Frequency of Injury to Front Teeth in Class II Skeletal and Dental Malocclusion
Keerthana Baskar1, Dr. Aravind Kumar Subramaniam2*, Dr. Sreedevi Dharman3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences(SIMATS), Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Professor and Head, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Reader, Department of Oral medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India
*Corresponding Author
Dr. Aravind Kumar Subramaniam,
Professor and Head, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, PH Road
Chennai 600077, Tamil Nadu, India.
Tel: 9841299939
E-mail: aravindkumar@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 18, 2021
Citation:Keerthana Baskar, Dr. Aravind Kumar Subramaniam, Dr. Sreedevi Dharman. Frequency of Injury to Front Teeth in Class II Skeletal and Dental Malocclusion. Int J Dentistry Oral Sci. 2021;8(8):3916-3919. doi: dx.doi.org/10.19070/2377-8075-21000801
Copyright: Dr. Aravind Kumar Subramaniam©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Many researchers have examined the prevalence of dental injuries in children and adolescents. This study was carried out to evaluate the frequency of traumatic injury in class II division 1 malocclusion patients and gender variation of the fracture. Data of 384 class II malocclusion patients was collected. Statistical analysis was done using SPSS version 19 .P value was set at 0.05. 38% of the patients had Ellis class III fracture followed closely by Ellis class II fractures (36%) in patients with class II malocclusion. Males were commonly affected than females. Ellis class III fracture (45.4%) was most prevalent among females and Ellis class II fracture (39.2%) in males. P value was >0.05 and hence the results were statistically not significant. Within the limits of the study, it was found that fracture of the anterior teeth was more in males than females. Ellis class II was the most common type of fracture that was observed among males and Ellis class III fracture was prevalent among females.
2.Introduction
3.Conclusion
4.References
Keywords
Fracture; Gender; Malocclusion; Prevalence; Trauma.
Introduction
Fracture in class II malocclusion is due to the incisor proclination,
maxillary prominence, class II division 1 and incompetent lip can
be the possible risk factors. An increased risk of incisor trauma
is present in children with an overjet that is greater than 6 mm
[10, 28].
Oral facial trauma usually can result in a wide spectrum of dental
injuries that ranges from enamel crown fractures with good
prognosis and complex injuries with reduced long-term prognosis
[24].
The prevalence of incisor injury has been reported to range from
6% to 34% [5]. [2] Falls, collisions, Sporting activities, road traffic
accidents are the most common cause for dental injuries [6, 3].
Variables such as age, sex, social economic status and behavioural
problems also influence the frequency of traumatic injury.
Studies have shown that patients aged 8 to 11 years had the highest
prevalence of dental trauma [6, 3]. Studies have shown a positive
correlation between the frequency of incisor trauma and its
sequelae [9].
The efficacy of intervention to traumatic injury is closely related
to the time of treatment and peak occurrence of incisor trauma.
The benefits of early orthodontic treatment will be inefficient if
dental trauma occurs before the start of the treatment. Trauma to
the front teeth can affect the aesthetic appearance of the patient
and cause significant distress to the patient.
Various clinical trials, in-vitro studies and reviews have been conducted
by our team. [(Ramesh Kumar et al., 2011 [37]; Felicita,
Chandrasekar and Shanthasundari, 2012 [17]; Dinesh et al., 2013
[11]; Jain, Kumar and Manjula, 2014 [20]; Kamisetty et al., 2015
[22]; Krishnan, Pandian and Kumar S, 2015 [26]; Rubika, Felicita
and Sivambiga, 2015 [39]; Viswanath et al., 2015 [50]; Sivamurthy
and Sundari, 2016 [44]; Felicita, 2017a, 2017b [15, 16]; Samantha, 2017 [40]; Vikram et al., 2017 [49]; Pandian, Krishnan and Kumar,
2018 [31])]. Now, we are focusing on epidemiological studies.
Previously our team has a rich experience in working on various
research projects across multiple disciplines. (Jain, 2017 [19]);
(Varghese, Ramesh and Veeraiyan, 2019 [46]); (Ashok and Ganapathy,
2019 [1]); (Padavala and Sukumaran, 2018 [29]); (Ke et al.,
2019 [23]); (Ezhilarasan, 2018 [12]); (Krishnan et al., 2018 [25]);
(Ezhilarasan, Sokal and Najimi, 2018 [14]); (Pandian, Krishnan
and Kumar, 2018 [31]); (Ramamurthy and Mg, 2018 [35]); (Gupta,
Ariga and Deogade, 2018 [18]); (Vikram et al., 2017 [49]); (Paramasivam,
Vijayashree Priyadharsini and Raghunandhakumar,
2020 [32]); (Palati et al., 2020 [30]); (Samuel, Acharya and Rao,
2020 [42]). Now the growing trend in this area motivated us to
pursue this project.
The purpose of this study was to describe the prevalence, extent
and severity of incisor trauma in class II skeletal and dental malocclusion
patients.
Materials And Methods
The study was conducted in a hospital set up in Saveetha dental
College, Chennai. The ethical approval was given by the institutional
research board. Data was obtained from the Dental Information
Archiving System of Saveetha Dental College. The population
type was all patients with class II malocclusion. Sampling
was done from June 2019-April 2020. The number of case sheets
that were reviewed was 384. Out of 384 patients, only 51 patients
had anterior fracture. Cross verification of the data was done with
the photographs that were embedded. To minimize sampling bias,
convenience sampling was done. An inclusion criterion was patients
with injury to front teeth with class II malocclusion. .Patients
who had injury of the incisor due to other reasons were not
included in this study.
The data was obtained from the Dental Information Archiving
System. The data was tabulated and analysed in Excel. The data
was imported to SPSS version 19 and chi squared test was done.
The dependent variable for the study is fracture of anterior teeth
and independent variable is age and gender. Type of analysis done
was correlation and association.
Results & Discussion
There were 384 patients with class II malocclusion. Out of these
384 patients, 50 patients had anterior fracture, out of which 28
were found to be males and 22 were females. It was found that
patients with Ellis class III fractures were found to be more which
was closely followed by patients with Ellis class II factors, the percentage
affected being 38% and 36% respectively. Patients with
class I fracture were found to be 26%. (Figure 1).
Association of gender with the type of fracture was studied in
the present study. Among females, Ellis class III was found in the
majority of patients (45.4%), followed by Ellis class II (31.8%)
and Eliis class I (22.7%). While in males, Ellis class II was more
common (39.2%), followed by Ellis class II (32.1%) and Ellis class
I fracture (28.5%). (Figure 2).
The P value of this study was > 0.05, hence the study was insignificant.
In the present study, it was found that patients with Ellis class III
fracture, that is fracture involving the pulp, found to be in the majority
(38%). In a study done by Koruluk et al, It was found that
fractures involving enamel only were found majorly (69.8%) [24].
The age group variation of this study was found to be 10 years-56
years. The mean age was found to be 26.72 years.
In a study done by Chen et al, it was found that boys had increased
incisor trauma compared to girls [9]. Similar results were
obtained in a study by Kaste et al. [24].
In most of the studies, it was found that trauma to the maxillary
central incisor was the most common, followed by lateral incisor
[2, 51]. Most of the studies associated with trauma are carried out
in the pre-adolescent and adolescent age groups.
In the present study, among females, Ellis class III (45.4%) was
experienced by most of the patients. While in male patients, Ellis
class II (39.2%) was the most common. No study has been done
on this association.
According to Jarvinen et al [(Järvinen, 1979)] 21, the range of injuries
increased in relation to larger overjet (> 6mm). The patients
between 8– 11 years of age were more prone to traumatic injuries
to anterior teeth according to previous studies [7, 43].
As the data was inadequate a lot of information was missing like
overjet, lip coverage of the patient was not assessed. The limitation
of the study includes, type of tooth fracture was not studied.
The study was done on a much smaller sample size, as it was a
university based study.
Our institution is passionate about high quality evidence based
research and has excelled in various fields ( (Pc, Marimuthu and
Devadoss, 2018 [33]; Ramesh et al., 2018 [36]; Vijayashree Priyadharsini,
Smiline Girija and Paramasivam, 2018 [48]; Ezhilarasan,
Apoorva and Ashok Vardhan, 2019 [13]; Ramadurai et al., 2019
[34]; Sridharan et al., 2019 [45]; Vijayashree Priyadharsini, 2019
[47]; Chandrasekar et al., 2020 [8]; Mathew et al., 2020 [27]; R et
al., 2020 [38]; Samuel, 2021 [41]). We hope this study adds to this
rich legacy.
Figure 1: The above depicted bar graph shows frequency distribution of type of fracture among patients with class II malocclusion. The X-axis denotes occurrence of fracture of anterior teeth (Ellis class I, II, III) and Y-axis denotes number of patients with class IImalocclusion. Ellis class III fracture was most prevalent (38%) in class II malocclusion patients and Ellis class I was the least prevalent (26%).
Figure 2: The above depicted graph shows association between gender and type of fracture in class II malocclusion patients. The X-axis denotes gender and Y-axis denotes number of patients with class II div 1 malocclusion and anterior fracture. Highest prevalence of Ellis class III (brown) was seen in females and Ellis class II (green) was most common among males in class II malocclusion patients. Chi- Square test was done and the association between gender and type of fracture in class II malocclusion patients was found to be statistically not significant since Pearson's chi square value : 0.927, DF: 2, p value: 0.629 (>0.05).
Conclusion
Within the limitations of the study, it was found that fracture of
the anterior teeth was more in males than females in patients with
class II malocclusion. Ellis class II was the most common type
of fracture observed among males and Ellis class III fracture was
prevalent among females. Thus, from the present study it has
been inferred that proclination of anterior teeth leads to accidental
trauma. Hence, early intervention and correction of proclination
by fixed orthodontic appliances prevents not only trauma but
also enhances the aesthetics and function.
References
-
[1]. A, P. A. et al. (2012) ‘Endodontic Management of C-Shaped Root Canal
System in Mandibular First Molar: A Rare Case Report’, International Journal
of Scientific Research, pp. 316–317.
[2]. Ashok V, Ganapathy D. A geometrical method to classify face forms. J Oral Biol Craniofac Res. 2019 Jul-Sep;9(3):232-235. doi: 10.1016/j.jobcr. 2019.06.001. Pubmed PMID: 31198677.
[3]. Chandrasekar R, Chandrasekhar S, Sundari KKS, Ravi P. Development and validation of a formula for objective assessment of cervical vertebral bone age. Prog Orthod. 2020 Oct 12;21(1):38. Pubmed PMID: 33043408.
[4]. ElDeeb ME, ElDeeb M, Tabibi A, Jensen JR. An evaluation of the use of amalgam, Cavit, and calcium hydroxide in the repair of furcation perforations. J Endod. 1982 Oct;8(10):459-66. Pubmed PMID: 6958784.
[5]. Estrela C, Decurcio DA, Rossi-Fedele G, Silva JA, Guedes OA, Borges ÁH. Root perforations: a review of diagnosis, prognosis and materials. Braz Oral Res. 2018 Oct 18;32(suppl 1):e73. Pubmed PMID: 30365614.
[6]. Ezhilarasan D. Oxidative stress is bane in chronic liver diseases: Clinical and experimental perspective. Arab J Gastroenterol. 2018 Jun;19(2):56-64. Pubmed PMID: 29853428.
[7]. Ezhilarasan D, Apoorva VS, Ashok Vardhan N. Syzygium cumini extract induced reactive oxygen species-mediated apoptosis in human oral squamous carcinoma cells. J Oral Pathol Med. 2019 Feb;48(2):115-121. Pubmed PMID: 30451321.
[8]. Ezhilarasan D, Sokal E, Najimi M. Hepatic fibrosis: It is time to go with hepatic stellate cell-specific therapeutic targets. Hepatobiliary Pancreat Dis Int. 2018 Jun;17(3):192-197. Pubmed PMID: 29709350.
[9]. Farzaneh M, Abitbol S, Lawrence HP, Friedman S; Toronto Study. Treatment outcome in endodontics-the Toronto Study. Phase II: initial treatment. J Endod. 2004 May;30(5):302-9. Pubmed PMID: 15107640.
[10]. Fuss Z, Trope M. Root perforations: classification and treatment choices based on prognostic factors. Endod Dent Traumatol. 1996 Dec;12(6):255- 64. Pubmed PMID: 9206372.
[11]. Gupta P, Ariga P, Deogade SC. Effect of Monopoly-coating Agent on the Surface Roughness of a Tissue Conditioner Subjected to Cleansing and Disinfection: A Contact Profilometric In vitro Study. Contemp Clin Dent. 2018 Jun;9(Suppl 1):S122-S126. Pubmed PMID: 29962776.
[12]. Hashem AA, Wanees Amin SA. The effect of acidity on dislodgment resistance of mineral trioxide aggregate and bioaggregate in furcation perforations: an in vitro comparative study. J Endod. 2012 Feb;38(2):245-9. Pubmed PMID: 22244646.
[13]. INGLE JI. A standardized endodontic technique utilizing newly designed instruments and filling materials. Oral Surg Oral Med Oral Pathol. 1961 Jan;14:83-91. Pubmed PMID: 13717698.
[14]. Jain AR. Prevalence of partial edentulousness and treatment needs in rural population of South India. World J Dent. 2017 Jun;8(3):213-7.
[15]. Janani K, Palanivelu A, Sandhya R. Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: an in vivo study. Brazilian dental science. 2020 Jan 31;23(1):8-p.
[16]. Jew RC, Weine FS, Keene JJ Jr, Smulson MH. A histologic evaluation of periodontal tissues adjacent to root perforations filled with Cavit. Oral Surg Oral Med Oral Pathol. 1982 Jul;54(1):124-35. doi: 10.1016/0030- 4220(82)90427-3. PMID: 6956820.
[17]. Jose J, Subbaiyan H. Different treatment modalities followed by dental practitioners for Ellis class 2 fracture–A questionnaire-based survey. The open dentistry journal. 2020 Feb 18;14(1).
[18]. Kakani AK, Veeramachaneni C, Majeti C, Tummala M, Khiyani L. A review on perforation repair materials. Journal of clinical and diagnostic research: JCDR. 2015 Sep;9(9):ZE09.
[19]. Kerekes K, Tronstad L. Long-term results of endodontic treatment performed with a standardized technique. J Endod. 1979 Mar;5(3):83-90. Pubmed PMID: 296248.
[20]. Ke Y, Al Aboody MS, Alturaiki W, Alsagaby SA, Alfaiz FA, et al. Photosynthesized gold nanoparticles from Catharanthus roseus induces caspasemediated apoptosis in cervical cancer cells (HeLa). Artif Cells Nanomed Biotechnol. 2019 Dec;47(1):1938-1946. Pubmed PMID: 31099261.
[21]. Krishnan RP, Ramani P, Sherlin HJ, Sukumaran G, Ramasubramanian A, Jayaraj G, Don KR, Santhanam A. Surgical Specimen Handover from Operation Theater to Laboratory: A Survey. Ann Maxillofac Surg. 2018 Jul- Dec;8(2):234-238. Pubmed PMID: 30693238.
[22]. Kumar D, Antony S. Calcified canal and negotiation-A review. Research Journal of Pharmacy and Technology. 2018;11(8):3727-30.
[23]. Kvinnsland I, Oswald RJ, Halse A, Grønningsaeter AG. A clinical and roentgenological study of 55 cases of root perforation. Int Endod J. 1989 Mar;22(2):75-84. Pubmed PMID: 2599663.
[24]. Manohar MP, Sharma S. A survey of the knowledge, attitude, and awareness about the principal choice of intracanal medicaments among the general dental practitioners and nonendodontic specialists. Indian J Dent Res. 2018 Nov-Dec;29(6):716-720. Pubmed PMID: 30588997.
[25]. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):3275-3280. doi: 10.1007/s00784-020-03204-9. Pubmed PMID: 31955271.
[26]. Hussainy SN, Nasim I, Thomas T, Ranjan M. Clinical performance of resinmodified glass ionomer cement, flowable composite, and polyacid-modified resin composite in noncarious cervical lesions: One-year follow-up. J Conserv Dent. 2018 Sep-Oct;21(5):510-515. Pubmed PMID: 30294112.
[27]. Nandakumar M, Nasim I. Comparative evaluation of grape seed and cranberry extracts in preventing enamel erosion: An optical emission spectrometric analysis. J Conserv Dent. 2018 Sep-Oct;21(5):516-520. Pubmed PMID: 30294113.
[28]. NICHOLLS E. Treatment of traumatic perforations of the pulp cavity. Oral Surg Oral Med Oral Pathol. 1962 May;15:603-12. Pubmed PMID: 14479440.
[29]. Noor SS. Chlorhexidine: Its properties and effects. Res J Pharm Technol. 2016;9(10):1755-60.
[30]. Padavala S, Sukumaran G. Molar Incisor Hypomineralization and Its Prevalence. Contemp Clin Dent. 2018 Sep;9(Suppl 2):S246-S250. Pubmed PMID: 30294152.
[31]. Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don KR, Jayaraj G, Santhanam A. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res. 2020 Jan-Feb;31(1):22-25. Pubmed PMID: 32246676.
[32]. Pandian KS, Krishnan S, Kumar SA. Angular photogrammetric analysis of the soft-tissue facial profile of Indian adults. Indian J Dent Res. 2018 Mar- Apr;29(2):137-143. Pubmed PMID: 29652003.
[33]. Paramasivam A, Vijayashree Priyadharsini J, Raghunandhakumar S. N6- adenosine methylation (m6A): a promising new molecular target in hypertension and cardiovascular diseases. Hypertens Res. 2020 Feb;43(2):153- 154. Pubmed PMID: 31578458.
[34]. J PC, Marimuthu T, C K, Devadoss P, Kumar SM. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018 Aug;20(4):531-534. Pubmed PMID: 29624863.
[35]. Rajablou N, Azimi S. An in vitro comparative SEM study of marginal adaptation of IRM, light- and chemically-cured glass ionomer, and amalgam in furcation perforations. Aust Endod J. 2001 Dec;27(3):119-22. Pubmed PMID: 12360666.
[36]. Rajendran R, Kunjusankaran RN, Sandhya R, Anilkumar A, et al. Comparative evaluation of remineralizing potential of a paste containing bioactive glass and a topical cream containing casein phosphopeptide-amorphous calcium phosphate: An in vitro study. Pesquisa brasileira em odontopediatria e clinica integrada. 2019 Oct 10;19.
[37]. Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJL. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig. 2019 Sep;23(9):3543-3550. Pubmed PMID: 30552590.
[38]. Ramamoorthi S, Nivedhitha MS, Divyanand MJ. Comparative evaluation of postoperative pain after using endodontic needle and EndoActivator during root canal irrigation: A randomised controlled trial. Aust Endod J. 2015 Aug;41(2):78-87. Pubmed PMID: 25195661.
[39]. Ramamurthy JA, Mg V. Comparison of effect of Hiora mouthwash versus Chlorhexidine mouthwash in gingivitis patients: A clinical trial. Asian J Pharm Clin Res. 2018 Jul 7;11(7):84-8.
[40]. Ramanathan S, Solete P. Cone-beam Computed Tomography Evaluation of Root Canal Preparation using Various Rotary Instruments: An in vitro Study. The journal of contemporary dental practice. 2015 Nov 1;16(11):869-72. [41]. Ramesh A, Varghese S, Jayakumar ND, Malaiappan S. Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients– A case-control study. Journal of periodontology. 2018 Oct;89(10):1241-8.
[42]. Teja KV, Ramesh S, Priya V. Regulation of matrix metalloproteinase-3 gene expression in inflammation: A molecular study. J Conserv Dent. 2018 Nov- Dec;21(6):592-596. Pubmed PMID: 30546201.
[43]. Ravinthar K. Recent advancements in laminates and veneers in dentistry. Research Journal of Pharmacy and Technology. 2018;11(2):785-7.
[44]. R H, Ramani P, Ramanathan A, R JM, S G, Ramasubramanian A, K M. CYP2 C9 polymorphism among patients with oral squamous cell carcinoma and its role in altering the metabolism of benzo[a]pyrene. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Sep;130(3):306-312. Pubmed PMID: 32773350.
[45]. Rajakeerthi R, Nivedhitha MS. Natural Product as the Storage medium for an avulsed tooth–A Systematic Review. Cumhuriyet Dental Journal. 2019 Jun 11;22(2):249-56.
[46]. Samuel SR. Can 5-year-olds sensibly self-report the impact of developmental enamel defects on their quality of life? Int J Paediatr Dent. 2021 Mar;31(2):285-286. Pubmed PMID: 32416620.
[47]. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51-60. Pubmed PMID: 31710096.
[48]. Seltzer S, Bender IB, Smith J, Freedman I, Nazimov H. Endodontic failures-- an analysis based on clinical, roentgenographic, and histologic findings. II. Oral Surg Oral Med Oral Pathol. 1967 Apr;23(4):517-30. doi: 10.1016/0030-4220(67)90547-6. PMID: 5227404.
[49]. Shokouhinejad N, Nekoofar MH, Razmi H, Sajadi S, Davies TE, et al. Bioactivity of EndoSequence root repair material and bioaggregate. Int Endod J. 2012 Dec;45(12):1127-34. Pubmed PMID: 22803801.
[50]. Siddique R, Jayalakshmi S. Assessment of Precipitate Formation on Interaction of Chlorhexidine with Sodium Hypochlorite, Neem, Aloevera and Garlic: An in vitro Study. Indian Journal of Public Health Research & Development. 2019 Nov 1;10(11).
[51]. Sinai IH, Romea DJ, Glassman G, Morse DR, Fantasia J, Furst ML. An evaluation of tricalcium phosphate as a treatment for endodontic perforations. J Endod. 1989 Sep;15(9):399-403. Pubmed PMID: 2576900.
[52]. Sridharan G, Ramani P, Patankar S, Vijayaraghavan R. Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med. 2019 Apr;48(4):299-306. Pubmed PMID: 30714209.
[53]. Teja KV, Ramesh S. Shape optimal and clean more. Saudi Endodontic Journal. 2019 Sep 1;9(3):235.
[54]. Tsesis I, Fuss ZV. Diagnosis and treatment of accidental root perforations. Endodontic Topics. 2006 Mar;13(1):95-107.
[55]. Varghese SS, Ramesh A, Veeraiyan DN. Blended Module-Based Teaching in Biostatistics and Research Methodology: A Retrospective Study with Postgraduate Dental Students. J Dent Educ. 2019 Apr;83(4):445-450. Pubmed PMID: 30745352.
[56]. Vijayashree Priyadharsini J. In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens. J Periodontol. 2019 Dec;90(12):1441-1448. Pubmed PMID: 31257588.
[57]. Vijayashree Priyadharsini J, Smiline Girija AS, Paramasivam A. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol. 2018 Oct;94:93-98. Pubmed PMID: 30015217.
[58]. Vikram NR, Prabhakar R, Kumar SA, Karthikeyan MK, Saravanan R. Ball Headed Mini Implant. J Clin Diagn Res. 2017 Jan;11(1):ZL02-ZL03. Pubmed PMID: 28274084.
[59]. Zhang H, Pappen FG, Haapasalo M. Dentin enhances the antibacterial effect of mineral trioxide aggregate and bioaggregate. J Endod. 2009 Feb;35(2):221-4. Pubmed PMID: 19166777.
