Endodontics

What opinions do Saudi endodontic residents hold about regenerative endodontics? Saeed S Al Qahtani, Salman Aziz, Hmoud Al Garni, Mohammed Sulmain Alaenazi Saudi Endodontic Journal 2019 9(1):1-7 Aim: The aim of this study is to investigate the opinions, current knowledge, and expectations of Saudi endodontic residents regarding the use of regenerative endodontics as part of future dental treatment and establishing a baseline for further research and development. Materials and Methods: Saudi endodontic residents all over Kingdom of Saudi Arabia (KSA) were contacted, for participation. A survey form consisting of 28 questions was personally distributed to all endodontic residents who were actively enrolled in a residency training program either Saudi board program or Master Degree and provided informed consent for inclusion into the study. Data were collected and statistical analysis was carried out using SPSS version 22. Results: Out of one hundred and fifteen endodontic residents 97 participated in this questionnaire-based survey. Two forms were excluded due to incomplete and unclear information. Out of the remaining 95 majority of the residents were male (67.4%) and belonged to Saudi board program. The greater part of residents agreed for the inclusion of regenerative endodontics in the dental curricula. Most of the candidates wanted to improve their skills in regenerative endodontics by participating in continuing dental education programs. The most popular belief (n = 81) was that regenerative therapy to save teeth is better than implants. Use of regenerative procedures in clinics was carried out by only 44 participants. Conclusion: The emerging importance of regenerative endodontics in KSA is evident through this study. This study highlights many core issues which need attention and forms a baseline for further research in regenerative endodontics.

Removal ability of MTA-, bioceramic-, and resin-based sealers from obturated root canals, following XP-endo® Finisher R file: An ex vivo study Taxiarchis G Kontogiannis, Nikolaos P Kerezoudis, Konstantinos Kozyrakis, Elefterios Terry. R. Farmakis Saudi Endodontic Journal 2019 9(1):8-13 Aim: Removability assessment of mineral trioxide aggregate (MTA)-, bioceramic-, and epoxy resin-based sealers, with or without XP-endo® Finisher R file, was achieved. Materials and Methods: One hundred and twenty extracted single-rooted premolars were randomly organized into three equal groups, instrumented up to #40.04 and obturated with single-cone technique by gutta-percha and one of the following sealers: MTA Fillapex, TotalFill BC Sealer, or AH Plus. Following setting of the sealer, D-RaCe instruments were used in retreating all specimens. In half of the specimens, XP-endo® Finisher R file was additionally applied following D-RaCe, as a final step in retreatment. Working length (WL) following the procedure and patency were recorded. All specimens were split and observed for residuals under optical microscopy. Images were acquired, placed adjacent to each other forming continuous strips, and focus stacked with Helicon Focus software. A blinded observer evaluated all photographs. Analysis included Chi-square tests and one-way ANOVA. Results: WL was fully regained in all cases. Patency regaining (in terms of canal cleanness) was easier in AH Plus groups. Residuals were significantly more in TotalFill groups (P < 0.0001). XP-endo® Finisher R file improved removal only in the AH Plus subgroup. Conclusions: TotalFill residuals were harder to remove than those from MTA Fillapex or AH Plus groups. Patency is also harder to regain. XP-endo® Finisher R file had a positive removal influence only in the AH Plus subgroup.

Restorative methods to rehabilitate endodontically treated posterior teeth by students and new graduates of King Saud University: A survey study Sahar A AlZain Saudi Endodontic Journal 2019 9(1):14-20 Aim: The aim of the study was to evaluate the efficiency of dental students and new graduates of College of Dentistry, King Saud University, in Riyadh, Saudi Arabia, to select the appropriate methods of restoring endodontically treated posterior teeth (ETPT) at different conditions of remaining sound tooth structure. Materials and Methods: A questionnaire was distributed among the 4th- and 5th-year dental students and new graduates. Respondents were requested to indicate their gender and level of education and to select the preferred restoration of ETPT at different conditions. Results were analyzed using one-way frequency and two-way cross-tabulations. Results: At >50% tooth remaining (condition A), 39.9% of the respondents preferred to use an amalgam restoration, while 30.9% preferred to use a restoration followed by a crown at 50% of remaining tooth (condition B). At <50% tooth remaining (condition C), 74.6% preferred to use a cast post-and-core and a crown. Respondents changed their choices of restoration to more advanced ones when teeth served as abutments for fixed or removable prostheses. Chi-square analysis demonstrated a statistically significant relationship between the selected restorative method at condition A and both gender (P = 0.045) and level of education (P = 0.001), between the method of restoration at condition B and both the gender (P = 0.000) and the level of education (P = 0.003), and between the selected restorative method at condition C and the level of education (P = 0.000). Conclusions: Respondents demonstrated a high knowledge when selecting the appropriate method of restoring ETPT at different clinical conditions.

Comparative evaluation of shaping ability of rotary and reciprocating nickel-titanium single file instruments on simulated root canals Arvind Kumar, A Sheerin Sarthaj Saudi Endodontic Journal 2019 9(1):21-26 Introduction: Effective cleaning of the root canal system is the primary objective of rotary instrumentation. For three-dimensional obturation of the root canal system, ideal preparation should have a continuously tapering funnel shape from the orifice to the apex. The study aimed to evaluate the shaping ability of two rotary and two reciprocating nickel-titanium (NiTi) single-file instruments on simulated root canals using image analysis software. Materials and Methods: Forty resin blocks with simulated canals of 30° curvature were divided into four experimental groups containing ten samples in each group. The canals were prepared using Reciproc (VDW, Munich, Germany), WaveOne (Dentsply, Maillefer, Ballaigues, Switzerland), OneShape (Micro-Mega, Besancon, France), and F360 (Komet, Brasseler, Lemgo, Germany) size 25 NiTi systems using X Smart Plus (Dentsply). Pre- and post-preparation canals were photographed in a standardized manner and were superimposed. The inner and outer walls of canal curvature were evaluated to determine the most significant change using the image analysis software. Results: The amount of resin removed from the inner walls was less with rotary single-file NiTi systems when compared with reciprocating. Preparation time was less with rotary instruments. No instrument separation was noted. All instrument systems maintained the original canal curvature. Conclusion: Rotary single-file systems maintained the canal curvature better than reciprocating single-file systems.

Sodium hypochlorite use, storage, and delivery methods: A Survey Sumaya O Basudan Saudi Endodontic Journal 2019 9(1):27-33 Aim: The aim of this study is to investigate sodium hypochlorite (NaOCl) delivery and storage methods by general dental practitioners (GDPs) and specialists. Materials and Methods: A self-reporting questionnaire was distributed to academic, governmental, and private dental centers in Riyadh, Saudi Arabia. The survey consisted of questions related to the concentration, duration, volume, delivery methods of NaOCl irrigation, storage materials, and conditions. Results: Of the 261 dentists that responded, 63.2% were GDPs, 21.8% were endodontists, and 14.9% were advanced restorative specialists. A NaOCl concentration of 2.5%–5% was the most commonly selected (52.7%), 37.2% used 5–10 ml for irrigation of each canal and 44.8% performed irrigation for <1 min. Dentists who used higher concentrations reported longer irrigation durations. Irrigant delivery by needles and a syringe was reported by 83.9% of respondents, but only 5.7% applied irrigation activation methods. Regarding storage conditions, 40% used clear containers, and 75.5% stored it at room temperature. Endodontists used significantly higher concentrations, longer durations, and activated the irrigant more than GDPs. Conclusion: The most commonly used NaOCl concentration is 2.5%–5%. The storage conditions of NaOCl and use of activation methods need to be improved. In addition, practices of specialists differed from those of GDPs with regard to concentrations, duration of irrigation, storage of NaOCl, and use of irrigation adjuncts.

Triple antibiotic paste versus propolis: A clinical quest for the reliable treatment of periapical lesions in primary molars DV Divya, Madu Ghanashyam Prasad, Ambati Naga Radhakrishna, Rayala Venkata Sandeep, Suravarapu Pavani Reddy, K V. K. Santosh Kumar Saudi Endodontic Journal 2019 9(1):34-39 Background: Teeth with infected root canals, particularly those in which the infection has reached the periradicular tissues, require effective treatment interventions to save the tooth. Lesion sterilization concept (lesion sterilization and tissue repair [LSTR]) was successful in treating periapical polymicrobial infection, but this poses a risk of development of antimicrobial resistance. Aim: The present study evaluated and compared both clinically and radiographically the healing abilities of Propolis liquid (natural therapeutic agent)-mixed Endoflas powder with LSTR (allopathic combination) for the management of periapical lesions in primary molars. Materials and Methods: A total of 30 selected primary molars were randomly divided into two groups of 15 each: Group 1 – Propolis liquid-mixed Endoflas powder and Group 2 – LSTR (3Mix). Follow-up after 3, 6, and 12 months was done to evaluate progress in clinical and radiographic parameters. The obtained data were subjected to statistical analysis. McNemar's test was applied between the time points in each group. Comparison of Group 1 with Group 2 was done using Chi-square test. Results: At the end of 12th-month follow-up, the overall clinical and radiographic success rate for Group 1 was 100%, whereas for Group 2, it was 93% and 60%, respectively. The difference in the radiographic success rate between the two groups was statistically significant (P < 0.05). Conclusion: In the present study, Propolis liquid-mixed Endoflas powder combination has shown better results than LSTR. This novel combination of Propolis liquid-mixed Endoflas powder can, therefore, be considered as the material of choice for pulpectomy in deciduous molars with extensive involvement of pulp and periradicular tissues.

The knowledge and attitude of general dental practitioners toward the proper standards of care while managing endodontic patients in Saudi Arabia Dania F Bogari, Nouran A Alzebiani, Rowaina M Mansouri, Faris G Aljiaid, Mohunned A Alghamdi, Majed Almalki, Khalid Merdad, Turki Y Alhazzazi Saudi Endodontic Journal 2019 9(1):40-50 Aim: The aim of this study was to assess the knowledge and attitude of general dental practitioners (GDPs) toward performing the proper standards of care while managing patients undergoing endodontic treatment in Saudi Arabia. Materials and Methods: An e-questionnaire was distributed among GDPs in Saudi Arabia (n = 650). The e-questionnaire questions covered the assessment of knowledge, attitude, and performance of GDPs toward practicing the proper standards of endodontic treatment in their clinic. Data were analyzed using SPSS version 22, and the relationships between categorical variables were established using Chi-square test. Results: Most of the participants reported obtaining full medical history before root canal treatment (RCT, 82.3%; P < 0.05). However, only 12.2% of the participants regularly measure the blood pressure for their patients before starting RCT. Only 56.3% of the participated dentists are applying rubber dam isolation during RCT, while 24.2% believe that partial isolation is sufficient for such a procedure (P < 0.05). Furthermore, 42.8% of the surveyed GDPs use cold test to confirm the endodontic diagnosis, while 55.5% think that percussion is a reliable method for diagnosis (P < 0.05). Surprisingly, 37.3% of the dentists still prefer leaving the tooth open for pain relief and drainage in abscess cases. Finally, only 28.7% of the participants mentioned performing regular follow-up after RCT. Conclusions: Our data show a clear deficiency in the standards of care provided by GDPs when performing RCT in Saudi Arabia. We hope that this publication will help highlight key areas where lack of knowledge and poor attitude exist while performing RCT by the GDPs in Saudi, thereby helping to raise treatment standards and improve treatment outcomes.

Effect of applying metal artifact reduction algorithm in cone beam computed tomography in detection of vertical root fractures of teeth with metallic post versus digital intraoral radiography Islam Shawky Shaker, Nashwa Salah Mohamed, Ahmed Mohamed Abdelsamad Saudi Endodontic Journal 2019 9(1):51-55 Background: Conventional radiographs are not an efficient diagnostic imaging modality to detect vertical root fracture. Cone-beam computed tomography (CBCT) is a three-dimensional imaging modality that overcomes the limitations of conventional radiography in the detection of vertical root fractures (VRFS), although metallic structures produce artifacts in the produced images and since most of the teeth with VRF are endodontically treated and have metallic posts in root canal so fracture detection may be difficult. Aim: This study aimed to determine the diagnostic accuracy of CBCT using metal artifact reduction algorithm in detection of VRF of teeth with metallic posts compared to digital intraoral radiography. Materials and Methods: One hundred and twenty single-rooted extracted human teeth were endodontically treated then placed in an acrylic block and metallic posts were inserted. The teeth roots were divided into two groups; one with induced VRF and the other having intact roots. Then, each tooth was coded and imaged three times using CBCT with and without metal artifact reduction algorithm and digital periapical radiography. Data were collected and statistically analyzed. Results: Digital periapical radiography showed statistically significantly lower diagnostic accuracy than CBCT modalities (P ≤ 0.05). The use of metal artifact reduction algorithm improved the diagnostic accuracy from CBCT1 to CBCT2 but with no statistically significant difference (P ≥ 0.05). Conclusion: From the study, we can conclude that in case of presence of metallic posts, CBCT with metal artifact reduction algorithm can improve detection of VRF.

Multidisciplinary approach to the treatment of a complicated crown-root fracture Badi B Alotaibi Saudi Endodontic Journal 2019 9(1):56-60 Complicated crown-root fractures are uncommon type of dental trauma but usually result in significant esthetic and functional problems to those affected. This case report demonstrates sequential endodontic, restorative, orthodontic, periodontal, and prosthodontic modalities for the conservative management of a complicated crown-root fracture of the maxillary left central incisor in a young patient. After root canal treatment and core buildup, the tooth was extruded using forced orthodontic eruption for 8 weeks and retention for 7 weeks. Zinc phosphate cement acrylic crown was used to preserve esthetics and function during the forced eruption and retention period.

A combined management of a rare case of a maxillary lateral incisor with accessory root and deep mesio-radicular groove Safura Anita Baharin, Masfueh Razali Saudi Endodontic Journal 2019 9(1):61-65 This case report describes the combined nonsurgical endodontic retreatment and surgical intervention of a failed root canal treatment associated with a maxillary lateral incisor with an accessory root and deep mesio-radicular groove. A 42-year-old female Malay patient presented with persistent infection associated with deep mesial pocket from her maxillary left lateral incisor (#22). The medical history was noncontributory and the tooth was previously root treated. Following comprehensive clinical and radiographic examination, a combined nonsurgical endodontic retreatment and surgical management of tooth #22 were carried out. The inability to debride the periodontal defect necessitates the amputation of the accessory root, and surgical debridement of the deep radicular groove was carried out. The clinical and radiographic examination 1 year after completion of treatment revealed evidence of healing. The early recognition of root and canal variation, correct diagnosis, and appropriate management of tooth with accessory root and deep radicular groove is essential to ensure favorable treatment outcome.

Prosthodontics

Questionnaires in prosthodontic research N Gopi Chander The Journal of Indian Prosthodontic Society 2019 19(1):1-2

Efficacy of prostheses bonding using silane incorporated to universal adhesives or applied separately: A systematic review Laercio Almeida De Melo, Ilnara De Souza Moura, Erika Oliveira De Almeida, Amilcar Chagas Freitas Junior, Tasiana Guedes De Souza Dias, Fabíola Pessoa Pereira Leite The Journal of Indian Prosthodontic Society 2019 19(1):3-8 Currently, the long-term success of esthetic rehabilitation with ceramics is required. Hence, professional knowledge about the most indicated dental material for each clinical situation as well as its usage protocol is essential. The aim of this systematic review of clinical and laboratorial studies was to compare the bond strength of prostheses using silane incorporated to universal adhesives or applied separately. The literature search in databases “Cochrane Library,” “MEDLINE,” “Web of Science,” “Scopus,” “LILACS,” “Scielo,” and “Google Scholar” was based on the keywords “Silane;” “Silanes;” “Silane coupling agent;” “Universal adhesive;” and “Universal adhesives.” A total of five articles were included in this review. In general, the studies showed better results for ceramic etching with hydrofluoric acid and application of silane separately to the universal adhesive. As a conclusion, the treatment with pure silane or as an additional pretreatment with universal adhesives improved the bond strength of glass ceramics. Hence, higher shear bond strength can be achieved, resulting in treatment longevity.

A study of change in occlusal contacts and force dynamics after fixed prosthetic treatment and after equilibration – Using Tekscan III Reddy Chaithanya, Suresh Sajjan, A V Rama Raju The Journal of Indian Prosthodontic Society 2019 19(1):9-19 Aim: A study has been undertaken to evaluate the changes in occlusal force dynamics after conventional prosthetic rehabilitation. Materials and Methods: In Phase I, the preprosthetic phase, force distribution of 50% ± 10% on either sides of arch in maximum intercuspation and disclusion time (DT) <1 s during mandibular excursions was attained in all patients using Tekscan before starting prosthetic treatment. Conventional procedures to replace missing tooth by fixed dental prosthesis were carried out. Occlusal corrections were performed using articulating paper to the satisfaction of operator and patient. In Phase II, postprosthetic phase, 1 week after cementation of the fixed partial dentures, the occlusal force dynamics were rerecorded and evaluated using Tekscan. Any corrections required were done to restore the equilibrium. Occlusal perception of patient before and after equilibration was recorded by means of a standard questionnaire both in pre- and postprosthetic phase. Twenty patients requiring replacement of a single posterior missing tooth were selected. The obtained values were statistically analyzed using Student's t-test. Results: Subsequent to rehabilitation, the right–left balance of occlusal load was lost and DT was significantly increased. However, the subjective evaluation revealed no significant decline in occlusal comfort. Conclusion: Null hypothesis was rejected. Operator's assessment of articulating paper marks and patient's occlusal perception is not reliable in restoring occlusal equilibrium.

Prosthetic treatment need and associated life course determinants in partially edentulous adults of age 18–35 years in Udupi taluk: A cross-sectional study Kriti Sharma, Shashidhar Acharya, Deepak Kumar Singhal, Nishu Singla The Journal of Indian Prosthodontic Society 2019 19(1):20-25 Aim: The aims of this study were to assess the prevalence of use and need for dental prostheses and to associate need with the life course determinants in young adults of age 18–35 years in Udupi taluk, Karnataka, India. Materials and Methods: It was a cross-sectional survey conducted on a total of 580 individuals those attended dental screening camps organized at random locations. A self-administered questionnaire was administered to participants to assess their life course determinants such as socioeconomic, behavioral, and psychological circumstances followed by an oral examination to assess their prosthetic status (WHO, 1997). Bivariate analysis followed by multivariate logistic regression analysis was carried out to determine the adjusted odds ratios (ORs) with 95% confidence interval (CI) for independent variables and the outcome. Results: The need and use of dental prostheses was observed in 38% and 2.2% of young adults, respectively. Adjusted multivariable analysis revealed that life course determinants such as parental rearing style (OR = 7.66 [95% CI: 3.88–15.14]) and interaction between expenditure at 10 years of age and economic hardships at 10 years of age (OR = 9.63 [95% CI: 3.12–29.72] and OR = 6.43 [95% CI: 1.89–21.88]) were significantly associated with the need for prostheses. Conclusion: The need for dental prostheses in the young adults can be related to socioeconomic and psychosocial circumstances during childhood, and thus the concept of life course approach has been highlighted.

An in vitro comparison of the effect of various surface treatments on the tensile bond strength of three different luting cement to zirconia copings BL Bhavana, PL Rupesh, Bharat Kataraki The Journal of Indian Prosthodontic Society 2019 19(1):26-32 Aim: The aim of this study was to evaluate and compare the tensile bond strength of zirconia copings subjected to three different surface treatment methods and cemented with three different luting agents. Materials and Methods: Seventy-two extracted maxillary premolar teeth were prepared to receive zirconia copings milled using computer-aided design/computer-aided manufacturing technology, which were divided into 9 groups of 8 specimens each. Three surface treatment protocols such as hydrofluoric acid etch treatment, air abrasion with 110-μm aluminum oxide (Al2O3), and tribochemical silica coating (Rocatec) treatment were carried out, and copings were cemented with three luting agents such as resin-modified glass ionomer cement (RelyX luting 2), 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) resin cement (Panavia F 2.0) and 4-methacryloxyethyl trimellitic acid (4-META) resin cement (G-Cem). Tensile bond strength of the copings was tested in a universal testing machine. Zirconia copings fabricated on the prepared extracted tooth. After the three surface treatments and cementing the zirconia crowns with three luting agents tensile bond strength is tested. The mean and standard deviations (SD) were calculated for the nine groups using one-way ANOVA, followed by Tukey–Kramer post hoc using the SPSS software. Results: The ANOVA test showed that the measured mean bond strength values were 4.22 MPa (tribochemicalsilica coating and MDP resin), 2.71 MPa (air abrasion and MDP resin), 2.61 MPa (tribochemical treatment with META), and 0.66 MPa (RelyX with air abrasion). According to the pairwise comparison of Tukey's honestly significant difference test, significant differences were exhibited among all the groups (P < 0.05). Conclusion: Tribochemical silica coating in combination with 10-MDP and 4-META adhesive resins provided the maximum bonding for zirconia copings.

Comparative evaluation of the effect of electrolyzed oxidizing water on surface detail reproduction, dimensional stability and Surface texture of poly vinyl siloxane impressions AS Mahalakshmi, Vidhya Jeyapalan, Vallabh Mahadevan, Chitra Shankar Krishnan, NS Azhagarasan, Hariharan Ramakrishnan The Journal of Indian Prosthodontic Society 2019 19(1):33-41 Aim: The aim of this in vitro study was to comparatively evaluate the effect of chemical disinfectants on the surface detail reproduction, dimensional stability and surface texture of polyvinyl siloxane (PVS) impressions. Materials and Methods: The impressions were then divided into five groups (fifteen samples per group) and subjected to a ten minutes immersion with 2% glutaraldehyde (Group I), 1% sodium hypochlorite (Group II), freshly prepared electrolyzed oxidizing water (EOW) with different pH values - acidic (Group III), alkali (Group IV) and neutral (Group V). The samples were examined pre and post-immersion under visual observation for surface detail reproduction, travelling microscope for measurement of dimensional stability and surface profilometer (3D) for evaluation of surface texture. A standardized master die was fabricated and seventy-five PVS test samples were made. The samples were subjected to immersion disinfection and studied for surface detail reproduction, dimensional stability and surface texture. Post-hoc test, paired t test and ANOVA were used to analyze dimensional stability statistically both within and between the test groups. Results: The surface detail reproduction was satisfactory with both pre and post-immersion test samples. A statistically significant dimensional change was observed post-immersion in Groups II, III and V test samples and a statistically insignificant dimensional change was observed in Groups I and IV test samples. There was a negligible change in surface texture post-immersion in Groups I, III, IV and V test samples with a slight increase in surface roughness post-immersion in Group II samples. Conclusion: In this study, all the test disinfectants produced satisfactory surface detail reproduction on Polyvinyl siloxane impressions. 2% glutaraldehyde and electrolyzed oxidizing water (alkali) have resulted in statistically insignificant dimensional change, while 1% sodium hypochlorite, electrolyzed oxidizing water (acidic) and electrolyzed oxidizing water (neutral) have resulted in statistically significant dimensional changes. All the test disinfectants except 1% sodium hypochlorite showed a reduction in surface roughness (Ra) values.

Effect of cigarette smoke on the surface roughness of two different denture base materials: An in vitro study Girendra Singh, Abhinav Agarwal, Manesh Lahori The Journal of Indian Prosthodontic Society 2019 19(1):42-48 Aim: This study aimed to evaluate the effect of cigarette smoke on the surface roughness of two commercially available denture base materials. Materials and Methods: A total numbers of 40 specimens were fabricated from two commercially available denture base materials: heat-cured polymethylmethacrylate and flexible denture base materials (20 for each). The specimens for each type were divided into four subgroups: subgroup I, heat-cured denture base material specimens (control group); subgroup II, flexible denture base material (control group); subgroup III, heat-cured denture base material specimen exposed to cigarette smoking group; and subgroup IV, flexible denture base material specimens exposed to cigarette smoking. The control groups were used for immersion in distilled water, and the smoke test groups were used for exposure to cigarette smoking. The smoke test group specimens were exposed to smoking in a custom-made smoking chamber using six cigarettes for each specimen. The surface roughness was measured using a profilometer, and the measurements were considered as the difference between the initial and final roughness measured before and after smoking. Paired t test and independent t-test were used to interpret differences in initial and final roughness values within and between groups respectively. Results: Paired t-test showed a significant difference between initial surface roughness and final surface roughness within each subgroup. Conclusion: The surface roughness of the specimens fabricated from the flexible denture base material was found to be more compared to heat-cured denture base specimens after exposure to cigarette smoke.

Retention and patient satisfaction with bar-clip, ball and socket and kerator attachments in mandibular implant overdenture treatment: An in vivo study Nitish Varshney, Sumit Aggarwal, Shalabh Kumar, SP Singh The Journal of Indian Prosthodontic Society 2019 19(1):49-57 Aim: The aim of this in vivo study was to evaluate and compare the retention and patient satisfaction in implant supported mandibular overdenture with three different attachment system. Materials and Methods: After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The retention force and satisfaction level with the attachments at baseline and after 6 months was measured in a standardised way using retentive device and VAS questionnaire. The study was based on evaluation of retention and patient satisfaction. 15 subjects were included in the study. The results obtained were statistically analyzed using one-way ANOVA test, and multiple comparisons were carried out using the Bonferroni tests. Results: At the end of six months, the retention force and satisfaction level was higher in Group 3 (Kerator attachment) as compared to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment) and patient satisfaction was equal in groups 1, 2 and 3 but the total number of interventions is significantly higher in the attachment bar. Analysis of variance with repeated measures showed significant differences in retention force among the three attachment types. Conclusion: (1) Group 3 (kerator attachment) exhibit higher retentive capacities than Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment). (2) patient satisfaction was higher in Group 3 (Kerator attachment) in compare to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment).

An in vitro study to compare the influence of different all-ceramic systems on the polymerization of dual-cure resin cement Anindita Majumder, TK Giri, S Mukherjee The Journal of Indian Prosthodontic Society 2019 19(1):58-65 Aim: The aim of the study is to compare the effect of composition of three different all-ceramic systems on the polymerization of dual-cure resin cement, using different curing cycles and evaluated immediately within 15 min and after 24 h. Materials and Methods: Resin cement disc samples were fabricated by polymerization through three different all-ceramic disc, namely: lithium disilicate discs – IPS e.max (Group B), leucitereinforced discs – IPS Empress (Group C), zirconia discs – Cercon (Group D), and without an intervening ceramic disc, as control (Group A). A total of 80 resin cement disc samples were fabricated for fur groups (n=20). Each group further consisted of two subgroups (n = 10), t10 and t20 according to two different exposure times of 10 and 20 s, respectively. Each of the 80 resin disc samples was evaluated for their degree of polymerization achieved, by measuring the microhardness(Vickers hardness number) of the samples immediately within 15 min and after 24 h, giving us a total of 160 readings. Oneway analysis of variance test, ttest, and paired ttest were used for multiple group comparisons followed by Tukey's post hoc for groupwise comparison. Results: Direct activation of the resin cement samples of control (Group A) showed statistically significant higher mean microhardness values followed by Groups C then B and D, both immediately and after 24 h. The mean microhardness for immediate post-activation was always inferior to the 24 h post-activation test. For both 10 and 20 s curing cycle, there was a significant increase in the microhardness of the resin cement discs cured for 20 s through the different ceramics. Conclusion: Ceramic composition affected the polymerization of dual cured resin cement. Doubling the light irradiation time or curing cycle significantly increased mean microhardness value. Greater degree of conversion leading to an increase in hardness was observed when the resin cement discs were evaluated after 24 h.

A spirometric and cephalometric comparative evaluation of mandibular advancement devices and occlusal jig Shaily Ujjwal, Pragati Kaurani, U Narendra Padiyar, Sudhir Meena, Devendra Pal Singh, Hemant Kr Sharma The Journal of Indian Prosthodontic Society 2019 19(1):66-73 Aim: Aim of the current study was to evaluate the effect of occlusal jig with increased vertical dimension and mandibular advancement device on the oropharangeal volume in completely edentulous patients using spirometry and cephalometry. Materials and Methods: The current study included includes 30 completely edentulous patient according to inclusion criteria. They were each subjected to cephalometric and spirometric analysis wearing CCD, OJ &#38; MAD. Results obtained were subjected to following statistical analysis, one-way ANOVA test, unpaired t-test, and Dunnett&#39;s test. Result: Both OJ &#38; MAD brings about significant change in oropharangeal volume hence both the devices are effective treatment of choice for OSA, while greater increase was observed in oropharangealvolume of OJ as compared to MAD. Spirometric analysis shows insignificant changes in the oropharangeal volume caused by MAD while OJ causes small but significant change in oropharangeal volume (PIFR]. Conclusion: Within the limitation of the study, it can be concluded that, on cephalometric &#38; spirometric evaluation, OJ shows greater increase in oropharangeal volume when compared to MAD in completely edentulous patient.  EDITORIAL   Questionnaires in prosthodontic research  p. 1 N Gopi Chander DOI:10.4103/jips.jips_386_18   [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta REVIEW ARTICLE Efficacy of prostheses bonding using silane incorporated to universal adhesives or applied separately: A systematic review p. 3 Laercio Almeida De Melo, Ilnara De Souza Moura, Erika Oliveira De Almeida, Amilcar Chagas Freitas Junior, Tasiana Guedes De Souza Dias, Fabíola Pessoa Pereira Leite DOI:10.4103/jips.jips_144_18   Currently, the long-term success of esthetic rehabilitation with ceramics is required. Hence, professional knowledge about the most indicated dental material for each clinical situation as well as its usage protocol is essential. The aim of this systematic review of clinical and laboratorial studies was to compare the bond strength of prostheses using silane incorporated to universal adhesives or applied separately. The literature search in databases "Cochrane Library," "MEDLINE," "Web of Science," "Scopus," "LILACS," "Scielo," and "Google Scholar" was based on the keywords "Silane;" "Silanes;" "Silane coupling agent;" "Universal adhesive;" and "Universal adhesives." A total of five articles were included in this review. In general, the studies showed better results for ceramic etching with hydrofluoric acid and application of silane separately to the universal adhesive. As a conclusion, the treatment with pure silane or as an additional pretreatment with universal adhesives improved the bond strength of glass ceramics. Hence, higher shear bond strength can be achieved, resulting in treatment longevity. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta ORIGINAL ARTICLES A study of change in occlusal contacts and force dynamics after fixed prosthetic treatment and after equilibration – Using Tekscan III p. 9 Reddy Chaithanya, Suresh Sajjan, A V Rama Raju DOI:10.4103/jips.jips_238_18   Aim: A study has been undertaken to evaluate the changes in occlusal force dynamics after conventional prosthetic rehabilitation. Materials and Methods: In Phase I, the preprosthetic phase, force distribution of 50% ± 10% on either sides of arch in maximum intercuspation and disclusion time (DT) <1 s during mandibular excursions was attained in all patients using Tekscan before starting prosthetic treatment. Conventional procedures to replace missing tooth by fixed dental prosthesis were carried out. Occlusal corrections were performed using articulating paper to the satisfaction of operator and patient. In Phase II, postprosthetic phase, 1 week after cementation of the fixed partial dentures, the occlusal force dynamics were rerecorded and evaluated using Tekscan. Any corrections required were done to restore the equilibrium. Occlusal perception of patient before and after equilibration was recorded by means of a standard questionnaire both in pre- and postprosthetic phase. Twenty patients requiring replacement of a single posterior missing tooth were selected. The obtained values were statistically analyzed using Student's t-test. Results: Subsequent to rehabilitation, the right–left balance of occlusal load was lost and DT was significantly increased. However, the subjective evaluation revealed no significant decline in occlusal comfort. Conclusion: Null hypothesis was rejected. Operator's assessment of articulating paper marks and patient's occlusal perception is not reliable in restoring occlusal equilibrium. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Prosthetic treatment need and associated life course determinants in partially edentulous adults of age 18–35 years in Udupi taluk: A cross-sectional study p. 20 Kriti Sharma, Shashidhar Acharya, Deepak Kumar Singhal, Nishu Singla DOI:10.4103/jips.jips_156_18   Aim: The aims of this study were to assess the prevalence of use and need for dental prostheses and to associate need with the life course determinants in young adults of age 18–35 years in Udupi taluk, Karnataka, India. Materials and Methods: It was a cross-sectional survey conducted on a total of 580 individuals those attended dental screening camps organized at random locations. A self-administered questionnaire was administered to participants to assess their life course determinants such as socioeconomic, behavioral, and psychological circumstances followed by an oral examination to assess their prosthetic status (WHO, 1997). Bivariate analysis followed by multivariate logistic regression analysis was carried out to determine the adjusted odds ratios (ORs) with 95% confidence interval (CI) for independent variables and the outcome. Results: The need and use of dental prostheses was observed in 38% and 2.2% of young adults, respectively. Adjusted multivariable analysis revealed that life course determinants such as parental rearing style (OR = 7.66 [95% CI: 3.88–15.14]) and interaction between expenditure at 10 years of age and economic hardships at 10 years of age (OR = 9.63 [95% CI: 3.12–29.72] and OR = 6.43 [95% CI: 1.89–21.88]) were significantly associated with the need for prostheses. Conclusion: The need for dental prostheses in the young adults can be related to socioeconomic and psychosocial circumstances during childhood, and thus the concept of life course approach has been highlighted. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An in vitro comparison of the effect of various surface treatments on the tensile bond strength of three different luting cement to zirconia copings p. 26 BL Bhavana, PL Rupesh, Bharat Kataraki DOI:10.4103/jips.jips_247_18   Aim: The aim of this study was to evaluate and compare the tensile bond strength of zirconia copings subjected to three different surface treatment methods and cemented with three different luting agents.Materials and Methods: Seventy-two extracted maxillary premolar teeth were prepared to receive zirconia copings milled using computer-aided design/computer-aided manufacturing technology, which were divided into 9 groups of 8 specimens each. Three surface treatment protocols such as hydrofluoric acid etch treatment, air abrasion with 110-μm aluminum oxide (Al2O3), and tribochemical silica coating (Rocatec) treatment were carried out, and copings were cemented with three luting agents such as resin-modified glass ionomer cement (RelyX luting 2), 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) resin cement (Panavia F 2.0) and 4-methacryloxyethyl trimellitic acid (4-META) resin cement (G-Cem). Tensile bond strength of the copings was tested in a universal testing machine. Zirconia copings fabricated on the prepared extracted tooth. After the three surface treatments and cementing the zirconia crowns with three luting agents tensile bond strength is tested. The mean and standard deviations (SD) were calculated for the nine groups using one-way ANOVA, followed by Tukey–Kramer post hoc using the SPSS software. Results: The ANOVA test showed that the measured mean bond strength values were 4.22 MPa (tribochemicalsilica coating and MDP resin), 2.71 MPa (air abrasion and MDP resin), 2.61 MPa (tribochemical treatment with META), and 0.66 MPa (RelyX with air abrasion). According to the pairwise comparison of Tukey's honestly significant difference test, significant differences were exhibited among all the groups (P < 0.05). Conclusion: Tribochemical silica coating in combination with 10-MDP and 4-META adhesive resins provided the maximum bonding for zirconia copings. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Comparative evaluation of the effect of electrolyzed oxidizing water on surface detail reproduction, dimensional stability and Surface texture of poly vinyl siloxane impressions p. 33 AS Mahalakshmi, Vidhya Jeyapalan, Vallabh Mahadevan, Chitra Shankar Krishnan, NS Azhagarasan, Hariharan Ramakrishnan DOI:10.4103/jips.jips_72_18   Aim: The aim of this in vitro study was to comparatively evaluate the effect of chemical disinfectants on the surface detail reproduction, dimensional stability and surface texture of polyvinyl siloxane (PVS) impressions. Materials and Methods: The impressions were then divided into five groups (fifteen samples per group) and subjected to a ten minutes immersion with 2% glutaraldehyde (Group I), 1% sodium hypochlorite (Group II), freshly prepared electrolyzed oxidizing water (EOW) with different pH values - acidic (Group III), alkali (Group IV) and neutral (Group V). The samples were examined pre and post-immersion under visual observation for surface detail reproduction, travelling microscope for measurement of dimensional stability and surface profilometer (3D) for evaluation of surface texture. A standardized master die was fabricated and seventy-five PVS test samples were made. The samples were subjected to immersion disinfection and studied for surface detail reproduction, dimensional stability and surface texture. Post-hoc test, paired t test and ANOVA were used to analyze dimensional stability statistically both within and between the test groups. Results: The surface detail reproduction was satisfactory with both pre and post-immersion test samples. A statistically significant dimensional change was observed post-immersion in Groups II, III and V test samples and a statistically insignificant dimensional change was observed in Groups I and IV test samples. There was a negligible change in surface texture post-immersion in Groups I, III, IV and V test samples with a slight increase in surface roughness post-immersion in Group II samples. Conclusion: In this study, all the test disinfectants produced satisfactory surface detail reproduction on Polyvinyl siloxane impressions. 2% glutaraldehyde and electrolyzed oxidizing water (alkali) have resulted in statistically insignificant dimensional change, while 1% sodium hypochlorite, electrolyzed oxidizing water (acidic) and electrolyzed oxidizing water (neutral) have resulted in statistically significant dimensional changes. All the test disinfectants except 1% sodium hypochlorite showed a reduction in surface roughness (Ra) values. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Effect of cigarette smoke on the surface roughness of two different denture base materials: An in vitro study p. 42 Girendra Singh, Abhinav Agarwal, Manesh Lahori DOI:10.4103/jips.jips_82_18   Aim: This study aimed to evaluate the effect of cigarette smoke on the surface roughness of two commercially available denture base materials. Materials and Methods: A total numbers of 40 specimens were fabricated from two commercially available denture base materials: heat-cured polymethylmethacrylate and flexible denture base materials (20 for each). The specimens for each type were divided into four subgroups: subgroup I, heat-cured denture base material specimens (control group); subgroup II, flexible denture base material (control group); subgroup III, heat-cured denture base material specimen exposed to cigarette smoking group; and subgroup IV, flexible denture base material specimens exposed to cigarette smoking. The control groups were used for immersion in distilled water, and the smoke test groups were used for exposure to cigarette smoking. The smoke test group specimens were exposed to smoking in a custom-made smoking chamber using six cigarettes for each specimen. The surface roughness was measured using a profilometer, and the measurements were considered as the difference between the initial and final roughness measured before and after smoking. Paired t test and independent t-test were used to interpret differences in initial and final roughness values within and between groups respectively. Results: Paired t-test showed a significant difference between initial surface roughness and final surface roughness within each subgroup. Conclusion: The surface roughness of the specimens fabricated from the flexible denture base material was found to be more compared to heat-cured denture base specimens after exposure to cigarette smoke. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Retention and patient satisfaction with bar-clip, ball and socket and kerator attachments in mandibular implant overdenture treatment: An in vivo study p. 49 Nitish Varshney, Sumit Aggarwal, Shalabh Kumar, SP Singh DOI:10.4103/jips.jips_281_18   Aim: The aim of this in vivo study was to evaluate and compare the retention and patient satisfaction in implant supported mandibular overdenture with three different attachment system. Materials and Methods: After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The retention force and satisfaction level with the attachments at baseline and after 6 months was measured in a standardised way using retentive device and VAS questionnaire. The study was based on evaluation of retention and patient satisfaction. 15 subjects were included in the study. The results obtained were statistically analyzed using one-way ANOVA test, and multiple comparisons were carried out using the Bonferroni tests. Results: At the end of six months, the retention force and satisfaction level was higher in Group 3 (Kerator attachment) as compared to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment) and patient satisfaction was equal in groups 1, 2 and 3 but the total number of interventions is significantly higher in the attachment bar. Analysis of variance with repeated measures showed significant differences in retention force among the three attachment types. Conclusion: (1) Group 3 (kerator attachment) exhibit higher retentive capacities than Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment). (2) patient satisfaction was higher in Group 3 (Kerator attachment) in compare to Group 1 (ball and socket attachment) and Group 2 (bar and clip attachment). [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta An in vitro study to compare the influence of different all-ceramic systems on the polymerization of dual-cure resin cement p. 58 Anindita Majumder, TK Giri, S Mukherjee DOI:10.4103/jips.jips_262_18   Aim: The aim of the study is to compare the effect of composition of three different all-ceramic systems on the polymerization of dual-cure resin cement, using different curing cycles and evaluated immediately within 15 min and after 24 h. Materials and Methods: Resin cement disc samples were fabricated by polymerization through three different all-ceramic disc, namely: lithium disilicate discs – IPS e.max (Group B), leucitereinforced discs – IPS Empress (Group C), zirconia discs – Cercon (Group D), and without an intervening ceramic disc, as control (Group A). A total of 80 resin cement disc samples were fabricated for fur groups (n=20). Each group further consisted of two subgroups (n = 10), t10 and t20 according to two different exposure times of 10 and 20 s, respectively. Each of the 80 resin disc samples was evaluated for their degree of polymerization achieved, by measuring the microhardness(Vickers hardness number) of the samples immediately within 15 min and after 24 h, giving us a total of 160 readings. Oneway analysis of variance test, ttest, and paired ttest were used for multiple group comparisons followed by Tukey's post hoc for groupwise comparison. Results: Direct activation of the resin cement samples of control (Group A) showed statistically significant higher mean microhardness values followed by Groups C then B and D, both immediately and after 24 h. The mean microhardness for immediate post-activation was always inferior to the 24 h post-activation test. For both 10 and 20 s curing cycle, there was a significant increase in the microhardness of the resin cement discs cured for 20 s through the different ceramics. Conclusion: Ceramic composition affected the polymerization of dual cured resin cement. Doubling the light irradiation time or curing cycle significantly increased mean microhardness value. Greater degree of conversion leading to an increase in hardness was observed when the resin cement discs were evaluated after 24 h. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A spirometric and cephalometric comparative evaluation of mandibular advancement devices and occlusal jig p. 66 Shaily Ujjwal, Pragati Kaurani, U Narendra Padiyar, Sudhir Meena, Devendra Pal Singh, Hemant Kr Sharma DOI:10.4103/jips.jips_94_18   Aim: Aim of the current study was to evaluate the effect of occlusal jig with increased vertical dimension and mandibular advancement device on the oropharangeal volume in completely edentulous patients using spirometry and cephalometry. Materials and Methods: The current study included includes 30 completely edentulous patient according to inclusion criteria. They were each subjected to cephalometric and spirometric analysis wearing CCD, OJ & MAD. Results obtained were subjected to following statistical analysis, one-way ANOVA test, unpaired t-test, and Dunnett's test. Result: Both OJ & MAD brings about significant change in oropharangeal volume hence both the devices are effective treatment of choice for OSA, while greater increase was observed in oropharangealvolume of OJ as compared to MAD. Spirometric analysis shows insignificant changes in the oropharangeal volume caused by MAD while OJ causes small but significant change in oropharangeal volume (PIFR]. Conclusion: Within the limitation of the study, it can be concluded that, on cephalometric & spirometric evaluation, OJ shows greater increase in oropharangeal volume when compared to MAD in completely edentulous patient. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta CASE REPORTS Maxillary hollow-bulb obturator: A paradigm shift p. 74 Aanchal Rajesh Punjabi, Gaurang Mistry, Omkar Shetty, Asha Rathod DOI:10.4103/jips.jips_181_18   Maxillary defects, whether congenital or acquired, make a patient encounter an array of physical and psychological difficulties, leading to an extremely poor quality of life. Rehabilitation of such a patient is often challenging due to the extent of the defect area coupled with the absence of adequate retention caused by the size and weight of the prosthesis. Further, providing a proper seal of the oronasal communication is of utmost importance to restore function. Taking the above factors into consideration, a combination of hollow-bulb obturator consisting of a titanium framework and a flexible, snap-on silicone cap is an effective prosthesis providing a long-term treatment, increased retention, and a happy patient. The fabrication protocol included the use of computer-aided design, titanium along with laser welding, and an intraoral trial before final fabrication, hence, reconfirming the success of the prosthetic design. The maxillary obturator presented in this article eliminates several disadvantages associated with a conventional hollow-bulb obturator, thereby providing a novel, viable option for a maxillofacial prosthodontist. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta A modified technique for fabrication of custom-made afterload brachytherapy appliance p. 79 Sumeet Jain, Namrata Agrawal, Aparna Dwivedi, Shobhit Bajaj DOI:10.4103/jips.jips_8_18   Radiotherapy for carcinomas that involve the mouth and its related structures has been improved by the usage of different prostheses known as radiation carriers. These prostheses can accurately position radionuclide such as radium, iridium, cesium, and cobalt to allow adequate transfer of a concentrated radiation dose to a tumor region. At the same time, they minimize the exposure to radiation of nearby tissues due to rapid fall-off the radioactivity and thus minimizing the side effects of radiation. This study emphasizes the usage of a modified technique for the development of afterload mold brachytherapy appliance for squamous cell carcinoma patients of hard palate/soft palate. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Fabrication of custom overdenture attachments using indigenously made parallelometer: A technique p. 83 Ravindra S Pawar, Pravin E Raipure, Rahul S Kulkarni, Mohana Tagore, Raguram Ganesan DOI:10.4103/jips.jips_282_18   Various types of attachments have been used during overdenture fabrication; however, no single attachment is perfect for every case. Irrespective of the attachment used, it is important to maintain parallelism between the attachments for ease of insertion and removal, functional efficiency, and durability of the prosthesis. It is challenging to obtain parallelism between attachments when the abutments are divergent, or multiple abutments are engaged. A simplified technique to fabricate cast overdenture attachments using indigenously made parallelometer has been described. This technique eliminates the need of making full-arch impressions and models and surveying the attachments before casting. With this technique, there is a reduction in the duration and cost of treatment, without any compromise in quality of the prosthesis. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta Two-visit CAD/CAM milled dentures in the rehabilitation of edentulous arches: A case series p. 88 Anish Varkey John, George Abraham, Anumol Alias DOI:10.4103/jips.jips_252_18   Computer-aided design-computer-aided manufacturing (CAD-CAM) has now found its place in the field of removable prosthodontics with the advent of its use in the fabrication of complete dentures. The conventional technique, by injection or compression molding using heat-polymerized resins, requires cumbersome laboratory procedures and up to five patient visits. For patients with time constraints and clinicians with a higher throughput rate, the CAD-CAM approach with a digital workflow can reduce the number of appointments and ensure speedy delivery of the prosthesis. This article describes the rehabilitation of completely edentulous arches using the Baltic Denture System (Merz Dental GmbH®) in just two patient visits. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta TECHNIQUE AND TECHNOLOGY A device for occlusal plane determination p. 93 Abdul Haque Maqsood Ahmed Inamdar, Shankar Pandharinath Dange, Kishor M Mahale, Smita Arun Khalikar DOI:10.4103/jips.jips_323_18   The correct orientation of the occlusal plane is the first and one of the important steps while recording jaw relationships in an edentulous patient. One of the most popular methods is to orient the occlusal plane to interpupillary line anteriorly and ala-tragus lines posteriorly which is usually accomplished by repetitive adjustment of the maxillary rim until a hand-held Fox's plane appears to be parallel to these lines. However, this process is time-consuming and error-prone. The eventual plane is almost always an educated guess, and this can be difficult for a new student. The device presented in this article marks the occlusal plane on wax rims parallel to interpupillary line anteriorly and the ala-tragus lines posteriorly, and thus, occlusal plane can be oriented in one simple step, thereby saving time and increasing efficiency of the operator. [ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta