Inverted Papilloma: A Case Report

Nabeela Riaz1                                      FCPS

Tooba Saeed2                                      FCPS, MCPS

Shagufta Yasmin3                              BDS

Inverted papilloma is a rare benign tumor of nasal cavity and paranasal sinuses. Although it is included in category of benign tumors, it has strong potential for local destruction, high recurrence rate and increased tendency towards malignancy. In this report, we present a case of an uncommon bilateral inverted papilloma of nasal cavities and paranasal sinuses.
KEY WORDS: Inverted papilloma, paranasal sinuses, local destruction.
HOW TO CITE: Riaz N, Saeed T, Yasmin S. Inverted papilloma: A case report J Pak Dent Assoc 2020;29(1):46-48.
DOI: https://doi.org/10.25301/JPDA.291.46
Received: 28 July 2019, Accepted: 17 December 2019

INTRODUCTION

Inverted papilloma is a benign sinonasal epithelial tumor categorized under sinonasal schneiderian papilloma. According to World Health Organization (WHO) 2005 classification, Schneiderian papilloma comprises inverted, oncocytic and exophytic papilloma.1 In 1854, Ward first described the inverted papilloma in the sinonasal cavity.2
Inverted papilloma arises from lateral wall of nasal cavity and it secondarily involves the maxillary, ethmoidal, frontal and sphenoidal sinuses. It is extremely rare for paranasal sinuses to be primarily involved, occurring only in 5% of the cases.3
It has three main characteristics that distinguish it from other benign sinonasal tumors, locally aggressive growth pattern, high rates of recurrence and increased tendency toward malignancy.4 10%-15% of the cases of the nasal cavity and paranasal sinuses are associated with squamous cell carcinoma.5
Inverted papilloma is 4 to 5 times more frequent in males in the 5th to 6th decade of life. Signs and symptoms are nonspecific, may include unilateral nasal obstruction which may cause pain, epistaxis, purulent discharge, olfactory disorders and recurrent rhinosinusitis.6
The pathogenesis of Inverted papilloma is unclear although allergy, chronic sinusitis and viral infections have been suggested as possible etiologic factors.

CASE REPORT

Fig 1

A 42 years old male presented to the department of Oral and Maxillofacial Surgery, Mayo Hospital Lahore on September, 2017 with left side swelling of the face and associated proptosis of the ipsilateral eye, for one year. Initially, there was only complaint of intermittent nasal obstruction and nasal discharge. After some time, a small nasal mass with associated facial swelling has been felt by the patient. Both nasal mass and facial swelling increased in size gradually. Eventually over a period of one year, left eye proptosis was also remarkable. Past medical and surgical histories were not significant. Clinically, there was a huge swelling on the left side of the face, extending cephalocaudally from the left supraorbital rim to the left angle of the mouth and mediolaterally from the left lateral nose to the left malar region, along with marked proptosis of the left eye that displacing the eyeball (Fig. 1). Swelling was soft to firm and non-tender on palpation. Overlying skin was intact in texture and temperature, but slight reddish in color. There was polypoid mass in the nose bilaterally, causing nasal obstruction. Mouth opening was normal. Intraorally, swelling also involved the hard palate bilaterally up to the junction of hard and soft palate, firm and non-tender with normal overlying mucosa.

 

CT scan revealed a soft tissue hypodense mass in bilateral nasal cavities extending into the bilateral ethmoidal, frontal and maxillary sinuses. Superiorly, mass had intracranial, extra axial extensions. Laterally mass was extending into the left orbital cavity, posteriorly into the nasopharynx and inferiorly it is eroding the hard palate (Fig. 2). Incisional biopsy was inconclusive showing benign inflammatory lesion.

Fig 2

Fig 3

 

Surgical excision under GA was planned. Lateral rhinotomy incision with infraorbital extension was used and mass was excised from the nasal cavities, sphenoidal, ethmoidal and bilateral maxillary sinuses (Fig. 3). Excisional biopsy was sent for histopathological
examination. Histological examination revealed polypoidal tissue lined by columnar cells with an admixture of mucin containing cells. Tissue enclosed in basement membrane which grows endophytically into the underlying stroma. Clinicohistopathologic correlation was suggestive of final diagnosis of Inverted papilloma.

 

DISCUSSION

The inverted papilloma also called Ringertz tumor, transitional cell papilloma, schneiderian cell papilloma, epithelial papilloma, is a group of benign neoplasm originating from the sinonasal mucosa. The name inverted is derived from the pattern of endophilic growth of the superficial epithelium to inside the adjacent stroma.
Typically, the schneiderian papillomas are unilateral, bilateral papillomas may also occur. 2
Inverted papillomas are generally diagnosed at a late stage,1-4 years after first onset of sinonasal symptoms. Functional signs and symptoms are nonspecific and vary according to the site of occurrence; they include nasal obstruction, anterior and/or posterior rhinorrhea, epistaxis, hyposmia or anosmia, symptomatic mass or facial pain. On clinical examination by endoscopic exploration of the nasal cavities, there is a reddish-gray lobulated tumor, firmer than an inflammatory polyp with a characteristic “raspberry” aspect. Inverted papillomas are friable on palpation and bleed on contact.1
Etiology is undefined, the possible etiologies are inflammatory origin and chronic infectious rhinosinusitis, allergies, Epstein-Barr virus and Human Papilloma virus.3 Pathologic examination is essential for diagnosis. Histologically inverted papillomas have an endophytic growth pattern consisting of invagination of the superficial IP epithelium into the underlying connective tissue stroma. The epithelium may be of squamous, transitional or respiratory type. The basal membrane is intact.2
Radiological assessment done with CT scan and MRI scan being the most common. Sinus CT is systematic. On CT scan, the aspect of IP is
nonspecific with an isodense unilateral homogeneous lesion mostly centered on the middle meatus of nose. Micro calcifications are found within the lesion in about 20% of cases. Bone erosions are frequently found. MRI is first imaging modality to perform for follow-up cases.1
Inverted papilloma is a benign neoplasm having association with squamous cell carcinoma. This association with malignancy, along with greater invasion potential and tendency for recurrence suggests the treatment paradigm for IP. Complete surgical excision including the adjacent uninvolved mucosa is the treatment of choice. Endonasal endoscopic approaches are used only for tumors of limited extensions while an external or combined external/endoscopic approach remains the treatment of choice for most of the lesions.4 Tumor recurrence usually occur in the first two years, but in some cases it occurs after 6 years of evolution so patient follow up for at least 6 years should be done.2

DISCLAIMER

The manuscript has not been published and is not under consideration for publication in any other journal.

CONFLICT OF INTEREST

We have no conflict of interests to declare.

FUNDING SOURCES

We have no funding sources to declare. This case report is being published after taking consent from the patient.

REFERENCES

  1. Lisan Q, Laccourreye O, Bonfils P. Sinonasal inverted papilloma: From diagnosis to treatment. Europ Annals Otorhinolaryngol, head and Neck Dis. 2016;133:337-41. https://doi.org/10.1016/j.anorl.2016.03.006
  2. Khandekar S, Dive A, Mishra R, Upadhyaya N. Sinonasal inverted papilloma: A case report and mini review of histopathological features. J Oral Maxillofac Pathol. 2015;1:405 https://doi.org/10.4103/0973-029X.174644
  3. Salomone R, Matsuyama C, Giannotti Filho O, Alvarenga ML, Martinez Neto EE, Chaves AG. Bilateral inverted papilloma: case
    report and literature review. Revista Brasileira de Otorrinolaringologia. 2008;74:293-96. https://doi.org/10.1016/S1808-8694(15)31103-4
  4. Neagos A, Alexandra C, Duca D, Iren C. Inverted papilloma of the nasal cavity-case report. Romanian J Rhinol. 2014;4:55-8.
  5. Cabov T, Macan D, Manojlovic S, Ozegovic M, Spicek J, Luksic I. Oral inverted ductal papilloma. British J Oral Maxillofac Surg.
    2004;42:75-7. https://doi.org/10.1016/S0266-4356(03)00195-5
  6. Jurgens PE. Inverted ductal papilloma of the lower lip: a case report. J Oral Maxillofac Surg. 2004;62:1158-61. https://doi.org/10.1016/j.joms.2003.08.043

  1. Professor and HoD, Department of Oral Maxillofacial Surgery, Mayo Hospital Lahore.
  2. SR, Department of Oral Maxillofacial Surgery, The University of Lahore.
  3. PG Trainee, Department of Oral Maxillofacial Surgery, Mayo Hospital Lahore.
    Corresponding author: “Dr. Tooba Saeed” < drtoobasaeed@yahoo.com >

Inverted Papilloma: A Case Report

Nabeela Riaz1                                      FCPS

Tooba Saeed2                                      FCPS, MCPS

Shagufta Yasmin3                              BDS

Inverted papilloma is a rare benign tumor of nasal cavity and paranasal sinuses. Although it is included in category of benign tumors, it has strong potential for local destruction, high recurrence rate and increased tendency towards malignancy. In this report, we present a case of an uncommon bilateral inverted papilloma of nasal cavities and paranasal sinuses.
KEY WORDS: Inverted papilloma, paranasal sinuses, local destruction.
HOW TO CITE: Riaz N, Saeed T, Yasmin S. Inverted papilloma: A case report J Pak Dent Assoc 2020;29(1):46-48.
DOI: https://doi.org/10.25301/JPDA.291.46
Received: 28 July 2019, Accepted: 17 December 2019

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Status of Vaccination Against Hepatitis B Among Dental Assistants of Multan

Mohsin Javaid1                                        BDS

Muhammad Jamil2                                BDS, FCPS

Mustafa Sajid3                                         BDS, FCPS

OBJECTIVE: Direct contact of dental health care workers with patients make them prone to get infection with hepatitis B and other communicable disease. The Objective of this study was to find out the status of vaccination against of Hepatitis B virus among dental assistants of Multan.
METHODOLOGY: This questionnaire-based cross-sectional study was conducted in Multan Medical & Dental College, from Sept 2018-Nov 2018. Ninety-five dental assistants filled a questionnaire designed and tested for this study. The ethical approval (MDC-0409) was taken from the Dental hospital, informed consent was obtained from the participants in the study.
RESULTS: Out of Ninety five participants, 68.42% participants were males and 31.58%were females. 89.48% participants were in favor of vaccinating against hepatitis B for dental assistant, while 44.21% participants were already vaccinated. Lack of motivation was the main reason for not receiving vaccination.
CONCLUSION: Self-reported rate of hepatitis B vaccination among Dental Assistants of Multan was low. Lack of motivation was the main impediment.
KEY WORDS: Hepatitis B vaccine, Dental Assistants, Health care workers, Dental health professionals.
HOW TO CITE: Javaid M, Jamil M, Sajid M. Status of vaccination against hepatitis B among dental assistants of multan. J Pak Dent Assoc 2020;29(1):42-45.
DOI: https://doi.org/10.25301/JPDA.291.42
Received: 21 December 2018, Accepted: 14 October 2019

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Frequency of Medical Co-Morbidities in Oral Surgery, Prosthodontic and Orthodontic Patients

Hafiz Nasir Mahmood1                                            BDS

Muhammad Waseem Ullah Khan2                    BDS, FCPS

Muhammad Azeem3                                                BDS

Sabiha Naeem4                                                          BDS, PhD

Asif Ali Shah5                                                             BDS, MSc, MDS

Muhammad Mudassar Saleem6                         BDS, FCPS

OBJECTIVE: Co-morbidity is a medical condition accompanied to the primary condition for which patient is seeking medical or dental care. To determine the frequency of medical co-morbid conditions in dental patients.

METHODOLOGY: After obtaining informed consent, a comprehensive predesigned history form was implemented to record patient’s medical conditions. Different variables recorded for each participant were age, gender and history of medical co-morbid conditions including diabetes mellitus, hypertension, ischemic heart diseases, renal disorders, typhoid, thyroid disorder, degenerative joint disorder, asthma, hepatitis B, hepatitis C, hepatitis A and E, HIV and tuberculosis.
RESULTS: In this study, hypertension accounted for 9.5% in total number of patients followed by degenerative joint disorders and hepatitis C with the same frequency of 5.2%. Diabetes mellitus and hepatitis B accounted for 3.4% of the patients
CONCLUSION: This study concludes that presentation of medically compromised patients in dentistry is inevitable.
KEY WORDS: Orthodontics; Prosthodontics; Oral surgery; Medical co-morbidities.
HOW TO CITE: Mahmood HN, Khan MWU, Azeem M, Naeem S, Shah AA, Saleem MM. Frequency of medical co-morbidities in oral surgery, prosthodontic and orthodontic patients. J Pak Dent Assoc 2020;29(1):38-41.
DOI: https://doi.org/10.25301/JPDA.291.38
Received: 16 July 2019, Accepted: 06 December 2019

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Effects of Various Mouthwashes on the Orthodontic Nickel-Titanium Wires: Corrosion Analysis

Mehreen Wajahat1                            BDS

Faisal Moeen2                                   BDS, MSc

Syed Wilayat Husain3                      PhD

Sumera Siddique4                            BDS, PhD

Zohaib Khurshid5                            BDS, MRes, MDTFEd, FPFA

OBJECTIVES: This project was carried out to identify the least corrosive mouthwash when Nickel Titanium (NiTi) wires are employed in the oral environment for longer periods during the orthodontic treatment.
METHODOLOGY: Corrosion of NiTi archwires was investigated in different mouthwashes and artificial saliva. Artificial saliva was taken as a standard medium. A potentiodynamic test was performed using Gamry’s potentiostat. This type of test comprises of a corrosion cell containing immersion medium, in which sample wire was dipped. A specified voltage was applied to complete electrochemical cell. Corrosion rate was calculated utilizing the Tafel equation through a software ‘Echem analyst’. One-way ANOVA was conducted to compare the mean corrosion rates of wires immersed in different media. Field Emission Scanning Electron Microscope (FESEM) was used to analyze the surface characteristics of NiTi wires after the corrosion testing.
RESULTS: NiTi wires tested in mouthwash containing HCl in 0.15% w/v of Benzydamine Hydrochloride (EnziclorTM) produced greatest corrosion (16.2300+4.405 MPY). While Dexapanthenol + permethol containing mouthwash (Hi-ParaentTM) showed minimum corrosion of the NiTi wires. The rate of corrosion was found to be insignificant in artificial saliva, the control medium.
CONCLUSIONS: Research concludes that mouthwashes which contain dexapanthenol + permethol (e.g, Hi-ParadentTM) are the safest most among those containing chlorhexidine gluconate + benzydamine hydrochloride(e.g, EnzicloreTM) and sodium monofluorophosphate (e.g, SecureTM) in terms of corrosion of NiTi wires .
KEYWORDS: Corrosion; Orthodontic wires, Nickel-titanium wires, Potentiodynamic analysis, Mouthwashes
HOW TO CITE: Wajahat M, Moeen F, Husain SW, Siddique S, Khurshid Z. Effects of various mouthwashes on the orthodontic Nickel-Titanium wires: corrosion analysis. J Pak Dent Assoc 2020;29(1):30-37.
DOI: https://doi.org/10.25301/JPDA.291.30
Received: 01 August 2019, Accepted: 01 November 2019

INTRODUCTION

Literature indicates that individuals with malaligned teeth are more prone to periodontal problems owing to the difficulty in accessing areas hence crowding of teeth creates hinderance in maintaining proper oral hygiene.1
Patients with such crowding who are more susceptible to dental caries might benefit from the additional use of fluoride mouth rinses in addition to regular brushing.2 Patients experiencing orthodontic treatment are prone to caries and periodontal disease since the presence of a fixed appliance may compromise the efficacy to maintain ideal oral cleanliness. There is some proof that an everyday use of fluoride mouthwash will decrease the danger of tooth decay and gum disease during treatment with fixed braces.3,4 The success of orthodontic treatment apart from other factors depends on the sliding mechanism between the wires and brackets.5
Corrosion of these wires owing to any stimulus increases friction. This friction provides higher resistance to sliding5-7 and can ultimately prolong the treatment duration. Nickel-titanium (NiTi) is one of the most commonly used wire materials in orthodontic treatment. Generally, these wires are considered corrosion resistant because of a protective passive film, titanium oxide (TiO2) which is formed on these NiTi wires. This layer shields the wire from corrosion and other environmental effects. Corrosion may occur if this layer is compromised due to any factor which can create a reducing environment in the oral cavity.
After the placement of orthodontic appliances in the oral environment the occurrence of certain cases of stomatitis have been reported.8
A substantial number of proprietary products are available in the form of topical analgesics or antiseptic mouthwashes which contain active chemicals to reduce pain and soreness. These products also aim to prevent secondary infections associated with oral ulcers.9 Mouthwashes containing chlorhexidine gluconate have shown to reduce traumatic oral ulcers associated with the initial period of fixed appliance treatment.9 But the long term use of these mouthwashes can lead to a risk of corrosion in the orthodontic wires. The oral cavity is continuously bathed with saliva, which is a complex mixture of dissolved electrolytes with a high chloride content, as well as various organic substances.10 During the orthodontic treatment, wires are mechanically activated to achieve the required tooth movement.11 This relative movement of wires and the friction in the brackets may lead to the process of corrosion, for example, fretting corrosion.12 So, the mouthwashes prescribed and incorporated into the daily use of the patient during treatment with these mechanically activated orthodontic wires may initiate the process of corrosion.
In-vitro corrosion rate of frequently used NiTi archwires used for the orthodontic treatment was assessed and compared in variously prescribed mouthwashes in the patients with gingivitis. The basic purpose of this research was to select the least corrosive mouthwash that should be prescribed when patient is put on NiTi wires for longer durations during the orthodontic treatment.

METHODOLOGY

Nickel Titanium (NiTi) dental archwires (Ortho Organizer,USA) were tested. NiTi wires of the diameter 0.012mm were selected based on their long term use in oral cavity during the first phase of orthodontic treatment. Three commonly used mouthwashes to treat gingivitis in the orthodontic patients were selected. Artificial saliva was selected as a control immersion medium. The wires to be tested were made non-conducting with an epoxy resin coating, leaving behind 2cm of the wire which was to be

Table 1: List of testing materials

dipped in the electrolyte (immersion media). After overnight drying, the wires were cleaned with ethanol followed by a step which involved washing with distilled water.

Table 2: Composition of Mouthwashes

NiTi archwires manufactured by Ortho Organizer, USA were utilized in this study. Energy Dispersive Spectroscopy (EDS) of as-received arch wire was carried out showing the composition of NiTi arch wires. Although NiTi is known to be equiatomic alloy (having equal amounts of Nickel and Titanium), some other elements were also found to be added.

PREPARATION OF ARTIFICIAL SALIVA

A mineral medium with a composition similar to saliva was prepared as described by Levallois et al.13 700ml of distilled water was poured into a 1000 ml glass beaker and this was stirred using a magnetic bar at 37oC. After each

preceding reagent had completely dissolved, a new reagent was added. Reagents were dissolved in distilled water in the
sequence listed in table-3. Geigy in 1972 showed that its composition was very close to saliva. Hydrogen carbonate utilized in the preparation of this medium is known for its buffering effects which are close to that of real in-mouth conditions of saliva. Phosphates

Table 3: List of Reagents (composition) of the artificial saliva (pH=6.9)

contributed to maintaining the pH value as close to neutrality as possible. Mineralization was also achieved by the addition of phosphates and calcium.13

POTENTIODYNAMIC TESTING

A potentiostat (R-600, Gamry instruments) was used to perform the potentiodynamic tests for corrosion analysis. All the test wires utilized were under no mechanical deformation during the corrosion tests. Prepared wires were dipped into the electrolyte (Immersion media) for 2-3 hours stabilize the potential prior to starting the experiment.
Metal alloys are immersed in solution in which they are to be tested so that a stable open circuit potential (OCP) can be attained before starting the polarisation scan. OCP measurements indicated that the OCP of the alloy at 3 hours was almost identical to OCP measured at several hours, depicting that once a potential is attained, it can be considered as constant because there is no effect of varying dipping
time of sample in solution. Dipping for more than 2-3 hours should however be avoided. Therefore this dipping time ( t= 2-3 hrs) was approved as the time requisite to get a stabilization for all the electrochemical measurements so as to avoid addition of any misleading values of already existing potential when potential is applied for the experiment.14 Sample wire was used as a working electrode. A saturated calomel electrode (SCE) was used as the reference electrode whereas a graphite rod was used as a counter electrode.
The potentiodynamic polarization curves were obtained from – 500 mV toward the anodic direction, with a scan rate of 1 mV/s and a final voltage of 1500 mV. Corrosion resistance parameters, including the corrosion potential (at this potential the sum of the anodic and cathodic reaction rates on the electrode surface is zero) and the corrosion rate (Icorr; the anodic current density at the potential of Ecorr), were obtained from these potentiodynamic polarization curves. The surface of the NiTi wire after corrosion testing was observed using
a Field Emission Scanning Electron Microscope (FESEM) (mira TESCAN). One-way ANOVA was conducted to compare the mean corrosion rates between NiTi wires immersed in the different media using SPSS-23. The inter-group corrosion rates between the four solutions was compared using the post-hoc Tukey analysis.

RESULTS

Potentiodynamic polarization curves of the NiTi wires in artificial saliva and three types of mouthwashes revealed an active-to-passive transition behavior in the polarization curves. Representative potentiodynamic polarization curves of NiTi wires in different immersion media are given below (Figure 1).
In Figure 1, represents series of potentiodynamic polarization curves, the cathodic section (passive region i.e., from 0.5V to 0.4 V, for standard solution) of these polarization

Figure 1: Potentiodynamic polarization curves of NiTi wires in chlorhexidine gluconate + Benzydamine Hydrochloride mouthwash (EnziclorTM), Sodium Monofluorophosphate (SecureTM) and Dexapanthenol + permethol (Hi-ParadentTM). (x-axis is in logarithimic scale)

curves shows no vertical stage and consists only of one smooth slope. After cathodic stage anodic stage (active region i.e., from 0.4V to 1.3 V) starts. The corrosion potentials of sample wires in four test solutions were close to each other with small peaks in anodic current. The current density was found to be lowest in artificial saliva i.e. 6.900 nA/cm2. Among the mouthwashes lowest current density was found in Hi-ParadentTM i.e., 8.200 nA/cm2. Lowest current density

Table 4: Corrosion Parameters

Ecorr=Corrosion potential, Icor=Current density, MPY=Mills Per Year. Potentiodynamic test of NiTi in Enziclor mouthwash has
given maximum value of corrosion rate i.e, 0.02498 MPY whereas minimum value of corrosion rate among tested mouthwashes was obtained in Hi-Paradent i.e. 0.004341 MPY

density represents lowest corrosion rate. The curve having more fluctuations in anodic section had more pitting effect e.g, the curve of Enziclore test (Blue in Fig 1) has more fluctuations as compared to the curve of Secure (Green in Figure 1) which had intermediate fluctuations. Hi-Paradent (Red in Fig 1) showed lowest fluctuations of potentiodynamic curve representing lowest corrosion rate. This figure shows a comparison of representative values in each immersion medium. All the other values of corrosion parameters i.e.,
Ecorr, Icorr and corrosion rates calculated from potentiodynamic polarization curves of all the samples in various media one by one are given in Table-4.

STATISTICAL ANALYSIS

One way ANOVA showed that there was no difference in the corrosion rates among NiTi wires immersed in the 3 types of mouthwash (p < 0.001). Mean Corrosion Rate for Nickel Titanium (NiTi) = 10.9772 + 5.4594.
Basically an ANOVA test and s post-hoc Tukey analysis was conducted to compare the intergroup differences in the corrosion rates between the 4 different solutions. In the Table 5, the descending order of the corrosion rates is as follows: EnziclorTM, SecureTM, Hi-ParadentTM, Artificial saliva.

Table 6 illustrates the inter-group corrosion rates. These solutions can be placed in two groups (EnziclorTM with SecureTM and Hi-ParadentTM with Artificial Saliva). Means, both EnziclorTM and SecureTM have statistically different (higher) corrosion rates from both Hi-ParadentTM and Artificial Saliva.

Table 5: Corrosion Rates of NiTi Wires as Per Different Immersion Media.

However, there is no difference in the corrosion rates between EnziclorTM and SecureTM. Also, it holds true vice versa.

Table 6: Comparison of the Corrosion rates of NiTi Wires Per Immersion Media.

That is, both Hi-ParadentTM and Artificial Saliva have statistically lower corrosion rates than EnziclorTM and SecureTM. There is no statistical difference between the corrosion rates of Hi-ParadentTM and Artificial Saliva. The inter-group differences between the four different solutions have been illustrated in table 6.
As shown, EnziclorTM has significantly greater corrosion rates than both Hi-ParadentTM (p = 0.006) and Artificial Saliva (p < 0.001). Also, SecureTM has a significantly higher corrosion rate than both Hi-ParadentTM (p = 0.005) and Artificial Saliva (p = 0.074).

SURFACE ANALYSIS

FESEM images showed the surface irregularities and small pits in the wires tested in EnziclorTM, confirming the corrosion in this media.
The literature showed that the surface defects produced during the manufacturing process of NiTi alloy can cause corrosion.15 Oshida et al. also reported the possibility of corrosion on the sites of surface defects created during fabrication.16 Localized corrosion on the NiTi surfaces can be enhanced due to the surface defects.17 NiTi wires showed the maximum corrosion resistance in Hi-ParadentTM and the highest vulnerability to corrosion

Figure 2: The SEM observations ( Mag 1.00 kx) of the tested NiTi wires after potentiodynamic tests in Artificial saliva, Hi-ParadentTM, SecureTM and EnziclorTM (a-d)

Table 7: pH of test solutions

in EnziclorTM mouthwash. It can be linked to the pH of media provided other factors are kept at constant. Lower or more acidic mouthwashes are hence more corrosive. This feature decreases as pH of the media increases or moves to alkalinity. The decreasing trend of corrosion is exactly in accordance with the increase in pH of media, as shown in Table 7.

DISCUSSION

Electrochemical nature of the oral cavity must be understood to know the process of corrosion in the oral cavity. Literature establishes that the leading features for an environment to be corrosive include oxidation potential (Pourbaix, 1973) and an inconstant presence of oxygen and hydrogen.18 In the oral cavity, anaerobic bacteria are present which make a range in the pressures of oxygen and hydrogen possible. Variable amounts of oxygen and hydrogen give rise to either oxidation or reduction in the oral cavity. Factors that will provide oxidation environment are considered to be least corrosive and vice versa. Therefore, mouthwashes whose chemicals tend to take away oxygen atoms from the outermost protective layer of NiTi lead to the breakdown of this passive film initiating corrosion of the underlying wire.
According to Ewers and Greener, the range of oxidation potential (the potential at which oxidation occurs) present in the oral cavity ranges from -58 to +212 mV relative to saturated calomel electrode (SCE) suggesting that the wires are not susceptible to corrosion normally.19 Therefore, artificial saliva was utilized as a control medium in this study. Results clearly showed the minimum rate of corrosion in this media i.e, 5.6493+1.8297. There was no difference observed in the rates of corrosion in the NiTi wires immersed in artificial saliva (p = 1.00) proving that NiTi wires were impervious to corrosion in articial saliva.
The study by Kim and Johnson showed that the characterization of NiTi wires reveal extensive pitting and localized corrosion after potentiodynamic polarization tests in 0.9% NaCl solution. In the case of clinical implications, the use of different chemicals in the form of mouthwashes may lead to pitting corrosion on the wires, causing increased friction.20 In the present study pitting corrosion was observed
on the surfaces of tested samples under FESEM (Figure 2d). Fretting corrosion (corrosion due to the motion of two mating surfaces against each other) was not seen in tested samples because fretting is a type of wear and this experiment was carried out in a static controlled setup. Apart from pits, long wedges were also observed on surfaces of tested wires. This was due to cold rolling, which is the processing of alloy into wires. Due to cold rolling, grains arrange along specific lines (rolling direction). These regions are susceptible to corrosion so the lengthy wedges were observed in FESEM images.
In the present study, as the chemical assembly of protective film on all NiTi wires is identical, omprising mainly of TiO2 with lesser amounts of NiO, but corrosion of wires did occur. Statistical analysis showed a significant difference in the corrosion rates among the NiTi wires tested in different mouthwashes (p < 0.001). The trend of corrosion of the NiTi wires in different immersion media established from this study can be summarized as:

EnziclorTM> SecureTM > Hi-ParadentTM > Artificial Saliva

This trend is exactly opposite to pH of immersion media. Therefore corrosion and pH can be called inversely proportional to each other. If all the other factors remain constant, the pH of the immersion media can help explain the corrosion trends observed in reverse order. The lower the pH of the media, the greater the corrosion rate. In other words, as the immersion media becomes more acidic, the corrosion tendency increases, and the corrosion resistance of the archwire decreases. For the present study, EnziclorTM had the least pH (Table 7). As a result, the NiTi wires exposed to EnziclorTM displayed the greatest corrosion rate. As the acidity decreased and the alkalinity increased, the corrosion rate decreases as well.
Corrosion occurs in different environments i.e, air, water, acids and chorus environment etc. However behavior is different in different environments. In the present study ingredients of immersion media caused and accelerated corrosion process. Acidic pH may dissolve the surface oxide films and avoids its reorganization thereby enhancing corrosion.21 Based on the results of this research, EnziclorTM mouthwash produced substantial amounts of corrosion (16.2300 + 4.4705 MPY) in the NiTi wires as compared to the other mouthwashes. According to a study on ‘Surface characterizations and corrosion resistance of nickel-titanium orthodontic archwires in artificial saliva of various degrees of acidity,’ a decrease in pH of the electrolyte leads to a rise in the values of Ecorr and Icorr. Decreasing pH gives rise to an increase in the concentration of H+; as a consequence, it will increase the cathodic reaction 2H+ + 2e- H2 on the NiTi wire. Therefore, the reaction at anode causes the metal to dissolve and this hastens the delivery of electrons for the cathodic reaction at the potential of Ecorr. The values of Ecorr and Icorr were amplified (mixed-potential theory).22
In the present case, EnziclorTM has the lowest pH because of an acidic component in its formulation. Consequently, Ecorr and Icorr values were higher in this medium leading to an increased rate of corrosion as compared to others. So, the cause of highest rate of corrosion in this medium ows to acidic pH and the presence of HCl in its composition (i.e, Chlorhexidine gluconate + Benzydamine HCl). This HCl breaks down increasing the concentration of hydrogen ions in this medium, leading to further increase in dissolution of metal. The anodic region in the polarization curves of wires was as a result of localized or pitting corrosion and not due to the uniform corrosion.
Fluoridated mouthwash could also create acidic environment.21 Mean corrosion rate in SecureTM (Fluoride containing) mouthwash was observed as 13.7283 + 3.8306.
Mean corrosion rate of the NiTi wires in Hi-paradentTM medium was found to be 8.3012 + 3.7743, which is minimum among all mouthwashes utilized in this study. The passive film on the NiTi wires provided a maximum resistance to ion-transfer in medium, making this medium least corrosive during the treatment with NiTi wires. From the discussion above it can be inferred that passive film constancy of NiTi wire in Hi-ParadentTM immersion medium was maximum, providing an utmost shield in this medium from corrosion.
The biocompatibility of any metal is linked mostly to the passive film on the surface of that metal. AES surface-depth profile analysis suggests that the amount of Nickel oxide on the surface of NiTi wires is lower as compared to Titanium oxide (TiO2).23-25 This Titanium oxide (TiO2) can provide good biocompatibility of the NiTi alloy.23,24 Corrosion of NiTi leads to biologically negative effects.23,26-28 Sample wires showed low values of Icorr and immunity to pitting corrosion in the artificial saliva.
The difference in the rates of corrosion between the following mouthwashes was found to be significant (Significant P values): –

  1. EnziclorTM and Hi-ParadentTM
  2. EnziclorTM and Artificial Saliva
  3. SecureTM and Hi-ParadentTM

As corrosion of these archwires can also be calculated with the individual chemicals present in these mouthwashes to assess the behaviour of different chemicals with different wires.
However further room of research exists in:-

a. Evaluation of the amount of nickel released after corrosion in the case of various mouthwashes (to avoid nickel allergy in patients with nickel hypersensitivity).
b. Evaluation of the effects of corrosion on American manufactured versus Chinese manufactured archwires using different mouthwashes.
c. Evaluation of the corrosion rate of archwires in various beverages (tea, coffee and acidic drinks).
d. Corrosion analysis of mechanically bent wires (as bends or curves manually placed in the SS wires by the dentist may become a target spot for corrosion).

CONCLUSIONS

Corrosion rate basically states, ‘rate of corrosion in Mills Per Year’ (1Mill=One 1000th of an inch) i.e, values of corrosion rate obtained convey the extent to which that specific mouthwash will cause corrosion in the wire in a year if repeatedly exposed to it whereas, the treatment time of orthodontic archwires (especially NiTi) inside the oral cavity is less than a year. But this is compensated in natural
environment as young orthodontic patients frequently take acidic drinks which may add to the effects of corrosion. Hence effects of corrosion which are obtained in a year’s period may practically be seen before the completion of one year in the oral cavity where the patient is not using mouthwash alone but taking other foods and drinks as well.
It can therefore be concluded that when the NiTi wire is used for longer periods during the orthodontic treatment, SecureTM and Hi-ParadentTM mouthwashes should be preferably recommended for treating gingival problems to ensure frictionless tooth movement as a result of minimum corrosion. EnziclorTM should be avoided in such cases owing to its corrosive effects on NiTi wires.

Author Contributions: Conceptualization, Mehreen Wajahat; Formal analysis, Sumera Siddique; Methodology, Mehreen Wajahat; Project administration, Faisal Moeen; Resources, Syed Wilayat Husain; Supervision, Faisal Moeen and Syed Wilayat Husain; Validation, Syed Wilayat Husain; Writing – original draft, Mehreen Wajahat; Writing – review & editing, Zohaib Khurshid.

Funding: “This research received no external funding” Acknowledgements: The author acknowledges the core backing of this research work to the team at the Institute of space technology especially Mr. Tahir, Engr. Abdul Moeez and Mr. Ahsan. The author is also very thankful to the team at the IRCBM COMSATS for their great cooperation. Dr Abdul Samad and Dr Akif Anwar are the names worth mentioning. Dr Sundus Iftikhar and Dr Tania Siddiqui were also very helpful.

CONFLICTS OF INTEREST

The authors declare no conflict of interest.

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  4. Alzoubi EEM, Borg VT, Gatt G, Aguis AM, Attard N. The importance of oral health education in patients receiving orthodontic treatment. J Oral Res Rev. 2019;11:12. https://doi.org/10.4103/jorr.jorr_24_18
  5. Griffiths HS, Sherriff M, Ireland AJ. Resistance to sliding with 3 types of elastomeric modules. Am J Orthod Dentofac Orthop. 2005;
    127:670-75. https://doi.org/10.1016/j.ajodo.2004.01.025
  6. Henao SP, Kusy RP. Evaluation of the frictional resistance of conventional and self-ligating bracket designs using standardized archwires and dental typodonts. Angle Orthod. 2004;74:202-11.
  7. Tselepis M, Brockhurst P, West VC. The dynamnic frictional resistance between orthodontic brackets and arch wires. Am J Orthod Dentofac Orthop. 1994;106:131-38. https://doi.org/10.1016/S0889-5406(94)70030-3
  8. Jensen CS, Menné T, Duus Johansen J. Systemic contact dermatitis after oral exposure to nickel: a review with a modified meta-analysis. Contact dermatitis. 2006;54:79-86. https://doi.org/10.1111/j.0105-1873.2006.00773.x
  9. Asher C, Shaw W. Benzydamine hydrochloride in the treatment of ulceration associated with recently placed fixed orthodontic appliances. Europ J Orthod. 1986;8:61-4. https://doi.org/10.1093/ejo/8.1.61
  10. Joseph A, editor Corrosion of orthodontic devices. Seminars in orthodontics; 1997: Elsevier.
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  14. Zaid B, Saidi D, Benzaid A, Hadji S. Effects of pH and chloride concentration on pitting corrosion of AA6061 aluminum alloy. Corrosion Science. 2008;50:1841-7. https://doi.org/10.1016/j.corsci.2008.03.006
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  21. Pataijindachote J, Juntavee N, Viwattanatipa N. Corrosion Analysis of Orthodontic Wires: An Interaction Study of Wire Type, pH and Immersion Time. Adv Dent &amp; Oral Health. 2018;10(1): 555780. https://doi.org/10.19080/ADOH.2018.10.555780
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  25. Köster R, Vieluf D, Kiehn M, Sommerauer M, Kähler J, Baldus S, et al. Nickel and molybdenum contact allergies in patients with
    coronary in-stent restenosis. The Lancet. 2000;356(9245):1895-97. https://doi.org/10.1016/S0140-6736(00)03262-1
  26. Ryhänen J, Niemi E, Serlo W, Niemelä E, Sandvik P, Pernu H, et al. Biocompatibility of nickel?titanium shape memory metal and its corrosion behavior in human cell cultures. Journal of Biomedical Materials Research: An Official Journal of The Society for Biomaterials and Japan Soci Biomater. 1997;35:451-57. https://doi.org/10.1002/(SICI)1097 4636(19970615)35:4<451::AIDJBM5>3.0.CO;2-G
  27. Guyuron B, Lasa JC. Reaction to stainless steel wire following orthognathic surgery. Plast Reconstru Surg. 1992;89:540-42. https://doi.org/10.1097/00006534-199203000-00025
  28. Huang HH. Surface characterizations and corrosion resistance of nickel-titanium orthodontic archwires in artificial saliva of various
    degrees of acidity. Journal of Biomedical Materials Research Part A: An Official Journal of The Society for Biomaterials, Japan Soci Biomater, Australian Soci Biomater Korean Soci for Biomater. 2005;74:629-39. https://doi.org/10.1002/jbm.a.30340

  1. Lecturer + PGT, Department of Dental Materials, Islamic International Dental College.
  2. Associate Professor, Department of Dental Materials, Islamic International Dental College.
  3. Professor, Department of Material Science and Engineering, Institute of Space Technology.
  4. Assistant Professor, Department of Physics and Astronomy, Texas Tech University, USA.
  5. Lecturer, Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, KSA.
    Corresponding author: “Dr. Mehreen Wajahat” < mehrinwajahat09@gmail.com >

Effects of Various Mouthwashes on the Orthodontic Nickel-Titanium Wires: Corrosion Analysis

Mehreen Wajahat1                            BDS

Faisal Moeen2                                   BDS, MSc

Syed Wilayat Husain3                      PhD

Sumera Siddique4                            BDS, PhD

Zohaib Khurshid5                            BDS, MRes, MDTFEd, FPFA

OBJECTIVES: This project was carried out to identify the least corrosive mouthwash when Nickel Titanium (NiTi) wires are employed in the oral environment for longer periods during the orthodontic treatment.
METHODOLOGY: Corrosion of NiTi archwires was investigated in different mouthwashes and artificial saliva. Artificial saliva was taken as a standard medium. A potentiodynamic test was performed using Gamry’s potentiostat. This type of test comprises of a corrosion cell containing immersion medium, in which sample wire was dipped. A specified voltage was applied to complete electrochemical cell. Corrosion rate was calculated utilizing the Tafel equation through a software ‘Echem analyst’. One-way ANOVA was conducted to compare the mean corrosion rates of wires immersed in different media. Field Emission Scanning Electron Microscope (FESEM) was used to analyze the surface characteristics of NiTi wires after the corrosion testing.
RESULTS: NiTi wires tested in mouthwash containing HCl in 0.15% w/v of Benzydamine Hydrochloride (EnziclorTM) produced greatest corrosion (16.2300+4.405 MPY). While Dexapanthenol + permethol containing mouthwash (Hi-ParaentTM) showed minimum corrosion of the NiTi wires. The rate of corrosion was found to be insignificant in artificial saliva, the control medium.
CONCLUSIONS: Research concludes that mouthwashes which contain dexapanthenol + permethol (e.g, Hi-ParadentTM) are the safest most among those containing chlorhexidine gluconate + benzydamine hydrochloride(e.g, EnzicloreTM) and sodium monofluorophosphate (e.g, SecureTM) in terms of corrosion of NiTi wires .
KEYWORDS: Corrosion; Orthodontic wires, Nickel-titanium wires, Potentiodynamic analysis, Mouthwashes
HOW TO CITE: Wajahat M, Moeen F, Husain SW, Siddique S, Khurshid Z. Effects of various mouthwashes on the orthodontic Nickel-Titanium wires: corrosion analysis. J Pak Dent Assoc 2020;29(1):30-37.
DOI: https://doi.org/10.25301/JPDA.291.30
Received: 01 August 2019, Accepted: 01 November 2019

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Correlation Between Demographic Perspective of PG Trainees and Research: A Cross-Sectional Multidisciplinary Study

Nabiha Farasat Khan1                            BDS, M.Phil, MHPE

Muhammad Saeed2                                BDS

Usama Saeed3                                          MBBS

OBJECTIVE: Demographic perspectives of future investigators (PG trainees of Medicine & Dentistry) have more or less effect on their achievements. Such perspectives may also work as barriers towards scientific activities. The aim of the study is to evaluate whether (if any) demographic perspectives working as barrier in research work among PG trainees.
METHODOLOGY: To assess the effects of demographic view on the research activities of 72 PG trainees a cross-sectional survey was carried out at 3 different public sector medical and dental institutes (Bolan Medical Complex Hospital (BMCH), Quetta Institute of Medical Sciences (QIMS) and Institute of Public Health (IPH) within 3 months (May-July 2018). Data was collected and analyzed by using SPSS version 20. A p-value of < 0.05 was considered significant.
RESULTS: Sixty-one percent of the study participants were males. Almost half (43%) PG trainees demonstrated positive attitude towards item number 3 “students can plan & conduct scientific research” (Mean±SD4.36±.65), 86.1% agreed to accomplish research work at undergraduate level, even in the absence of a supervisor (p-0.004). Low father educational level induces a lack of interest in PG trainees research work (p-0.01), whereas PG trainees having illiterate mothers present a strong correlation between lack of research work and un co-operative faculty (p<0.001) which creates hurdle in their scientific activities.
CONCLUSION: PG trainees of Pakistani community demonstrates positive attitude towards research activities. They express keenness regarding scientific task but due to low parental education level they face un-cooperative faculty which intern reduces their interest in research work. Whereas over-loaded curriculum, social and family commitments and job duties medical PG’s face time management issues.
KEY WORDS: Demographic perspective, PG trainees, Dentistry, Medicine, Hurdles, Research.
HOW TO CITE: Khan NF, Saeed M, Saeed U. Correlation between demographic perspective of pg trainees and research: A cross-sectional multidisciplinary study. J Pak Dent Assoc 2020;29(1):24-29.
DOI: https://doi.org/10.25301/JPDA.291.24
Received: 26 April 2019, Accepted: 04 October 2019

INTRODUCTION

Research is an essential element in promotion and betterment of patient’s care and health system through bridging the gap between basic and clinical sciences.1
Components of research (systematic literature search, critical appraisal, independent learning and scientific paper writing) enhance physician skills, amplify under/postgraduate medical student’s scientific knowledge, help to figure out issues and works as main incentive
guaranteeing the key growth scale.2-5 Globally, many developed and under developed countries have implemented compulsory courses that flourish and nurture positive attitude towards research.6
Regardless of its importance, various researchers have pointed out barriers against scientific research so the number of researchers continues to dwindle worldwide,7-13 Although investigators recognize barriers towards research work, however none of them has investigate the role of demographic view (age, gender, marital status and maternal education) on research work among PG trainees
of medicine & dentistry. This study was therefore started to evaluate the effects of demographic views on research activities among postgraduate medical and dental students in 3 public center medical institutes.

METHODOLOGY

A questionnaire based cross-sectional survey was carried out on 72 PG trainees of Bolan Medical Complex Hospital (BMCH), Quetta Institute of Medical Sciences (QIMS) and Institute of Public Health (IPH). Permission to conduct the study was granted by the principal Bolan Medical College, Quetta. All participants working as PG trainees in BMCH, QIMS & IPH were included in the study, whereas house
officers were excluded from study. A demonstrator from dental section distributed & collected validated questionnaire formulated by Amin TT8 which recorded PG trainee’s demographic views (age in years, gender, parental education status, marital status, type of schooling). Confidentiality was confirmed. Attitudes and perceptions about research barriers were recorded with 16 questions using a Five point Likert scale; 1= Strongly Disagree (SD) 2= Disagree (D), 3=Neutral (N), 4= Agree (A), 5= Strongly Agree (SA) to assess trainee’s responses. Likert scale variables were recoded for further analysis by combining categories agree and strongly agree in to a single group agree recoded 3, categories strongly disagree and disagree into a single category disagree coded as 1 while neutral was retained and coded as 2. Higher the score, higher the attitude level and thus, barrier was measured.
The information collected was analyzed by using statistical software SPSS-20. Chi-square test was used to evaluate association between research barriers and demographic details. Normality assumption was evaluated with Kolmogorov-Smirnov test.

RESULTS

There were 80 PG trainees, 8 of them were absent at the time of data collection giving 90% response rate. Out of these remaining 72 PG trainees 38 (52.77%) participants belonged to BMCH, 15 (20.83%) from QIMS and 19 (26.38%) were MBBS doctors of IPH. Majority (61.1%) were males and between 28-30 years of age (mean age of

Table 1: Demographic view of PG Trainees from BMCH, CMH & IPH

23.3 ± 4.6 years). Detailed demographic data of participants is presented in Table 1.
Table 2 demonstrate the distribution of scores on attitudes and perceptions about barriers in scientific research among the dental and medical PG trainees. PG trainees exhibited willingness to conduct research (Mean±SD 4.36±.65) mean while they noticed lack of lab & other facilities as major

Table 2: Distribution of scores on Attitudes and Perceptions about Barriers in scientific research among the dental and medical postgraduate trainees

Table 3: Presenting association between research barrier & demographic view

hurdle in their research activities (Mean ±SD 4. 30) whereas lack of time, motivation and/or reward also becomes an issue among PG trainees towards their scientific approach (Mean±SD 4.23±0.91 & 4.23 ±0.77 respectively).
Attitudes and barriers scores of PG trainees in relation to socio-demographic and personal characteristics response rate is presented in Table 3. Low father educational level decreases PG trainees interest in research (p-0.01) whereas statistically significant correlation was found between low mother educational level and un co-operative faculty

Bar Chart presenting barriers towards research work among PG trainees of Medicine & Dentistry

(p-<0.001) causing deficient interest in research of PG trainees. Strong co-relation was also observed between undergraduate participation and their views about ready to conduct research in the absence of supervisor (p-0.004), whereas no correlation was observed between age and attitude and research barriers among PG trainees. Likewise schooling and marital status didn’t effect PG trainees research work.
Bar chart presented barriers towards research work among PG trainees of medicine & dentistry.

DISCUSSION

This study aims to highlight the obstacles faced by local postgraduate residents in conducting research with an aim to improve research productivity and overall health care in the field of dentistry.
This study evaluates outcome of demographic role of local PG trainees on research work with the aim to ameliorate research efficacy which would exhibit outcome in the field of medicine & dentistry. In developed countries like Canada & US research is mandatory,14however controversy exist between developed and under developed countries as in India 91% PG trainees did not demonstrates research work during their PG training.15 On the other hand Pakistani students express their interest in scientific activities as 68.7% medical students participated in research work,6 however as research is not essential nor mandatory for medical students; research work ratio is still unsatisfactory. 1,16 The main reason behind this deficient research work in developing countries is limited financial sources also lack of research skills and work senior faculty member do not have enough experience in research skills and writing which affecting in mentoring the new researchers. Therefore, new policies of PMDC and HEC are forcing the PG trainees to take interest in research. Moreover, students financial support for research enhance student participation in research activities. Thus paying special attention to students’ research budgets increases chance of student participation in the research works.2 Poverty, lack of resources, poor access to the literature, and poor knowledge about the research.17,18 created a large disparity in research productivity in low-income areas of the country such as in Balochistan. Research is not a high priority for medical students of this province to carry out; even then participants of our study demonstrated positive attitude towards research work by accepting the beneficial role of research in their medical education. Highest mean score was detected on item number 5 “students carry out clinical research” (Mean±SD 4.36 ± 0.65). Same results were identified worldwide as other researcher also declare medical students interest in scientific activities.8,19-21 Amin
TT, Khan H & Aslam A identified significant improvement in the attitudes of medical students with increasing years of study in medical college.8,14,19 Whereas in Morae’s study, participants presented highest interest (81.7%) in research activities.20 This positive attitude towards research is a response to early exposure to research methodology & its importance, introduction & participation in workshops &
conferences which enhance interest of under-graduate medical students in research work.22
Researchers noticed a significant effect of parental education on their children’s educational attainment, that effects on their mind setup providing a positive outcome that improves opportunities and decision making abilities and influences their children’s achievements. Results demonstrates a positive outcome, as environment created by educated parents ameliorate the chances for their children and decision process.23,24 Research proved positive correlation regarding the impact of family involvement on educational outcomes.24 This was confirmed in our study as a strong correlation was observed between PG trainees father educational level and lack of interest in their research work (p-.001). On contrary Amin TT recognized 56.3% highly qualified fathers of his study participants. The reason of this
two-fold difference is low literacy rate of males (39%) in Balochistan.25

Chevalier detected a positive relation between maternal education and her offspring’s education.23 In Saudia Arabia 46% mothers were highly qualified.8

Unfortunately this phenomenon was not true in case of our study as 25% mothers of our study participants were illiterate and the ratio
of highly qualified mothers was very low (only 10%) demonstrating almost doubled difference with well-known cause; very low female literacy rate in Balochistan (16%).
We also noticed statistically significant results in case of PG trainees of uneducated mother facing un co-operative faculty (p-<0.001). This is because the children belonging to uneducated parents are shy and less competent, unable to deal and explain their views to others.26 Researchers found highly qualified mothers exhibiting more positive beliefs, expressing higher expectations for their children’s academic
achievement and these expectations are related to their children’s subsequent achievements. Moreover, mothers’ education is predictive of parental warmth.24
Subsequent deficiency in research knowledge and skills of physicians could have negative effects on educational, clinical research and health care, shortening the translation of bridging between basics and clinical work.27 This fact was confirmed in current study as our findings demonstrated inadequate skill and knowledge of research of the faculty as a main personal barrier towards research (p-0.011). On the other hand, 37.1% (n=157/423) participants of Amin TT realizes faculty low research knowledge and skill reduces their involvement in scientific activities.8
In our research 24 % PG trainees feels lack of interest causing deficient research activities (p-.009), other studies also detected the origin of deficient interest in research is lack of motivation or shortage of funding, over loaded curriculum,13 time management,2,28 or lack of supervisor/mentor and/or limited facilities and high work load.2,29 Attractive stipend/scholarship, review/reformation of curriculum and trained and easy availability of supervisor/mentor, enrollment early in research of medical students have been recommended that can boost interest of under/postgraduate medical and dental students in scientific activities and assists undergraduate medical students to engage in research during their graduation which would make them able to conduct research easily in their post-graduation.27 Medical and electronic data availability assist in discovering knowledge gap thus helps PG trainees to initiate their research work. The students cited bounded approach to the relevant medical and other electronic databases made them difficult to initiate their research activities.4
PG trainees of current research also disclose the fact that restricted approach of relevant electronic and medical databases is inconvenient for them to work on knowledge gap (p-0.31).4
Poor economy & poverty may be a major cause of this problem in developing countries whereas this is not observed in developed countries.8
A number of barriers exhaust and discourage medical students to continue research activities. Time was seen to be a significant barrier to pursue research interest. Mohammad Ismial from Ireland recognized only 23 & 28 % medical students feeling easy to continue their research work with adequate time.30 On the other hand, in current research work we recognized 63% PG trainees (n=12/19) of medicine from IPH faces “Lack of time” to complete their research work (p-.034). The respondents of other research studies supported our observations where students reported lack of time as a major obstacle.4,8,11,13 Medical students declare lengthy medical curriculum and intense terms of contact hours as a main reason behind not participating in scientific work. Similarly, it was the main issue of Amin research participants where time management was a major obstacle in their research work (62.4%).8 Likewise Funston detected lack of time a 2nd major obstacle in research activities of his respondents.9
In comparison Pearson detected 84% students endorsed insufficient time to participate in research. This concern can be overcome through slotting a proper time in curriculum for research work.

STRENGTH & WEAKNESSES OF WORK

Although Pakistani researchers evaluate attitude and barriers of research among medical students of Punjab, KPK and Karachi however to the best of our knowledge this research is the first to assess the demographic role on attitude and find barriers of research among medical and dental PG trainees in Balochistan which is one of the most important strategical site in the world but unfortunately, also a least developed and most backward province in the country.
This research utilized self-reported questionnaire in which response rate may result in possible selection bias. Another limitation was that PG trainees of different departments face divergent obstacles which might not be discussed in the study. Further research can be undertaken in a more rigorous manner by increasing the sample size and using a more scientific approach. In addition, it could have been more interesting to survey the research hurdles with more generalized results obtained through conducting this research on medical students studying in Makran Medical College Turbat, Jhalwan Medical College Khuzdar and Lorali Medical College of Balochistan.

CONCLUSION

Majority of PG trainees accept the importance of research and its advantage in future through demonstrating good attitude towards research work. However, maternal education, faculty’s inadequate skills and knowledge in research, lack of interest, limited access to information sources, limited facilities and time management are the main barriers to research in medicine and dentistry PG trainees.

RECOMMENDATIONS

Conducting theoretical and practical research methodology courses/workshops, forming a responsive and helpful research team assistant to support students and providing them required facilities/equipment, and giving financial support for the student’s research activities in form of stipend/scholarship can help to remove the existing barriers to research. Young researchers should be encouraged through
attractive stipend/scholarship, conduction of conferences and research workshops to enhance their interest in research work. Faculty development programmes to improve research culture and increase students’ motivation and participation can be initiated.

ACKNOWLEDGEMENT

We are grateful to the PG trainees of BMCH, QIMS & IPH for their voluntarily participation in assessing hurdles towards scientific activities among PG trainees of dental and medical institutes.

FUNDING RESOURCES

None

CONFLICT OF INTEREST

None declared

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  9. Funston G, Piper RJ, Connell C, Foden P, Young a MH, O’Neill P. Medical student perceptions of research and research-orientated careers: An international questionnaire study. Med Teach 2016;38:1-8. https://doi.org/10.3109/0142159X.2016.1150981
  10. Sheikh ASF, Sheikh SA, Kaleem A, Waqas A. Factors contributing to lack of interest in research among medical students. Adv Med Educ Pract 2013;4:237-43. https://doi.org/10.2147/AMEP.S51536
  11. AlGhamdi KM, Moussa NA, AlEssa DS, AlOthimeen N, Al-Saud AS. Perceptions, attitudes and practices toward research among senior medical students. Saudi Pharm J. 2014;22:113-17. https://doi.org/10.1016/j.jsps.2013.02.006
  12. Abushouk AI, Hatata AN, Omran IM, Youniss MM, Elmansy KF, Meawad AG. Attitudes and Perceived Barriers among Medical Students towards Clinical Research: A Cross-Sectional Study in an Egyptian Medical School. J Biomed Educ. 2016; Article ID 5490575, 7 pages. https://doi.org/10.1155/2016/5490575
  13. Imran Saeed, Khan NF, Bari A, Khan RA. Factors contributing to the lack of interest in research activities among postgraduate medical students. Pak J Med Sci. 2018;34:913-17. https://doi.org/10.12669/pjms.344.15411
  14. Aslam A. Research Challenges for Postgraduate Residents in Dentistry. Pakistan Oral Dent J. 2017;36:683-87.
  15. Baig SA, Hasan SA, Ahmed SM, Ejaz K, Aziz S. Reasons Behind the Increase in Research Activities Among Medical Students of Karachi, Pakistan , a Low-Income Country. Educ Health. 2013; 26:117-21. https://doi.org/10.4103/1357-6283.120705
  16. Council D, Commission HE. PMDC BDS curriculum. 2003; 67.
  17. Salam N. Balochistan Strategy Pakistan Poverty Alleviation Fund Balochistan Strategy: a road map to inclusive socio-economic development for the province. 2013. p. 1-110.
  18. Safdar P, Ikram K, Noshab F, Ahmed M. Pakistan – Balochistan Economic Report: From Periphery to Core, Volume 1. Summary
    Report. 2008.
  19. Khan H, Khawaja MR, Waheed A, Rauf MA, Fatmi Z. Knowledge and attitudes about health research amongst a group of Pakistani
    medical students. BMC Med Educ 2006;6:54. https://doi.org/10.1186/1472-6920-6-54
  20. Moraes DW, Jotz M, Menegazzo WR, Menegazzo MS, Veloso S, Machry MC, et al. Interest in research among medical students:
    Challenges for the undergraduate education. Rev Assoc Med Bras 2016;62:652-58. https://doi.org/10.1590/1806-9282.62.07.652
  21. Alsied SM, Ibrahim NW. Exploring Challenges Encountered by EFL Libyan Learners in Research Teaching and Writing. IAFOR J Lang Learn 2017; 3:143-58. https://doi.org/10.22492/ijll.3.2.06
  22. Bhalerao S, Prasad BS. Journal of Ayurveda and Integrative Medicine Attitude of interns towards research as a career option. J Ayurveda Integr Med 2016;7:76-7. https://doi.org/10.1016/j.jaim.2015.06.001
  23. Chevalier A. Parental Education and Child ‘ s Education: A Natural Experiment. IZA Discuss Pap. 2004; (1153): 1-30.
  24. Davis-kean PE. The Influence of Parent Education and Family Income on Child Achievement: The Indirect Role of Parental Expectations and the Home Environment. J Fam Psychol. 2005;19: 294-04. https://doi.org/10.1037/0893-3200.19.2.294
  25. Magsi J, Khail M, Abdullah K. Literacy rate and education. http://balochistan.gov.pk/mics/MICS-4-Web/4-1-ResultsLiteracy%20&%20Education. 2004;29-42.
  26. Ghaffar A, Shah FA, Mehmood S, Idrees M, Zaman A, Ali R, et al. Following Them in the Footprints: The Effect of Parental Illiteracy on the Drop-Out of Their Children. World Appl Sci J. 2013;23:18-23.
  27. Stockfelt M, Karlsson L, Finizia C. Research interest and activity among medical students in Gothenburg , Sweden , a cross-sectional study. BMC Med Educ BMC Medical Education; 2016;16:226. https://doi.org/10.1186/s12909-016-0749-3
  28. Jeje EA, Elebute OA, Mofikoya BO, Ogunjimi MA, Alabi TO. Research experience of resident doctors who attended research methodology courses of the National Postgraduate Medical College of Nigeria. Niger Postgrad J. 2017; 24:31-6. https://doi.org/10.4103/npmj.npmj_153_16
  29. Aslam F, Shakir M, Qayyum MA. Why Medical Students Are Crucial to the Future of Research in South Asia. PLoS Med. 2005; 2:
    1110-1. https://doi.org/10.1371/journal.pmed.0020322
  30. Ismail IM, Bazli MY, Flynn SO. Study on Medical Student ‘ s Attitude Towards Research Activities between Study on medical student ‘ s attitude towards research activities between University College Cork and Universiti Sains Malaysia. Procedia – Soc Behav Sci [Internet]. Elsevier B.V 2015;116:2645-9. https://doi.org/10.1016/j.sbspro.2014.01.628

  1. Associate Professor, Department of Oral Pathology, Bolan Medical College, Quetta.
  2. Senior Demonstrator, Department of Prosthodontics, Bolan Medical College, Quetta.
  3. Student 2nd Year, Dow Medical College, Karachi.
    Corresponding author: “Dr. Nabiha Farasat Khan” < nabihasaeed@hotmail.com >

Correlation Between Demographic Perspective of PG Trainees and Research: A Cross-Sectional Multidisciplinary Study

Nabiha Farasat Khan1                            BDS, M.Phil, MHPE

Muhammad Saeed2                                BDS

Usama Saeed3                                          MBBS

OBJECTIVE: Demographic perspectives of future investigators (PG trainees of Medicine & Dentistry) have more or less effect on their achievements. Such perspectives may also work as barriers towards scientific activities. The aim of the study is to evaluate whether (if any) demographic perspectives working as barrier in research work among PG trainees.
METHODOLOGY: To assess the effects of demographic view on the research activities of 72 PG trainees a cross-sectional survey was carried out at 3 different public sector medical and dental institutes (Bolan Medical Complex Hospital (BMCH), Quetta Institute of Medical Sciences (QIMS) and Institute of Public Health (IPH) within 3 months (May-July 2018). Data was collected and analyzed by using SPSS version 20. A p-value of < 0.05 was considered significant.
RESULTS: Sixty-one percent of the study participants were males. Almost half (43%) PG trainees demonstrated positive attitude towards item number 3 “students can plan & conduct scientific research” (Mean±SD4.36±.65), 86.1% agreed to accomplish research work at undergraduate level, even in the absence of a supervisor (p-0.004). Low father educational level induces a lack of interest in PG trainees research work (p-0.01), whereas PG trainees having illiterate mothers present a strong correlation between lack of research work and un co-operative faculty (p<0.001) which creates hurdle in their scientific activities.
CONCLUSION: PG trainees of Pakistani community demonstrates positive attitude towards research activities. They express keenness regarding scientific task but due to low parental education level they face un-cooperative faculty which intern reduces their interest in research work. Whereas over-loaded curriculum, social and family commitments and job duties medical PG’s face time management issues.
KEY WORDS: Demographic perspective, PG trainees, Dentistry, Medicine, Hurdles, Research.
HOW TO CITE: Khan NF, Saeed M, Saeed U. Correlation between demographic perspective of pg trainees and research: A cross-sectional multidisciplinary study. J Pak Dent Assoc 2020;29(1):24-29.
DOI: https://doi.org/10.25301/JPDA.291.24
Received: 26 April 2019, Accepted: 04 October 2019

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Location of the Mental Foramen Using Volumetrically Rendered CBCT Images

 

Wafa Mohammed Alfaleh1                             BDS, MSC

OBJECTIVE: To determine mental foramen location using volumetrically rendered Cone Beam Computed Tomography (CBCT).
METHODOLOGY: This is a retrospective study composed of data from 200 scans of patients which were referred to the oral and maxillofacial radiology clinic. Localization was done bilaterally based on the relationship between the mental foramen and posterior teeth in their long axes. six possible position were identified (Position 1: anterior to the first premolar, Position 2: in line with the first premolar, Position 3: between premolars, Position 4: in line with the second premolar, Position 5: between second premolar and first molar, Position 6: in line with first molar). For analysis descriptive statistic were used (mean and frequency).
RESULTS: In total, 200 scans were analyzed, 112 (56%) were females and 88 (44%) males with a mean age of 32.5 years (±13.1). Four hundred sites were assessed. The most common position of the mental foramen was in line with the second premolar (position 4) with a prevalence of 45.5%, followed by position 3 (41.5%). The prevalence of the other mental foramen position types combined (type 1, 2, 5 and 6) were 13% .bilateral symmetry was noted in 71% of the cases.
CONCLUSIONS: Mental foramen location can be variable therefore, clinicians should be aware about this variation before surgical procedures involving mental foramen region. CBCT is recommended to avoid possible complication.
KEY WORDS: Mental Foramen, panoramic radiography, Mandible, CBCT.
HOW TO CITE: Alfaleh WM. Location of the mental foramen using volumetrically rendered CBCT images. J Pak Dent Assoc 2020;29(1):19-23.
DOI: https://doi.org/10.25301/JPDA.291.19
Received: 24 April 2019, Accepted: 02 October 2019

INTRODUCTION

One of the major advances in the past decade in dentistry was the introduction of Cone Beam Computed Tomography (CBCT). It reconstructs a virtually 3D image using a cone-shaped beam in a single scan. 1-4 The Mental Foramen (MF) is an important anatomical structure located on the buccal surface of the mandible, frequently in a position superior to the mandibular canal. The canal forms a curve during its course anterior to the MF, it provides sensory innervations and nutrition to the gingiva, soft tissue of the chin and lower lip. 6,7
Accurate localization of the MF is hard due to the lack of consistent anatomical landmarks for reference and is clinically not accessible for visualization or palpation.8
Variable anatomical positions of the foramen have been described in the literature. 8-10 Accurate localization of MF
prior to any surgical procedure is essential in order to avoid damage to the mental nerve, and hence rendering the patient with a numb lower lip. Direct observation and measurements on dry mandible has demonstrated the vertical position of the foramen to be frequently inferior to the apices of the mandibular second premolars. It lies midway between the crest of the alveolar ridge and the inferior border of the mandible.
11 Most of previous studies on the location of the MF have used panoramic radiographs. However, panoramic radiography has some limitations in accurate identification and localization of MF due to its inherent magnification and geometrical distortion.
In 2013, Von Arx et al12 evaluated the MF position using corrected CBCT images and found that it was located between the two premolars in 56 % of cases, whereas Khojastepour et al13 in 2015 studied MF location in Iranian population using CBCT images and found that the most common location was below the second premolar.
Volumetric rendering (VR) is now a common image processing tool available in most CBCT image processing software utilized by clinician in the dental field. The objective of this study is to determine the location of the
MF in a group of patients and assess the symmetry on both sides using CBCT with a volume rendering imaging processing tool. The results will be compared with findings in previous studies

METHODOLOGY

This study was approved by institutional review board of College of Dentistry, King Saud University, Riyadh, Saudi Arabia. Registration number NF2277.
The study was conducted retrospectively from CBCT scans of 200 patients seen in the Oral and Maxillofacial Radiology clinic at the College of Dentistry at King Saud University, Riyadh, Saudi Arabia. The CBCT examinations were originally done for various reasons, more commonly, implant site assessment, TMJ, orthognathic surgery preoperative assessment. None of the scans were done for the evaluation of position of MF.

Exclusion criteria:

  • Completely edentulous mandible.
  • Patients with missing teeth between mandibular first premolar to mandibular first molar on either side.
  • Double mental foramen
  • Patients with pathological lesions in the mandible that may affect the location of the MF
  • History of trauma or surgical intervention in the premolar area.

Patients had been scanned with Iluma (Imtek Imaging, 3M Co., USA) with a large field of view .The CBCT examination were performed for each patient utilizing 3.8 mA, 120 kV, and a 40 second exposure time with 0.29 mm reconstruction voxel size. The volumetric data set for each patient were saved on the workstation linked with the CBCT.
After acquisition of the volume, the DICOM data was transferred in order to generate a 3D volumetrically rendered
image of the patients using Iluma vision 3D softwear. Based on the classification proposed by Al Jasser and Nwoku (1998)14 the location of the MF in relation to the teeth was identified according to the following.

Position 1: Situated anterior to the first premolar
Position 2: In line with first premolar
Position 3: Between the first and second premolars
Position 4: In line with second premolar
Position 5: Between second premolar and first molar
Position 6: In line with first molar

The 3D volumetrically rendered image was examined by oral and maxillofacial radiologists (author). All images were evaluated in standard dim light condition. The right and left mental foramina were observed separately and recorded on a specially designed form.
Descriptive statistics of various positions were used (mean and frequency). The results were presented according to side and gender. The SPSS (version 21) was used for analysis. The mean and standard deviation of all the measurements were assessed. Comparison of value of all measurements was made between sides and genders using Chi square -test. Differences between genders were considered significant at P < 0.05.

RESULTS

Two hundred CBCT images were analyzed .The mean age of the participants in the current study was 32.5±13.1 years. 112 (56%) were females and 88 (44%) were males. The most common position for the MF in this sample was position 4 (45.5%), followed by position 3 (41.50%). Position 5 was found to be 11.25%, whereas. Positions 1, 2, or 6 were infrequently reported as shown in Figure1. Figure 2 shows the percentage of MF position of both genders, position 4 was the most common among females (49.11%) whereas Position 3 was the most common among males (45.45%). Figure 3 & 4 demonstrate the 3D volume rendering of position 4 & 3 respectively. Table 1, demonstrate frequency

Fig 1: The Percentage of the Most Common Mental Foramen Positions

Fig 2: The Percentage of Various Positions of Mental Foramen among Males and Females

Fig 3: 3D volume rendering CBCT image demonstrating the position of MF. In line with the long axis of the second premolar (position 4).

Fig 4: 3D volume rendering CBCT image demonstrating the position of MF between the first and second premolar (position 3).

Table 1: Frequency and percentage of MF position based on gender for right and left side.

Table 2: Position of mental foramen by gender and symmetry.

and percentage of MF position based on gender for right and left side.
There was no statistically significate difference between right and left side of both gender using Chi square test with P> 0.05 For the entire sample, 71% (n=142), MF was symmetrically located where as in 29% (n=58) of the subject the MF was not symmetrically located. In terms of gender difference, MF was found to be symmetrical in 70% of females and 73% of males. The difference was not found to be statistically significant with P > 0.05.
The most common position that located symmetrically was position 3 (46.48%) followed by position 4 (45.77%). Whereas cases observed in position 1 or 2 were not symmetrically located. (Table 2).

DISCUSSION

Variation in the MF location has been reported in literature worldwide. Precise identification of MF location is critical both in diagnostic and clinical procedures. The most common locations of the MF as described within the literature have been below the apex of the first premolar or consistent with the second premolar or between them. Racial and gender differences have been reported in the literature.11,13,15 Previous studies on the MF location in White North American, British and Turkish populations found that the MF was located in line with the first premolar.
In Asians, the MF was located in line with the second premolar where as in Africans, the location was posterior to
second premolar.16-20
The position of mental foramen on panoramic radiographs is affected by the horizontal course of inferior alveolar nerve.21 Studies have reported that in up to 25% of cases, important structures such as the MF cannot be precisely determined when using panoramic radiographs.8 When compared to CBCT.. Various reasons have been cited, including improper patient positioning, acute bending during rotation of the tube and film around the patient’s head.22,23 However, in this study, MF was clearly recognized in all samples as images were acquired using VR CBCT.
Al-Mahalawy et al. (2017)15 used panoramic and CBCT images, whereas Naik et al. (2017)11 used dry mandible and Ngeow and Yuzawati used panoramic radiography (2003)24 for evaluation of MF position and found that the most common position was in line with the second premolar (position 4) followed by position 3 which is the same finding
reported in this study; however, this study examined the location of the MF using only VR CBCT images.
In 2013, Von Arx et al12 conducted a study to evaluate MF position using corrected.

CBCT images and found that the most common location was between the two premolars (position 3) which contradicts this study findings where position 4 is the most common position. Khojastepour et al. (2015)13 in their cross sectional study on CBCT images, found that the MF was most commonly located in line with second premolar (position 4) which concurs with findings in this study.
Apinhasmit et al. in 200625 evaluated the location of MF on dry mandibles in Thai population. They found that the majority of the MF (69.57%) were located in the same vertical line with the long axis of the second premolars in both genders (position 4) followed by position 3 which is in agreement with the findings of this study.25
However they found no significant gender difference in location which contradicts the finding reported in this study where position 4 is more common in females and position 3 is more common in males.
In Turkish population, Gungor et al26 in 2006 examined 360 panoramic radiographs to evaluate the position of MF.
They found that 71.5 % MF was located in line with the first premolar26, which contradict the finding of this study that reported position 4 (at line with second premolar) as the most common position of the studied sample. Alkhateeb et al27 in 1994 evaluated the position of the MF in Saudi population using panoramic radiographs and found that 83.7% of the sample had the MF located either at position 3 and 4 collectively.26 However he did not state the prevalence for each position, therefore, it is difficult to compare their result with this study.
In our study, the MF was found to be symmetrical in the majority of the samples, which is in agreement with the
results reported by others.14,15,24,26,28 However, they found that position 4 was the most common position to be
symmetrical, followed by position 3 whereas in this study, position 3 was the most symmetrical position followed by position 4.
Al Jasser and Nwoku in 199814 concluded that the location of the MF is not gender related and this contradicts the finding of this study in which the location of MF in males was different than females.
Based on reports from different studies conducted on different populations, the location of the MF does show racial, ethnic and gender differences.11,13,15,28 Therefore, the location of the MF must be assessed based on the individual population, without consideration of its location in other different populations groups.
In 2D images MF may occasionally be misdiagnosed as a well-defined radiolucency related to the apex of mandibular
premolars, or misinterpreted if there is enlarged marrow space mimicking the mental foramen. Such errors can be completely removed when utilizing 3D volume rendering.
Therefore, CBCT is recommended prior to any surgical procedure in the vicinity of MF region.

CONCLUSION

The location of MF is variable among different populations, and assuming a generic MF location can lead to unpleasant mental region paresthesia or anesthesia.. CBCT precisely localized the position of MF, and is strongly recommended before any surgical procedure involving the MF region.

CONFLICT OF INTEREST

The author of this manuscript has no conflict of interest to declare.

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  2. Scarfe WC, Farman AG. What is cone-beam CT and how does it work? Dent Clin North Am. 2008; 52:707-30 https://doi.org/10.1016/j.cden.2008.05.005
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  6. Arzouman M J, Otis L, Kipnis V, Levine D. Observations of the anterior loop of the inferior alveolar canal. Int J Oral Maxillofac Implants 1993; 8: 295-300.
  7. Bavitz JB, Harn SD, Hansen CA, Lang M. An anatomical study of mental neurovascular bundle-implant relationships. Int J Oral Maxillofac Implants 1993;8:563-67.
  8. Phillips J L, Weller RN, Kulild JC. The mental foramen: Size and position on panoramic radiographs. J Endod 1992;18:383-86. https://doi.org/10.1016/S0099-2399(06)81224-0
  9. Yosue T, Brooks SL. The appearance of mental foramina on panoramic radiographs. I. Evaluation of patients. Oral Surg Oral Med Oral Pathol 1989;68:360-64. https://doi.org/10.1016/0030-4220(89)90224-7
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  12. von Arx T, Friedli M, Sendi P, Lozanoff S, Bornstein MM. Location and dimensions of the mental foramen: a radiographic analysis by using cone-beam computed tomography. J Endod 2013;39:1522-28. https://doi.org/10.1016/j.joen.2013.07.033
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  14. Al Jasser N M, Nwoku AL. Radiographic study of the mental foramen in a selected Saudi population. Dentomaxillofac Radiol 1998;27:341-43. https://doi.org/10.1038/sj.dmfr.4600388
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  17. Mwaniki D L, Hassanali J.The position of mandibular and mental foramina in Kenyan African mandibles. East Afr Med J 1992;69:210-13.
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  1. Associate Professor, Department of Oral Medicine and Diagnostic Science, King Saud University, College of Dentistry.
    Corresponding author: “Dr. Wafa Mohammed Alfaleh” < walfaleh1@ksu.edu.sa >

 

Location of the Mental Foramen Using Volumetrically Rendered CBCT Images

 

Wafa Mohammed Alfaleh1                             BDS, MSC

OBJECTIVE: To determine mental foramen location using volumetrically rendered Cone Beam Computed Tomography (CBCT).
METHODOLOGY: This is a retrospective study composed of data from 200 scans of patients which were referred to the oral and maxillofacial radiology clinic. Localization was done bilaterally based on the relationship between the mental foramen and posterior teeth in their long axes. six possible position were identified (Position 1: anterior to the first premolar, Position 2: in line with the first premolar, Position 3: between premolars, Position 4: in line with the second premolar, Position 5: between second premolar and first molar, Position 6: in line with first molar). For analysis descriptive statistic were used (mean and frequency).
RESULTS: In total, 200 scans were analyzed, 112 (56%) were females and 88 (44%) males with a mean age of 32.5 years (±13.1). Four hundred sites were assessed. The most common position of the mental foramen was in line with the second premolar (position 4) with a prevalence of 45.5%, followed by position 3 (41.5%). The prevalence of the other mental foramen position types combined (type 1, 2, 5 and 6) were 13% .bilateral symmetry was noted in 71% of the cases.
CONCLUSIONS: Mental foramen location can be variable therefore, clinicians should be aware about this variation before surgical procedures involving mental foramen region. CBCT is recommended to avoid possible complication.
KEY WORDS: Mental Foramen, panoramic radiography, Mandible, CBCT.
HOW TO CITE: Alfaleh WM. Location of the mental foramen using volumetrically rendered CBCT images. J Pak Dent Assoc 2020;29(1):19-23.
DOI: https://doi.org/10.25301/JPDA.291.19
Received: 24 April 2019, Accepted: 02 October 2019

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