anonymous self-administered questionnaire consisting of thirteen multiple-choice questions was distributed among 350 undergraduate dental students in mid-senior and senior levelsduring lec¬tures at the endof the second semester of 2011, with a response rate of 90.00%.Results were analyzed and compared by means of cross-tabulationtests and chi-square test was used to test associations between the level of undergraduate studyand the independent variables. Lastly, Pearson’s correlation coefficient was used to investigate associations between variables.All statistical analyses were carried out at a significance level less than 0.05 & 0.01.

RESULTS:

About 62.00% of the senior students reported that exposures occurred outside the patient’s mouth. A high percentage of both the mid-senior and senior students (74.70% and 70.70%, respectively) reported that they were exposed to multiple sources of incidents. The vast majority of studied groups stated that they didn’t follow Infection Control Protocol after Incident Exposure.

CONCLUSION:

Dental students encounter exposure incidents but are less likelyto report them, thus it is imperativethat the principles of infection control training and reporting of all exposure incidents continue to be accentuatedduring the course ofundergraduate dental education.

KEYWORDS:

exposure incident, bloodborne exposure, risk factors, infection control protocol

ORIGINAL ARTICLE
Assessment Of Post- Operative Sensitivity In Posterior Resin-based Composite Restorations With Two Placement Techniques
Shama Asghar , Asghar Ali , Saqib Rashid , Tasleem Hosein
(Pages 98 - 103)
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Abstract
OBJECTIVE:

The objective of this study was to assess the post-operative sensitivity of posteriorresin-basedcomposite in Class I cavities of different sizes with two placement techniques.

METHODOLOGY:

It was a Quasi Experimental study. Sample size was 131 patients with two Class I cavities (depth between 3-4 mm) in molar teeth (ipsilateral or contralateral). Two molars in the same patient were restored with posterior composite (QuixfilDentsplyDetrey) using bulk and incremental placement techniques respectively. The patients were recalled at day 7 post-operatively and 2 item questionnaires were used to record the presence and absence of sensitivity that was triggered by cold and hot stimuli. Data was collected using data collection proforma.

Data was analyzed with SPSS for windows using McNemar chi-square test.

RESULTS:

Incremental and bulk placement techniques showed statistically significant difference for the occurrence of post-operative sensitivity for cold (p- value < 0.002) and hot (p-value<0.001). The chi-Square test was applied to analyze post-operative sensitivity in both techniques with different cavities sizes. The result was significant with p-value <0.0001.

CONCLUSIONS:

The incremental technique was found to be superior to bulk placement technique in preventing post-operative sensitivity in class 1 cavities of various sizes.

KEY WORDS:

Post-operative sensitivity, incremental technique, posterior composite restoration, bulk technique, C-factor, polymerization shrinkage.

ORIGINAL ARTICLE
In Vitro Comparison Of The Apical Seal Obtained By Resin Based And Calcium Hydroxide Based Sealers
Syed Abrar Ali , Tasleem Hosein , Arshad Hasan , Saqib Rashid
(Pages 104 - 107)
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Abstract
OBJECTIVE:

The objective of this study was to compare micro-leakage of the apical seal obtained by resin based and calcium hydroxide based sealers.

MATERAIL AND METHOD:

One hundred extracted single rooted human teeth were collected from the Department of Oral Surgery of Fatima Jinnah Dental College Hospital Karachi over the period of one year and randomly assigned into two groups of 50 teeth each G1 ( CaOH based sealer , Seal Apex )and G2 (Resin based sealer , AH26). The teeth were sectioned at the cement-enamel junction and the roots were stored in saline for a week .The canal were prepared with step back technique under 5.25 % Sodium Hypochlorite irrigation and Gates Glidden was used for coronal flaring. Teeth in both groups were obturated using a standard cold lateral condensation technique. The root canal sealer used in group 1 was Sealapexand in group 2 was AH26.The roots were then suspended in 2% methylene blue solution for 1 week and left to dry for 24 hours. The roots were longitudinally sectioned using a separating disc. A millimeter scale was used to measure the distance from the apical foramen to the most coronal dye penetration point. Measurements were recorded and means were calculated. SPSS (version 11) was used to compare the mean dye penetration for G1 and G2 with “T” test at 95 % level of significance.

RESULT:

The mean dye leakage value for Group 1 (AH26) was 2.69 mm (±0.58)while Group 2 (Sealapex) demonstrated mean dye leakage of 4.36 mm (±0.75). The difference was statically significant. (p<0.05)

CONCLUSIONS:

Resin based sealer (AH26) resulted in less leakage in comparison to CaOH based sealer (Sealapex)

KEY WORDS:

Root can sealers, root canal, gutta-percha, Obturation, Resin based sealer, Calcium Hydroxide based sealer

ORIGINAL ARTICLE
Pattern Of Crown Fractures In 9–18 Years Old Students In District Khairpur Mirs, Sindh
Syed Abrar Ali , Tasleem Hosein , Arshad Hasan , Saqib Rashid
(Pages 108 - 112)
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Abstract
OBJECTIVE:

To observe the pattern of crown fractures in schoolchildren aged 9-18 years.

METHODOLOGY:

Nine public and 4 private Primary to higher secondary schools of KhairpurMirs District, Sindh, were included in this cross sectional study.Selected study participants were examined with disposable tongue spatula under daylight by a single examiner. Data related to gender, age, tooth involved, number of teethinvolved, type of tissue injuryand treatment taken for coronal trauma were recorded.

RESULTS:

The male/female ratio was recorded as 2:1. Atotal of 4.32% males and 3.28% females exhibited crown fractures.Central incisor was the most affected tooth (64.47%) followed by maxillary lateral incisor (10.52%), mandibular central incisor (7.89%), mandibular lateral incisor (5.26%), maxillary canine (2.63%) and mandibular canine (1.31%). In addition, single tooth trauma was identified in most of the cases. Fracture observed in enamel was 52.6%, which was significantly greater than fracture in enamel & dentine with or without pulp involvement.

CONCLUSION:

An overall 4% occurrence of coronal trauma among 9-18 year-old students of district khairpurMirs, Sindh, Pakistan was identified. Maxillary central incisor and fracture involving enamel only were the most common findings.

KEY WORDS:

Dental trauma, Crown fracture, Enamel fracture, School-children

ORIGINAL ARTICLE
Preparation Of A Radiopaque Fissure Sealant By Incorporating Higher Fractions Of Tin-methacrylate And Measuring Their Radiopacity Using X-ray Microtomography
Aftab Ahmed Khan , Asaad Javaid Mirza
(Pages 113 - 118)
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Abstract
OBJECTIVE:

Fissure sealants are generally radiolucent and are not clearly visible radiographically. Many attempts have been made to make them radiopaque in accordance with ISO standard – 4049. The inclusion of heavy metals and glasses make the sealants radiopaque but these heavy metals are used for radiopacity to some weight percent. This study was performed to develop fissure sealants with higher fractions up to 9.5gm of tin-methacrylat in which tin was chemically incorporated into methacrylate polymer and measuring their Linear attenuation coefficient (LAC) with the help of X-ray micro-tomography.

METHODOLOGY:

The control material was made by mixing 10.0 gm Ethylene Glycol Dimethacrylate (EGDMA), 0.05 gm Camphorquinone (CQ) and 0.05 ml N, N-Dimethyl-P-Toluidine (DMPT) into an amber-colored bottle. Four types of experimental sealants were produced by increasing the weight of Tin-Methacrylate (SnM) and reducing the weight of EDGMA. Mixtures of the same ingredients were prepared in the same manner with increasing weight % of SnM as 5.0, 7.5, 8.5, and 9.5 gm and decreasing quantity of EGDMA as 5.0, 2.5, 1.5 and 0.5 gm respectively.

RESULTS:

Results show that the increasing weight of SnM increased radiopacity up to 8.5gm. The experimental sealant containing 9.5 gm of SnM caused unworkable consistency of the mix.

CONCLUSION:

Under the conditions of this study, best combination of workable mix and radiopacity was obtained when the weight of SnM was increased to 8.5 gm.

KEYWORDS:

Fissure Sealants; Radiopacity; X-ray Attenuation; Linear attenuation coefficient

ORIGINAL ARTICLE
Prevalence Of Dental Caries In The First Permanent Molars In Children Between 8-12 Years
Nazia Sultan Ali , Nadia Sultan Ali , Mahjabeen Khan , Irfan Qamruddin , Hussain Askary , Amyna Sajwani
(Pages 119 - 123)
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Abstract
OBJECTIVE:

To determine prevalence of dental caries in first permanent molars among 8 – 12-years children.

METHODOLOGY:

The survey involved a cross-sectional study with dental examination. The study was conducted in the area of Garden West located in the city of Karachi, Pakistan. Four schools were selected for the survey. Four hundred and forty seven children were included in the study, ranging from 8 to 12 years of age. Total number of children in government school was 101, whereas 346 children were enrolled in private schools. The diagnostic criteria for dental caries as recommended by WHO (1986) was followed. Data analysis was performed by using SPSS program version 16.

RESULT:

In this study, there were four hundred and forty seven children, ranging from 8 to 12 years of age. Of the 447 children, 137(30.6%) had dental caries in their 1st permanent molars. In females there were 179 students whose first molars were free from caries while 94 had caries in their first permanent molars. Based on entire sample, no caries was found in first permanent molars among 310 (69.4%), while 8 (1.8%) subjects had all (four) first molars affected by dental decay

CONCLUSION:

The prevalence of dental caries in first permanent molars among 8 – 12-years children was 30.60%. Given this finding, it is strongly suggested that oral health services gear up for addressing this comprehensively and as a priority in Pakistan.

KEY WORDS:

Dental caries, Children, Schools, Prevalence, Oral health, Dental decay.

ORIGINAL ARTICLE
Correlation Of Anb Angle And Wits Appraisal In Different Malocclusion Groups
Subuhi Ghani , Abdul Jabbar
(Pages 130 - 133)
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Abstract
OBJECTIVE:

The purpose of this study was to determine the correlation of ANB angle and Wits appraisal in Angle’s class I, class II division I and class III malocclusion groups.

MATERIAL AND METHODS:

Lateral cephalograph was taken to measure the ANB angle and Wits appraisal in angle’s class I, class II division I and class III malocclusion groups.

RESULTS:

The correlational analysis of ANB angle in the three malocclusion classes showed, that there was a weak correlation of ANB angle in all three malocclusion groups but statistically significance (P-value < 0.05) in class II division I and class III malocclusion.

CONCLUSION:

This research concluded that, there is a weak correlation between ANB angle and Wits appraisal in all three malocclusion groups but it is statistically significant in class II div I and class III malocclusion.

KEY WORDS:

ANB angle, Wits appraisal, Anteroposterior jaw relationship.

REVIEW ARTICLE
A Review of 9 Palatal Swellings
Santosh Patil , Suneet Khandelwal , BharatiDoni , Farzan Rahman
(Pages 134 - 139)
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Abstract

Palatal swellings can at times be a challenging task for a clini cian to diagnose. A mass or swelling of the palate can result from developmental, inflammatory, reactive or a neoplastic process. In differential diagnosis, swellings of odontogenic origin (cyst or tumor) must be considered because they are very common. This article reviews various common palatal swellings, their clinical presentation, differential diagnosis and management aspects.

KEYWORDS:

Differential diagnosis, hard palate, swelling, inflammatory, cystic, neoplastic.

CASE REPORT
Unusual Keratocysticodontogenic Tumor Invading The Maxillary Sinus: A Case Report
Maryam Al Hindi
(Pages 140 - 143)
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Abstract

Keratocysticodontogenic tumor (KCOT) is a benign tumor that has a high recurrence rate. It mostly involves the mandible and occasionally invades maxillarycanine area. Involvement of the sinus is very rare. A case of a 24 yearold young lady with KCOT involving the maxillary sinus is reported. The panoramic radiograph showed 1.5 X 1.5 cmwell circumscribed radiolucency that surrounded an impacted right wisdomupper tooth which involved the maxillary sinus. “Dentigerous cyst” and “follicula r cyst” were the differential diagnosis. Accordingly,enculation of the lesion under local anesthesia was the only treatment. Thehistologicaldiagnosis of the specimen was “keratocysticodontogenic tumor”. The failure of including KCOT in the differential diagnosis in this reported case increased the risk of recurrence and resulted inthe need for a long follow up.

Key words:

Keratocysticodontogenic tumor,Odontogenickeratocyst, Maxillary sinus, Enucleation, Recurrence

CASE REPORT
The Importance of Elapsed Time Between Tooth Bleaching and Replacement of Composite Resin Restorations: Case Report.
Fahad iqbal , Sergio Paulo Hilgemberg , Eugenio Jose Garcia
(Pages 144 - 146)
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Abstract

An increased demand for esthetic treatment requires the dentists to keep abreast with the contemporary knowledge of both, the advancements in dental materials and latest techniq ues to deal with them. This clinical case reports the association of tooth bleaching and replacement of direct resin composites on upper central incisors fractured and restored during childhood.

Key words:

Composite resin, dental bleaching, fractured incisors.

CLINICAL ARTICLE
Clinical Success in Resin Bonded Bridges
Fahim Vohra , Haroon Rashid
(Pages 147 - 153)
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Abstract

Resin bonded bridges offer a conservative approach to the restoration of edentulous spaces than conventional bridgework. However, since their introduction, the main concern regarding resin bonding bridge work has been increased debonding rates and inferior longevity. Increasing published scientific reports have shown success rates of seven to nine years provided that vital success factors are respected. Clinical success in resin bonded bridgework is dependent on identification of high risk cases, appropriate assessment, optimum bridge design, maximum tooth coverage and meticulous clinical technique. This paper will examine design principles vital in the success of resin bonded bridgework and present two clinical cases.

Key words:

Resin bonded bridge, clinical success, de-bonding, bridge design, case selection

TECHNIQUE
Stabilizing Mandibular Complete Dentures Using the Neutral Zone Impression Technique
Haroon Rashid , Fahim Ahmed Vohra , Tasneem Zoeb Haidry , Geeta Devi Karmani
(Pages 154 - 159)
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Abstract

Fabrication of complete dentures using the neutral zone technique is neither recent nor original. During the past few decades, many articles which have incorporated or related to what we have named the ‘‘neutral zone technique’’ have been published. The aim of this case report is to describe the technique to fabricate a mandibular complete denture in muscular balance, as muscular control will be the major stabilizing and retentive factor during function. The neutral zone technique is fairly easy to perform but requires an extra visit and relatively high laboratory costs. This article elaborates on a case of a 62 years old male patient with mandibular atrophic ridge treated by utilizing the neutral zone technique.

Key words:

(a). Atropic residual ridges, b) Mandibular complete denture, c) Stability, d) Tissue conditioner