MTA Cvek Pulpotomy Followed by Fragment Re-Attachment in Traumatized Young Permanent Maxillary Left Central Incisor – A Case Report

Most common form of dental trauma in children are the fractures of crown mainly in anterior teeth. A case of complicated crown fracture treated with Cvek pulpotomy using MTA followed by fragment re-attachment with careful follow-up is presented here. Tooth fragment re-attachment provides feasible conservative alternative approach to restore esthetics and tooth function. Successful outcomes have been shown by the long term follow up of the treatment with the preservation of pulp vitality and continued development of root. Clinical results have also shown good esthetics and functional results of presented technique. KEYWORDS: Complicated crown fracture, Cvek pulpotomy, MTA, fragment re-attachment HOW TO CITE: Zalan AK, Zubairy KK, Zaman H, Maxood A, Gul A, Anser M. MTA cvek pulpotomy followed by fragment re-attachment in traumatized young permanent maxillary left central incisor – A case report. J Pak Dent Assoc 2021;30(1):70-73.

A Permanent solution to Restore Occlusal Vertical Dimension and Partial Edentulism – Overlay Removable Partial Denture

Tooth wear is a common problem seen in population and poses restorative challenge to a dentist as well. Extensive dental procedures are usually required for the treatment of tooth wear associated with loss of occlusal vertical dimension. An overlay removable partial denture provides conservative treatment option for patients with moderate to severe worn down dentition and partial edentulism. It is designed in such a way that some part of denture component also covers the occlusal surface of remaining teeth and replace the remaining teeth to achieve a functionally stable occlusion. This case report is about a patient who was given cast metal overlay upper and lower denture for a correction of lost vertical dimension of occlusion, replacement of few missing teeth and for the prevention from further tooth wear. KEYWORDS: Tooth wear, vertical dimension, overlay denture HOW TO CITE: Aziz S, Nazeer MR, Zafar K, Ghafoor R. A Permanent solution to restore occlusal vertical dimension and partial edentulism – Overlay removable partial denture. J Pak Dent Assoc 2021;30(1):66-69.

Leukemia and Periodontal Health

Leukemia is a malignant neoplasm that arises from hematopoietic cells. leukemia has high prevalence among Saudi and Pakistani populations (6.2% and 4.1% respectively). Dentists should perceive the serious complications of leukemia and its therapies and to manage leukemic patients in dental practice safely and effectively. Oral manifestations of hematological malignancies may represent the initial sign of the underlying hematopoietic disease. 65% of leukemia lesions have some form of oral manifestations. Accordingly, the purpose of this review is to summaries all the general manifestations of Leukemia as well as the oral manifestations to facilitate early diagnosis and referral. Leukemia oral manifestations could be pale mucosa or spontaneous bleeding gingiva or bruising and petechiae in the hard and soft palate. Gingival hyperplasia, ulcerations, and opportunistic infections with Candida albicans and Herpes Viruses can occur in oral mucosa. Dental care for leukemic patients should focus on trauma prevention and meticulous oral hygiene. Antibiotics should be used to prevent and to treat infections (bacterial, virus and fungal infections). Periodontal surgeries like gingivoplasty procedures are considered elective treatments before the diagnosis and or treatment of leukemia and it should not be performed until the patient completes and maintains their antineoplastic treatment. Dentists plays an essential role in the early diagnosis of the leukemia; therefore, they should lead a proper investigation and referral to reach proper diagnosis. KEYWORDS: Gingival Bleeding, Leukemia, Oral Manifestations, Periodontal Surgeries. HOW TO CITE: AlHazmi BA. Leukemia and periodontal health. J Pak Dent Assoc 2021;30(1):61-65

Clinical Comparison of 5% Potassium Nitrate and 10% Strontium Chloride Toothpastes in Alleviating Dentin Hypersensitivity Following Manual Scaling: A Pilot Study

OBJECTIVE: The objective of this study was to compare the efficacy of dentifrices containing potassium nitrate and strontium chloride in reducing dentinal sensitivity pain. METHODOLOGY: A pilot study was conducted in Islamic International Dental Hospital Islamabad, Pakistan (Duration two weeks). Forty participants were selected, aged between 18-40 years, having dentin hypersensitivity with the minimum score of 4 on Visual Analog Scale. Participants were randomly allocated with dentifrices containing 5% w/w potassium nitrate and 10 % w/w strontium chloride and were asked to use it for 2 weeks and come back for follow up. Statistically significant correlations were found using the Man Whitney test. A pre-designed proforma was used to acquire information about the patient. Sensitivity was determined with the aid of the Visual Analog Scale. RESULTS: There was greater reduction in moderate pain from 85.8% to 71.4% with strontium chloride and from 84.2% to 79% with potassium nitrate. CONCLUSION: 10 % w/w strontium chloride is more effective than the 5% w/w potassium nitrate for the management of dentin hypersensitivity. KEYWORDS: Toothpastes, Sensitivity, Strontium Chloride, Potassium Nitrate HOW TO CITE: Kiani AZ, Hassan S, Rafiq T. Clinical comparison of 5% potassium nitrate and 10% strontium chloride toothpastes in alleviating dentin hypersensitivity following manual scaling: A pilot study. J Pak Dent Assoc 2021;30(1): 56-60.

Analysis of Dental Practitioners Perception Towards Dental Implants

OBJECTIVE: To investigate the dental practitioner's knowledge, attitude and practice towards dental implants. METHODOLOGY: This study was carried out from May'2019 - Oct 2019. 752 dental practitioners who were currently practicing were included in the study. A well-structured questionnaire was used for data collection. SPSS-25 was used for statistical analysis. Spearman correlation was used to find the effect of gender, knowledge and attitude. The P <0.05 was considered statistically significant. RESULTS: In this study 80.9% dental practitioners were aware of the appropriate implant material while, 57.9% had knowledge about the types. 30.3% knew about the implant surface modifications whereas 46.1% dentists were aware of possible implant placement approaches. 49.3% believed that the distance between dental implants to be 3mm and between a dental implant and natural tooth to be 1.5 mm. 76% dentists claimed that dental implants have biomechanical complications. Whereas 67.8% knew about the Branemark's theory of osseointegration. Regarding the attitude of dental practitioners, 28.9% had received implant hands on trainings while 9% felt competent to place an implant. CONCLUSION: This study describes that dental practitioners had an appropriate knowledge of each aspect of implantology. Moreover despite the fact majority felt that they are not competent enough to practice it. Thus, it is important that the curriculum, teaching standards, the materials and methods regarding dental implants need to be reviewed and more exposure of hands-on workshops is to be provided not only for the graduates but also the undergraduates during their clinical learning. KEYWORDS: Dental Implants, Dentist's opinion, Knowledge HOW TO CITE: Ahmed N, Abbasi MS, Mariam Q, William H, Iftikhar H, Badar H, Irfan AB. Analysis of dental practitioners perception towards dental implants. J Pak Dent Assoc 2021;30(1):45-49

The Psychology of Coronavirus Fear: Are Dentists of Pakistan Suffering from Corona-Phobia?

OBJECTIVE: The objective of this study is to evaluate the level of anxiety and fear among Pakistani dentists due to COVID-19. METHODOLOGY: Data of 386 dentists evaluated who responded to the questionnaire sent via social media. Fear of coronavirus scale (FCV-19S) was used for evaluation of fear among Pakistani dentists. Data was entered and analyzed using SPSS version 21. One way ANOVA, chi-square and independent t-test were used for statistical analysis. P-value <0.05 was considered as significant. RESULTS: The overall mean FCV-19S score was 26.22 ± 4.907, which is on the higher end. Females showed higher fear scores as compared to males (p<0.001). A statistically significant difference between the scores of General Dental Practitioners (GDP) and specialists was also observed (p<0.001), Statistically, a significant difference was observed between all 4 age groups of dentists, young and elderly dentists demonstrating higher scores (F (3,382) = 8.618, p< 0.001). CONCLUSION: We conclude that due to the current COVID-19 crisis, majority of the dentists of Pakistan are afraid and among them, females, GDPs, young and elderly dentists are found to be more anxious and have a greater fear of getting infected by coronavirus during COVID 19 Pandemic. KEYWORDS: Anxiety, Fear, Pakistani, Dentist, COVID-19 HOW TO CITE: Majeed MM, Saleem Z, Sarwar H, Ramzan Z, Iqbal SN, Naeem MM. The psychology of coronavirus fear: Are dentists of pakistan suffering from corona-phobia?. J Pak Dent Assoc 2021;30(1):1-6.

Papillon Lefevre Syndrome: Diagnosis and Management in Two Affected Siblings – A Case Report

Papillon-Lefèvre syndrome (PLS) an autosomal recessive disorder characterized by diffuse transgradient palmar-plantar hyperkeratosis, with premature loss of deciduous and permanent teeth, along with the calcification of the dura mater. This results in teeth radiographically appearing as “floating” in the soft tissue. Genetic studies of patients with PLS have mapped the major gene locus to chromosome 11q24-q21 and revealed mutation and loss of function of the cathepsin gene. It affects 1- 4 people per 1 million population with no gender or racial predilection. Dermatological manifestations, usually occurs before four years of age, include hyperkeratosis of palms and soles, nail dystrophy, hyperhidrosis and keratinization on elbows and knees with the lesions appearing as white, yellow-like or red plaques or patches that then develop cracks, crusts, or deep fissures. KEYWORD: Papillon-lefevre syndrome, hyperkeratosis HOW TO CITE: Zalan AK, Zubairy KK, Maxood A, Niazi M, Zaman H, Gul A, Anser M. Papillon lefevre syndrome: Diagnosis and management in two affected siblings – A case report. J Pak Dent Assoc 2020;29(4):264-268.

Association of Curve of Spee with Vertical Skeletal Patterns

OBJECTIVE: To find the mean curve spee depth and association in three different skeletal vertical patterns (Hypodivergent, Normodivergent and Hyperdivergent). METHODOLOGY: Orthodontic models of mandibular arch and Lateral cephalogram of 110 patients with the mean age of 17.16±4 years, 26.4% (N=29) males and 73.6% (N=81) females were taken from the patients who visited for the orthodontic treatment, to the Department of Orthodontics of Karachi Medical and Dental College. Skeletal divergence defined by the mandibular plane (Lower border of mandible) to sella-nasion line angle (SN-MP). It was measured on lateral cephalogram and Curve of spee depth measured on mandibular cast. RESULTS:Out of 110 patients 20.9% (N= 23) were hypodivergent, 29.1% (N=32) were normodivergent and 50% (N=55) were hyperdivergent. The curve of spee among these three groups were 3.39±0.30mm, 2.62±0.23mm and 2.02±0.45mm. One-way ANOVA has been applied and it showed highly significant differences in the value of curve of spee depth among three vertical skeletal patterns with the p-value of 0.000. Moving from Hypodivergent to Hyperdivergent cases, the curve of Spee depth reduces. CONCLUSION: It has been found that there is a significant difference in curve of spee among hypodivergent, normodivergent and hyperdivergent patients. KEYWORDS: Dentistry, Curve of Spee, Vertical Skeletal Patterns, Orthodontic Diagnosis. HOW TO CITE: Rehman SA, Rizwan S, Faisal SS, Hussain SS. Association of curve of spee with vertical skeletal patterns. J Pak Dent Assoc 2020;29(4):254-258.

Effect of Hydrogen Peroxide on Cyclic Fatigue Resistance of NiTi Endodontic Files

OBJECTIVE: To investigate the effect of nickel titanium rotary endodontic file immersion in hydrogen peroxide on cyclic fatigue resistance. METHODOLOGY: Twenty Six Protaper Universal (Dentsply Maillerfier) F1 files were randomly divided into two experimental groups. In Group I, Protaper universal variable taper F1 files were immersed in normal saline where as in Group II, the files were soaked in hydrogen peroxide (6% w/v) for 2 hours at 37°C. Cyclic fatigue of each file was checked by recording the number of rotations required to break a file in a 90°curve with a 5 mm radius. For statistical analysis of data, Two-way ANOVA was applied. A p value of <0.05 was considered significant. RESULT: Out of Twenty Six, Six files fractured spontaneously after immersion in hydrogen peroxide. Twenty files were subjected to fracture resistance testing. Statistically significant difference in cyclic fatigue resistace between the two groups was found (p=0.002). The files soaked in Group II required less revolutions to fracture than the ones immersed Group I. CONCLUSION: The immersion of NiTi endodontic files in hydrogen peroxide significantly reduces cyclic fatigue resistance. Therefore, immersion of the NiTi endodontic files in hydrogen peroxide solution for removal of clogged debris should be discouraged. KEYWORDS: Cyclic fatigue, Endodontic instruments, Hydrogen peroxide, NiTi HOW TO CITE: Sarwar H, Naeem MM, Shabbir S, Riaz S, Afaq H, Shabbir J. Effect of hydrogen peroxide on cyclic fatigue resistance of NiTi endodontic files. J Pak Dent Assoc 2020;29(4):246-248.

Trends in Endodontic Protocols Amongst Dentists in Lahore

OBJECTIVES: To determine the trends in endodontic protocols amongst practicing dentists in teaching institutions and private clinics in Lahore. METHODOLOGY: A cross sectional survey was conducted amongst dentists working in the teaching institutions and in the private clinics of Lahore. A pre-piloted questionnaire survey adopted from Kohli et al with slight modifications was used. In this descriptive study 270 practicing dentists were selected using consecutive sampling with a 5% level of significance and margin of error. RESULTS: The 270 respondents had a mean age of 28.16 ± 6.18 participated in this study among which 111 (41.1%) were males and 159(58.9%) were females with the mean age of 30.28 ± 7.416 and 26.68 ± 4.62 respectively (12.2%) were consultants, 175(64.8%) were general dentists whereas 62(23%) were postgraduate residents. In our study population, 76(28.1%) dentists were using magnification among which 67(88.2%) were using loupes and 9(11.8%) were using microscope. The prevalence of the rubber dam usage for isolation among our respondents was 110(40.7%) only, 201(74.4%) dentists reported for routine removal of smear layer. Manual canal preparation technique was the most commonly used method practiced by 149(55.2%) dentists. 136(50.4%) dentists were using beveled needles for irrigation, whereas only 71(26.3%) were using side venting irrigation needles. Majority of the dentists (45.2%) were not using any method to increase the efficacy of the irrigants. CONCLUSION: There are deficiencies in the endodontic protocols followed by majority of the dentists in Lahore and these short comings should be addressed by governing bodies. KEYWORDS: Root canal therapy, Endodontic, Practice Patterns, Dentists HOW TO CITE: Lodhi Sk, Ehsan S, Rafique A, Saleem MN. Trends in endodontic protocols amongst dentists in Lahore. J Pak Dent Assoc 2020;29(4):239-245. DOI: https://doi.org/10.25301/JPDA.294.239 Received: 30 July 2020, Accepted: 08 September 2020