Volume 20 – Issue 4 (Oct – Dec 2011)

Abstract

As a consequence of several paradigm shifts and the increasing need and demand for implant restorations by patients, these days’ implant related procedures are more frequently performed by general dental practitioners (GDP). The resulting lack of not following a team approach by the GDP has increased the rate of implants related complications. Thus dentists upon graduation need to be made competent by incorporating, in the curriculum, relevant concepts and procedure related to dental implants. This will enable local dental institutes not only to be in line with those in developed countries but they will also produce dental graduates competent for the practice of dental implants. The implant related curricular content shall comprise of learning and training of; indication of oral implants in overall treatment planning of patients, understanding of the basic aspects of healing and tissue integration, basic biomechanical andmaterial science principles, patients’ evaluation, selection and identification of their treatment complexity, relevant ethical and moral considerations, surgical and prosthetic techniques, monitoring,maintenance and management of complications related to peri-implant tissues and implant prosthesis. This writing elaborates upon the strategy for overcoming the barriers to introducing dental implants in dental undergraduate studies and for ensuring desired learning and the acquisition of skills related to these issues of implant-supported dental restorations by graduating dentists.

KEYWORDS

Curriculum,Dental Practitioner, Implants, Strategy,Undergraduate

OBJECTIVE

The aimof this studywas to compare burnout levels between dental academics and nonacademics in Riyadh andEastern Province, SaudiArabia and investigate the factors affecting their burnout levels.

METHODOLOGY

The Maslach Burnout Inventory Survey (Arabic version), including the emotional exhaustion, depersonalization, and personal accomplishment scales, and questions on demographic information were used to evaluate burnout among 370 Saudi dentists in academic and nonacademic hospitals. The data were statistically analyzed byANOVAand t-test.

RESULTS

The compliance ratewas 62.97%(223/370).Among the analyzed subjects, age, gender, patients/week, working hours/week, years of experience, and rank were factors affecting the burnout levels.Academics had lower burnout levels than non academics.

CONCLUSIONM

Among Saudi dentists, non academics tend to have higher burnout levels than academics. Burnout levels are affected by age, gender, years of experience, rank, and workload

KEYWORDS

MaslachBurnout Inventory,Dentist,Burnout,Occupational stress,Workload

OBJECTIVE

To assess the perception of dental, art and business students on the importance of smile attractiveness and the understanding on effect of skin tone on tooth shade value as perceived by the 3 groups.

METHODOLOGY

It was a cross sectional, analytical study conducted in Art, Business and Dental Schools. Ninety 90 students (3 groups of 30 each)were selected by non probability, purposive sampling. 24 pictureswere run in front of the participants as power point presentations. The pictures were of two individual smiles, a male and a female, with changes made to colour of teeth and skin, inAdobe Photoshop. The participants were asked to grade each picture on a rating scale. SPSS 17.0 was used for data analysis. Frequency distribution of all variables was determined. Association of smile attractiveness with gender and profession was determined using Chi-square test. Mean ranks and score (of the 24 pictures) of smile attractiveness as perceived by the 3 groupswere compared using Kruskall-Wallis test.Level of significancewas set at 0.05

Results

The sample size consisted of 34.1%males and 64.8%females. For the dental group smile attractiveness was very important as opposed to the business and art students. For females, smile attractiveness was more important than theirmale counterparts. Fair skinwith bright andmoderately bright teeth rated as themost attractive smile,whereas fair skinwith dark teeth rated as the least attractive smile.

CONCLUSIONS

There is a difference in perception of smile attractiveness between males and females. Art, business and dental students also have different perceptions of smile attractiveness with respect to skin tones and tooth shade values.

KEYWORDS

Smile,Attractiveness, Skin tone,Tooth shade

OBJECTIVE

To compare the frequency of interappointment pain between 2.5% Sodium Hypochlorite and 3% Hydrogen Peroxide as a root canal irrigationmaterial. Design:Clinical trial.
Setting: Study was conducted at Dental OPD, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan fromFebruary 2009 to July 2009.

METHODOLOGY

Sixty single-rooted, single-canal permanent teeth of sixty patients were selected randomly and equally divided in two groups. In groupA(n=30), 2.5%Sodiumhypochlorite (NaOCl)was used as an irrigation material while in group B (n=30), 3% Hydrogen peroxide (H2O2) was used. Canals were left empty for 72 hrs between visits. On second visit, interappointment pain was scored onVisualAnalogue Scale (VAS) (0= No pain,1- 3=mild, 4-6=moderate, 7-10= severe) by each patient on the proforma provided.

RESULTS

Interappointment pain was observed in 32/60 patients and the rest did not experience any pain. Pain was significantly high in group B thanA(70% vs. 36.7%; p=0.01). Severity of pain was also compared which was significantly high in group B than group A (p<0.012). Female experience more pain as compared to male.While correlation of agewith painwas not found (p>0.05).

CONCLUSION

NaOCl performed better clinically in terms of inter appointment pain when compared with H2O2.

KEY WORDS

Hydrogen Peroxide (H2O2), Interappointment pain, Root canal Irrigants, Sodium Hypochlorite (NaOCl),VisualAnalogue Scale (VAS).

OBJECTIVE

1.To determine the proportion of dental institutions’ faculty teaching repair of composite restorations to dental students (undergraduate).
2.To evaluate the factors that affect the decisionmaking process ofResinComposite restoration repair.

METHODOLOGY

An 11 itemquestionnairewas presented to the facultymembers of all the dental institutions in Karachi. Nine out of ten dental institutions participated in the survey and a total of 38 faculty members from the department of Operative Dentistry filled the questionnaire.

RESULTS

About 90% of the respondents stated that composite repair is advisable whereas 70% of the respondents stated that they have performed such type of interventions and have achieved success. Around 40% stated that they teach such procedures to students and60%stated that the course of instruction is at clinical level.

CONCLUSION

1.The findings of the present study indicate that the teaching of the repair of defective composites has found a place in primary dental degree curricula in almost all the dental institutions in the Karachi.
2.Occlusal relationship and patient’s existing oral hygiene appeared to be the most important factors in decision making process.

KEYWORDS

composite, resin, repair, replacement, survey, restoration, composite defects.

OBJECTIVE

To evaluate the light intensity output of the composite curing units used in the dental institutions of Karachi.

METHODOLOGY

It was a cross sectional study in which a total of 29 halogen composite curing units were examined. The light intensity output was measured using Cure-Rite meter. A cut off of 300mW/cm was taken as adequate light output.ANOVAandKruskal-Wallis testwere applied.Level of significancewas kept at 0.05.

RESULTS

The mean light output intensity was 345.2 mW/cm (SD 251.1 mW/cm ). Out of 18 units at undergraduate institutions, 11 had poor light output while 3 out of 11 at postgraduate institutions had poor light output.The condition of light cure unit’s casing had a significant associationwith the light output (p-value of 0.011).

CONCLUSIONS

About half of the curing units at the dental institutions have poor light intensity output which may result in an inadequate quality of dental service.This is an alarming situation for the clinicians.Asmishandling of the equipment is a leading cause of its poor performance, the external casing of the light cure unit can be taken as a proxy for its light output.

KEYWORDS

CompositeRestorations,CuringLight,Light intensity,Dental Institutions

OBJECTIVES

The objectives of this study were to evaluate the antibacterial effects of Calcium hydroxide and Chlorhexidene as intra canalmedicaments in a sample of Pakistani population.

METHODOLOGY

Eighty, single rooted teeth of patients with necrotic pulps and periradicular lesion who presented atDepartmentOfOperativeDentistry, Fatima Jinnah Dental College Hospital, AzamBastiwere recruited in the study.At first appointment the root canals were cleaned, shaped and dried. Initial samples for bacteriological examination were taken. Medicaments to be tested were placed in the root canals and access cavities were sealed with temporary filling material. After seven days, samples were taken again from the root canal and inspected for growth of microorganism to determine the efficacy of the medicament used. Data was compared using ‘Pearson’s Chi-square test’ on S.PS.S version 10 for windows.

RESULTS

Twenty three (57.5%) out of 40 case swith Chlorhexidene dressing yielded negative cultures.Whereas Calcium Hydroxide group showed negative cultures in 18 (45%) out of 40. There were no statistically significant differences between the two medicament groups. (p-value is 0.263).

Conclusions: Chlorhexidene has better antibacterial effects than calcium hydroxide clinically.However, there were no statistically significant differences among the medicaments tested.

KEYWORDS:

Antibacterial effects,Calciumhydroxide,Chlorhexidene, Intra canalmedicaments

OBJECTIVE

The study was conducted to determine the Frequency and determinants of oral substance abuse among patients seeking dental care at Department of Periodontology, Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences,DowUniversity ofHealth Sciences,Karachi.

METHODOLOGY

Across session studywas conducted during January to June 2011.Atotal of 2259 patientwere interviewed from a structured questionnaire atDepartment of Periodontology,Dr. Ishrat-ul- abad Khan, Institute of Oral health Sciences, Dow University of Health Sciences,, Karachi. The questionnaire was based on demographic data along with risk factors resulting in use of substance abuse. The substance abuse included Pan and cigarettes, Niswar, betel nut, Pan, cigarettes, Niswar and Betel nut and gutka. The data was collected on the performa and analyzed using SPSS windows version 17. Frequencies and percentages were calculated for categorical variables including age, gender, education, type of substance used. Stratification was done with substance user and non-user to see the effect on their oral health. Chi-square was used to compare the categorical variables at 5% level of significance between substance user and non-user.

RESULTS

There were 2259 respondents consented for interview regarding use of substance abuse by them.Most of the patients 1362 (60.3%) belonged to younger age group 18-25 years. Female respondents were 1384(61.3%). Most of the dental care seekers were graduates 984 (43.6%) out of 2259, there were 884 (39.1%) substance abuser. The type of substance abusedmostlywere pan and cigarettes both 1375 (60.9%) and cigarettes, niswar, beetle nuts all together in 483 (21.4%). On examination the oral health statuswas good only in 582 (25.8%).Mostly substance abuse was started on self basis 433(49%) compared to others 45 (51%). It was also found that unemployment 300(33.9%)was themajor reason for substance abuse.

CONCLUSION

The frequency of oral substance abusewas found in 39.1% of the patients seekingmedical advice at the dental and oral institute.The commonest determinants of substance userwere younger age group between 18- 25 years, commoner in male than female, one third were graduates and unemployed were found more addicted to substance use. The study found that the type of substance abuse at the time of interview were multiple variety of substance. Pan along with cigaretteswas used by maximum number of participants. Pan and cigarettes along with Niswar and betel nutswere used by quarter of the sample.

KEYWORDS

Substance abuse, Frequency, risk factors, determinants, cigarettes, Pan,Niswar,Arica nut,Gutka

OBJECTIVE

The aimof this studywas to investigate the primary reasons for simple extraction of permanent teeth in Dental Section of a tertiary care hospital and to identify themost frequently extracted teeth.

METHODOLOGY

The patients selected for this study were identified by reviewing dental notes from medical records of patients who had undergone dental extraction at Dental clinic, at The Aga Khan University Hospital, Karachi. Total of 124 charts were reviewed retrospectively. Data regarding the age, gender, co morbid conditions, date of extraction, number and type of tooth extracted and the cause of exodontia were recorded in a proforma. Descriptive analysiswas done using SPSS version13.0.

RESULTS

Atotal of 147 teeth extracted from 77 patientswere included for analysis.Out of 77 patients, 56%were females and 44% were males.Average age was 49.7 + 16 years. (11-83 years). Reasons for extraction were: 42.2% extractions were due to caries, 30.6% were extracted for periodontal reasons, 6.1%for orthodontic reasons, 10.2% for mixed reasons, 6.1% for failed endodontics, 4.1% on account of tooth fracture and 0.7% for pre-prosthetic reasonsMaxillary secondmolars were themost frequently extracted teeth.More posterior teethwere extracted due to carieswhile periodontitiswas themain reason for extraction in the anterior teeth.

CONCLUSION

Caries was found to be the primary reason for exodontia of permanent teeth in all age groups, followed by periodontitis and orthodontic reasons. Maxillarymolarswere themost frequently extracted teeth.

KEYWORDS

Tooth extraction, dentition, permanent, Exodontia

OBJECTIVE

This study set out to evaluate the satisfaction for a group of patients were with some independent variables and criteria of conventional Removable Partial Dentures (RPDS) and to compare their subjective evaluations with those of a dentist using objective criteria to examine the quality of the prostheses.

METHODOLOGY

A questionnaire was developed into three sections using questions adapted from previous studies. The first part included the personal data, medical history, denture experience, age of prosthesis, opposing denture, and Kennedy classification. The second part had questions related to patient satisfaction, and the third part had a criteria to be evaluated by the dentist.

RESULTS

Sixty-one (61) female patients who received ninety four (94) new RPDS in the college of Dentistry, KSU were recalled. The mean age of the patients was 45.4 years with an age ranged from 22 to 65 years. Results showed that 85%of patientswere satisfiedwith their dentures.However, 50.8%of patients appeared unhappy about food remains under RPDs.Asignificant relationship between patient satisfaction and the quality of the removable partial dentures that were evaluated by the dentist for retention, stability, extension and occlusion (P ranged from 0.000 to 0.026), except for oral hygiene,where the patient’s satisfactionwas non-significant (P= 0.609).

CONCLUSION

There was a significant patient’s satisfaction with the age of prosthesis (n ranged from 50% to 89.1%, P= 0.010). On the contrary, non-significant associationwas found in regard to patient’s age,medical history, experience, opposing dentition, and Kennedy classification and location (P ranged from 0.092 to 0.940), although therewere high percentages of patient’s satisfaction (n ranged from75%to100%).

KEYWORDS

Dentist evaluation, Patient’s satisfaction,Removable partial denture quality, Saudi female patients

OBJECTIVE

The aim of this investigation was to conduct a survey among private dental practitioners in Riyadh concerning their attitude towards treatment of children including thosewith special care needs.

METHODOLOGY

The sample was drawn from dentists working in private dental clinics in Riyadh for a questionnaire survey. A 5 point Likert-type scale was used to describe the participants’ response to questions concerning adequacy of undergraduate training, preference of behavior modification techniques, barriers preventing dentists fromtreating children and themost suitable incentive options for dentists in treating children.

RESULTS

Atotal of 204 responses were returned with a response rate of 20.4% which provided valid and usable information. The sample included 96.1% Non-Saudi and 3.9% Saudi dentists, 58.1% male and 41.9% female dentists 64.7% general practitioners, 30.5% specialists and 4.7% consultants. Among the 204 respondents, 85% treated children, 65.7% reported time consumption and financial loss as a major barrier in treating children and 60.8%favored tell-show-do as the preferredmethod of behaviormanagement technique.

CONCLUSIONS

Our study suggests that majority of private practitioners have a positive attitude towards treating children but time consumption and financial loss was found to be a major barrier in treating children and thosewith special health care needs effectively.

KEYWORDS

Pediatric patients, special care needs, attitude, barriers.

OBJECTIVE

To evaluate, the mesiodistal dimensions of permanent teeth, frequency of Bolton ratio & the presence of Bolton discrepancy outside 2 SD of the Bolton’s mean in an orthodontic population, irrespective of the type ofmalocclusion.

METHODOLOGY

The study was carried out at the department of orthodontics Fatima Jinnah Dental College & Hospital, Karachi. The sample comprised of 150 pairs of good quality pre- treatment study models with fully erupted & complete permanent dentition from first molar to first molar, which were selected from the orthodontic patient pool. Dental casts having grossly carious teeth, prosthesis or anomalies of teeth were not included. The mean, range and standard deviation were calculated for the mesiodistal dimensions of the teeth, anterior ratio and overall ratio.A2- sample t- testwas used to test for the statistical difference betweenmeans.

RESULTS

In general there was no difference between themesiodistal dimensions of themales and females so the subgroupswere combined for further calculations.Mean overall ratiowas found to be 91.54%(SD2) and the value ranged from 86.42%to 96.70%.Mean anterior ratio was found to be 78.85%(SD 2.3) and the values ranged from 72.49%to 83.14%. This study found that 13 subjects (9.1%) had overall ratio& 22 subjects (14.7%) had anterior ratio outside 2 SDofBolton’smean.

CONCLUSIONS

With such a high number of significant discrepancies, it is important to routinely perform Bolton tooth size analysis before starting orthodontic treatment asTSDis prevalent among orthodontic patients

KEYWORDS

Bolton tooth size discrepancy,Bolton ratio, tooth size discrepancy (TSD), orthodontic population

OBJECTIVE

To study the osseointegration of dental implants placed in Beagle dogs using an adapted surgical technique and to compare it with conventional method by estimating implant stability by Resonance Frequency Analysis (RFA)

METHODOLOGY

Dental implantswere placed bilaterally in themandible ofBeagle dogs using press-fit aswell as undersized implant bed preparation technique.Assessment of primary stabilitywas carried out 0 day, 2weeks and 12weeks after implantation using theRFAmethod, and Implant StabilityQuotient (ISQ) valueswere recorded.

RESULTS

At the time of implant installation (day 0) the mean ISQ values were 64.41 ± 4.86 for the press-fit and 74.13 ± 4.47 for the implants inserted with the undersized preparation. The difference was found to be statisticallysignificant (p<0.01). The ISQ values after 2 weeks and 12 weeks also showed similar trend however, these differences were not statistically significant (p> 0.05). No significant decreases were found in the ISQ value of the press-fit and undersized implantsmethods as compared to the day 0 (p> 0.05).

CONCLUSION

The results of this study showed that the undersized implant bed preparation may significantly improve the primary stability which may help in a better osseo integration. This method can be used in compromised bone to achieve better osseointegration.

KEY WORDS:

dental implants, primary stability, Resonance frequency analysis, ISQ values, bone integration, surgical technique

OBJECTIVE

The purpose of this study is to evaluate the effect of systemic administration of aspirin, on osseointegration around titaniumimplants in the tibia of rabbits.

METHODOLOGY

Sixteen adult male rabbits were included in this study. One screw-shaped titanium implant was inserted in the tibiae of each rabbit.The animalswere divided into two groups, groupAacted as control, groupB received daily intramuscular injections of aspirin for 8 weeks. After 8 weeks the rabbits were sacrificed, and the osseointegration around titaniumimplantswas examined by scanning electronmicroscope.

RESULTS

The combined use of aspirin with titanium implants in the tibia of rabbits resulted in significant increase the rate of osseointegration around dental implants. Conclusion: Systemic administration of Aspirin may positively influence osseointegration around titanium implants.

KEYWORDS

Aspirin Dental implants, sseointegration, canning electronmicroscope.