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Results in Journal Dental Journal (Majalah Kedokteran Gigi): 702

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Fransiska Monika, Retno Widayati
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p191-195

Background: The treatment options for adults with skeletal Class III malocclusion can be dentoalveolar compensation, also known as orthodontic camouflage, or orthognathic surgery. Camouflage treatment can be carried out with teeth extractions, distalisation of the mandibular dentition, and use of Class III intermaxillary elastics. However, intermaxillary elastics as anchorage has its own risk–benefit. Purpose: To explain that camouflage treatment with teeth extractions can be performed in a mild to moderate skeletal Class III malocclusion using intermaxillary anchorage with elastics, while minimising the deleterious effects and achieving a satisfactory treatment outcome. Case: Our patient was a 25-year-old female who had a skeletal Class III pattern, with normal maxilla and a protruded mandible. She had a straight facial profile with a Class III canine and molar relationship on her right and left sides. Anterior crossbite was also present with crowding on both the maxilla and the mandible. Case Management: The treatment plan was carried out with dentoalveolar compensation by extracting teeth. Extraction of the lower first premolars was conducted to eliminate the crowding and correct the anterior crossbite. The mandibular incisors were retroclined and the maxillary incisors were proclined with dentoalveolar compensation. Passive self-ligating system was used with standard torque prescription, intermaxillary anchorage, and no additional appliances for anchorage control. Class I canine and incisor relationship were both achieved at the end of the treatment, while maintaining the Class III molar relationship. Conclusion: Orthodontic camouflage treatment in an adult patient using a passive self-ligating system and intermaxillary anchorage can improve facial profile and improve dental occlusion.
Amandia Dewi Permana Shita, Zahreni Hamzah, Zahara Meilawaty, Tecky Indriana, Ari Tri Wanodyo Handayani, Dyah Indartin Setyowati
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p217-222

Background: The Pandalungan community is a unique community established through the assimilation of two dominant cultures: the Javanese and Madurese. Both of these communities created a community with a new culture called the Pandalungan community culture. The people of this community live in coastal, rural and urban areas. Generally, research on the uniqueness in the oral health behaviour of the Pandalungan community has not been conducted since the oral health practices of the Pandalungan community are considered to be the same as that of the Javanese community. Purpose: In order to develop programmes for oral health prevention, this research aims at comparing the oral health profiles of the elderly (classified as per age) living in the rural and urban areas in the Jember Regency. Methods: The research employs a cross-sectional approach. The subjects of the research were selected on the basis of the total number of elderly people who attended the monthly meetings of the Karang Werda (those not willing to participate in the study were excluded). The study was conducted by organising extensive interviews, performing observations and intraoral examinations. Each group was classified into three subgroups on the basis of age: pre-elderly, elderly and high-risk elderly. The intraoral examination conducted included the oral hygiene index-simplified (OHI-S), the number of teeth missing, the depth of the pocket and the number of all functional tooth units (all-FTU). Results: The oral health profile of people in the rural community was poor when compared to the oral health profile of people living in the urban community (by accounting for nearly all the variables in the examination). Conclusion: The oral health profile of the elderly people in the Pandalungan community was poor. Adequate prevention and care are essential to maintain the oral health of people in the Pandalungan community.
W. Widyastuti, Dian Widya Damaiyanti, Dian Mulawarmanti, Cindy Aprilia Sari, Diah Ayu Siwi
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p229-234

Background: Periodontitis affects approximately 20%–50% of the global population and is caused by gram-negative bacteria, such as Porphyromonas gingivalis (P. gingivalis). Host modulation therapy (HMT) is part of a periodontal therapy that is used as an adjunct to conventional periodontal treatment to reduce tissue damage. Lemuru fish oil containing EPA and DHA can reduce the formation of MMPs and will further increase the number of fibroblasts there by stimulating collagen formation. Purpose: To determine the effect of lemuru fish oil gel on the collagen density and width of the periodontal tissue induced by P. gingivalis and the correlation between these parameters. Methods: Thirty male Wistar rats were divided into five groups. Induction of P. gingivalis was carried out first, then lemuru fish oil gel was applied to the gingival sulcus for 14 days, according to collagen scores in histological preparations using Masson's trichrome (MT). The width of the periodontal ligament was measured with an image raster program in µm. The data were analysed using statistics to test hypotheses using SPSS version 24. Results: Significant differences in the results of the collagen density were observed between groups K- and K+ and groups K+ and P2. Meanwhile, no significant difference was observed between groups K- and P2, P3, P2 and P3 and K+ and P1. The mean values of the periodontal ligament widths were K- (299.61 ± 51.82µm), K+ (425.85 ± 61.54µm), P1 (346.93 ± 33.53µm), P2 (370.15 ± 49.42µm) and P3 (379.6 ± 49.26). Conclusion: Lemuru fish oil can affect the width of the ligament and the collagen density with an optimal concentration of 20%. The correlation between the collagen density and the periodontal ligament width was negative and not significant.
Dewi Sartika Santoso, C. Christnawati, Cendrawasih Andusyana Farmasyanti
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p223-228

Background: Bimaxillary and bidental protrusion Class I Angle malocclusions have a characteristic convex facial profile and protrusion lips due to the labial inclination of the anterior teeth. Extraction of the first four premolars is the most common choice for orthodontic treatment of these cases when all the permanent teeth are complete and in good condition. Orthodontic treatment can be performed using the Begg or Straightwire techniques. Purpose: This study aims to investigate the difference in the effect of orthodontic treatment with Begg and Straightwire appliances on molar position, occlusal plane, and anterior and posterior facial height. Methods: Sixty pairs of lateral cephalograms before and after the treatment of patients with bimaxillary and bidental protrusive Angle malocclusion Class I, aged 18–35 years old, who underwent orthodontic treatment using the Begg and Straightwire techniques with the extraction of all first premolars that met the inclusion criteria. Data analysis was performed using two-way repeated analysis of variance (p0.05). Medium correlation was found between variables in both the Begg and Straightwire techniques. Conclusion: Molars were extruded and mesialized and the occlusal plane angle and height of the anterior and posterior faces increased after the Begg appliances treatment. The molars moved mesially and occlusally and there was a decrease in the occlusal plane angle, as well as the height of the anterior and posterior faces, after treatment with the Straightwire appliances. However, there was no difference between the two techniques.
Nungky Devitaningtyas, Ahmad Syaify, Dahlia Herawati
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p212-216

Background: Periodontitis causes an increased receptor activator level in the nuclear factor-κβ ligand (RANKL), which is one of the inflammatory mediators that plays a role in osteoclastogenesis. The open flap debridement (OFD) technique is the preferred treatment when accompanied by regenerative periodontal treatment using guided tissue regeneration (GTR) and guided bone regeneration (GBR). Carbonated hydroxyapatite is a GBR material that serves as a scaffold and has strong osteoconductive properties for bone regeneration. Propolis is natural product that can decrease osteoclastogenesis in periodontitis by decreasing the RANKL expression. Purpose: To investigate the RANKL expression after open flap debridement by applying carbonated hydroxyapatite to 10% propolis in the alveolar bone of rabbits. Methods: Nine induced-periodontitis rabbits (Oryctolagus cuniculus) were divided into three treatment groups of Group A OFD, Group B OFD followed by the application of carbonated hydroxyapatite, and Group C OFD followed by application of 10% propolis-carbonated hydroxyapatite. Each group was selected one to euthanised on the seventh, 14th and 28th day, respectively, and prepared using histology slides. The data was analysed using a two-way ANOVA followed by a post-hoc LSD test (p
Nurul Fatikhah, Gilang Yubiliana, Fedri Ruluwedrata Rinawan
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p206-211

Background: Dental and oral health problems among elementary students can be resolved through an oral health programme in schools. The main factor that inhibited this scheme was that the recording and reporting still employed a manual system, making it less effective and efficient. The electronic application of this programme can help managers to complete both of these tasks. Purpose: This study’s aim is to assess the effectiveness of the electronic application that is utilised in the oral health school programme to increase the quality of the information relating to the recording of dental health data in schools. Methods: This study used a pre-test and post-test one-group design, and the sample consisted of 37 oral health programme managers in schools who were chosen via simple random sampling. The data in this study was analysed using the Wilcoxon signed-rank test. Results: The results showed that the use of the electronic application as part of the oral health scheme influenced the quality of the information when details were recorded and reported. This can be seen in the rise in the standard of the information that was noted and disclosed when comparing data before and after using the electronic application; the average value of 1.54 (standard deviation=1.45) increased to an average value of 3.58 (standard deviation=2.84) with a significance level of 0.000 (p
Fransiska Rima Tallo, Ida Bagus Narmada, I. G. A. Wahju Ardani
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p201-205

Background: Previous studies on root resorption were reviewed by panoramic radiographs. Cone-beam computed tomography (CBCT) showed that 41.5% of teeth experienced resorption when panoramically examinated, while 68% of teeth experienced resorption when the examination method used was CBCT. Root resorption occurs in the maxillary central incisor (as much as 74%) and in the maxillary lateral incisor (as much as 82%). The maxillary canines have the most resorption, followed by the lateral maxillary incisors. Purpose: The aim of this study was to determine the differences of apical resorption in anterior maxillary teeth before and after orthodontic treatment in skeletal Class I/II cases of extraction. Methods: Samples from this study were the results of panoramic photographs of 50 patients treated by fixed orthodontic appliances at the Dental and Oral Hospital Airlangga University. These were selected according to the sample criteria. The evaluation method consists of measuring root and crown lengths with a digital application (RadiAnt DICOM Viewer). Subsequently, the measurements were evaluated using CBCT images. Results: The data were statistically analysed using normality tests with Shapiro–Wilk and Kolmogorov–Smirnov tests. Based on the results of paired sample tests, it was found that every treatment group had significant differences in the average length of the crowns and roots, with a result of p=0.000 (p
Aqsa Sjuhada Oki, Moch Febi Alviansyah, Christian Khoswanto, Retno Pudji Rahayu, Muhammad Luthfi
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 196-200; doi:10.20473/j.djmkg.v53.i4.p196-200

Background: Physical exercise has been proven to accelerate wound healing. Physical training itself consists of aerobic (continuous training) and anaerobic (interval training) exercise. The effectiveness of continuous physical exercise on post-tooth extraction wound healing is the focus of this study. Purpose: This study aims to investigate the differences in post-tooth extraction wound healing in Wistar rats (Rattus norvegicus) after aerobic and anaerobic exercise based on the number of fibroblasts and neovascularisation. Methods: Wistar rats were divided into three groups: the control group (K1); K2 undertook continuous aerobic exercise, swimming at 50% maximum swimming capacity (MSC) with an additional 3% bodyweight load; K3 undertook anaerobic continuous exercise, swimming at 65% MSC with a 6% load. The rats swam three times per week for six weeks. The number of fibroblasts and neovascularisation were examined three days after tooth extraction. Data was analysed using the one-way analysis of variance (ANOVA) and Least Significant Difference (LSD) tests (p
R. Rahmatillah, Isyana Erlita, Buyung Maglenda
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p181-186

Background: The adhesion of root canal filling material to dentin is one of the crucial factors in determining the success of endodontic treatment. However, the smear layer that forms during instrumentation serves as an interface that impedes the bonding mechanism of the filling material. A proper irrigation solution is required to remove the smear layer and provide a dentin surface that supports the bonding mechanism of the filling material in establishing good adhesion. Purpose: This study aims to evaluate and compare the bond strength of filling material with different final irrigation solutions. Methods: Mandibular premolars were prepared by a crown down, pressure-less technique and divided into three final irrigation groups (2.5% NaOCl, 17% EDTA and 20% citric acid). The root canal of each tooth was obturated using epoxy sealer and gutta-percha. A two-millimetre-thick section of the apical third portion of each group was arranged for the push-out assessment using a universal testing machine in an apical to coronal direction at 1 mm/min crosshead speed. Results: A one-way ANOVA test indicated the difference in push-out bond strength among the groups (p
Tengku Natasha Eleena Binti Tengku Ahmad Noor
Dental Journal (Majalah Kedokteran Gigi), Volume 53; doi:10.20473/j.djmkg.v53.i4.p187-190

Background: Xerostomia, generally referred to as dry mouth, has been identified as a side effect of more than 1,800 drugs from more than 80 groups. This condition is frequently unrecognised and untreated but may affect patients’ quality of life and cause problems with oral and medical health, including burning mouth syndrome (BMS). Purpose: The purpose of this case is to discuss how to manage a patient with BMS caused by xerostomia secondary to medication that has been taken by the patient. Case: We reported that a 45-year-old male military officer from the Royal Malaysian Air Force came to Kuching Armed Forces Dental Clinic with dry mouth and a burning sensation since he started taking 10 mg of amlodipine due to his hypertension. After a thorough physical and history examination, we made a diagnosis of burning mouth syndrome (BMS) caused by xerostomia secondary to amlodipine. Case Management: Oral hygiene instructions, diet advice and prescription of Oral7 mouthwash has been given to reduce the symptoms of BMS. The patient has been referred to the general practitioner to reduce his amlodipine dosage from 10 mg to 5 mg (OD) in order to prevent xerostomia, and oral hygiene instructions have been given. A review after two weeks showed significant changes in the oral cavity, and the patient was satisfied as he is no longer feeling the burning sensation and can enjoy his food without feeling difficulty in chewing and swallowing. Conclusion: Adverse drug events are normal in the oral cavity and may have a number of clinical presentations such as xerostomia. Xerostomia can cause many implications as saliva helps in maintaining oral mucosa and has a protective function. The signs of adverse drug incidents in the oral cavity should be identified to oral health care professionals.
Lisa Prihastari, Rima Ardhani Iswara, Ghina Al Afiani, Fajar Ramadhan, Mega Octaviani, Willy Anugerah Hidayat, Muhammad Al Faqih, Ahmad Ronal
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 175-180; doi:10.20473/j.djmkg.v53.i4.p175-180

Background: The anxiety associated with dental visits is one of the obstacles preventing dentists from improving oral health and is also a significant predictor of dental visit evasion, which is frequently observed in Indonesia. Purpose: To identify the level of dental fear and anxiety in the population of Jakarta, Indonesia and establish the relationship with sociodemographic factors. Methods: A cross-sectional method was used with a sample size of 1811 respondents aged 17–65 years old who were asked to complete the validated Indonesian versions of modified dental anxiety scale (MDAS) and dental fear scale (DFS) questionnaires. The data obtained was then analysed using nonparametric and chi-square tests. Results: The prevalence of subjects with moderate to high dental anxiety and fear was 16.3% (295 respondents) and 36.1% (654 respondents), respectively. The primary sources of dental fear and anxiety were dental drilling and anaesthesia before tooth extraction. The results of the nonparametric and chi-square tests show that both are significantly related to gender, age, educational status, income level, insurance and history of dental visits (p = < 0.05). Conclusion: Several sociodemographic factors are associated with dental fears and anxiety among the participants in Jakarta, Indonesia.
Jevina Sicilia Ahliawan, Zahreni Hamzah, Mei Syafriadi
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 144-148; doi:10.20473/j.djmkg.v53.i3.p144-148

Background: Tooth loss can disrupt the mastication process. Mastication disorders limit the amount of food a person consumes, affecting nutrition. The number of functional tooth units (FTUs) can affect nutritional status, measured using the body mass index (BMI). Purpose: The purpose of this study is to analyse the effect of the number of FTUs on the BMI in the elderly. Methods: This research was conducted in four villages in the Jember Regency. The number of subjects was 189, aged 45 years and over. The number of FTUs was calculated based on the anterior and posterior teeth that have contact with the antagonist and the BMI using the BMI formula. The data was analysed using a linear regression test; the level of significance is 0.005. Results: A simple linear regression test showed that there was significant correlation between FTU and BMI (p=0.366). Conclusion: The number of FTUs affects BMI; the higher the number of FTUs, the greater the BMI.
Ristya Widi Endah Yani, Taufan Bramantoro, Farida Wahyuningtyas, Talitha Zulis Islaamy
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 153-158; doi:10.20473/j.djmkg.v53.i3.p153-158

Background: Dental caries may cause discomfort and pain when chewing food, which in turn leads to insufficient absorption of nutrients, including iron, by the body. Lack of iron intake can cause iron-deficiency anaemia. Iron deficiency may also decrease salivary secretion and buffer capacity due to reduced salivary gland function, which may lead to dental caries. Purpose: This study aims to analyse the correlation between dental caries and serum iron (Fe) levels in the students of Mamba’ul Khoiriyati Islamiyah (MHI) Madrasa Aliyah in Bangsalsari Jember. Methods: Out of 71 students aged 15-18 years, 24 students were examined for caries with the DMF-T index and blood samples were also collected using the phlebotomy technique to assess the serum iron (Fe) level in µg/dL. The data were analysed using the Spearman’s correlation test (α = 0.05). Results: The average DMF-T score was high (7 ± 3.4) and the average serum iron (Fe) level was below normal (38 ± 11.5 µg/dL). The Spearman’s correlation test for dental caries and serum iron (Fe) levels showed significant results (p
Elfira Maharani, Dyah Karunia, Pinandi Sri Pudyani
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 170-174; doi:10.20473/j.djmkg.v53.i3.p170-174

Background: Fixed orthodontic appliances, such as Edgewise and Straightwire techniques, can increase the amount of plaque retention containing Streptococcus mutans (S. mutans), which can lead to white spot lesions. Purpose: The aim of this study is to analyse the correlation of fixed orthodontic treatment with Edgewise and Straightwire techniques on the incidence of white spot lesions and accumulation of S. mutans. Methods: The samples consisted of three groups: control group (n=8), Edgewise technique group, and Straightwire technique group. We observed the samples at the sixth month and eighth month of the treatment, after the installation of the fixed orthodontic appliances. The observation of white spot lesions with caries detector was applied in all regions. Bacterial swabs were acquired in the lateral incisor region, then a bacterial culture procedure was carried out on selective media of S. mutans, and then a bacterial count was performed. The data was analysed using two-way ANOVA, the post-hoc least square differences test, and the Pearson’s correlation test. Results: The number of white spot lesions in the Edgewise group was higher than in the Straightwire group in the sixth and eighth month of treatment with insignificant difference (p>0.05). The number of S. mutans bacteria increased in all groups, but there were no significant differences (p>0.05). There was no significant relationship between the number of white spot lesions with the accumulation of S. mutans between groups (p>0.05). Conclusion: The Edgewise and Straightwire techniques increase the incidence of white spot lesions but accumulation of S. mutans with the incidence of white spot lesions has no relationship.
Mohamed Salim Younus, Karam Ahmed, Duran Kala
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 140-143; doi:10.20473/j.djmkg.v53.i3.p140-143

Background: Children were compared to their siblings, cousins or peers regarding the eruption of their permanent teeth. Genetic and environmental factors can affect dental development and, therefore, the body mass index (BMI) could be considered as a factor that may influence dental development. Purpose: To determine any possible association between BMI and either dental caries or the eruption of permanent teeth (central incisor and molar). Methods: A cross-sectional study was completed for six-year-old school children. A total of 218 children (116 boys, 102 girls) from public elementary schools in Erbil City were entered into the study. Dental caries assessments were carried out using the WHO criteria for decayed, missing and filled primary teeth and indices (DMFT). BMI was used to classify obesity status. Results: Overall, 27.98% of the children were classified as overweight, 59.17% as normal and 12.84% as underweight. The DMFT was 5.247, while 12.39% of the children were caries-free. Conclusions: Children of normal weight had most permanent teeth erupted and a low caries index. Underweight children had fewer erupted teeth and a higher caries index. The complex relationship between body composition and oral health should be considered in paediatric patients.
Nelvi Yohana, Siti Bahirrah, N. Nazruddin
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 133-139; doi:10.20473/j.djmkg.v53.i3.p133-139

Background: Camouflage treatment of skeletal Class II malocclusion can be performed using extraction or non-extraction techniques. These treatments can cause changes in occlusal plane. Steep occlusal plane during corrective treatment generally relapses after active orthodontic treatment, resulting in unstable interdigitation. Purpose: This study aims to determine and evaluate changes in occlusal plane inclination in skeletal Class II malocclusion cases using extraction or non-extraction techniques of the permanent maxillary first premolar. Methods: The samples consisted of initial and final cephalometry of 40 adult patients with skeletal Class II malocclusion divided into two groups, namely extraction of the permanent maxillary first premolar and non-extraction group. The inclination of occlusal planes in both groups was measured using the ImageJ software, then the factors associated with these changes were observed. Furthermore, the occlusal plane inclination was compared between the extraction and non-extraction groups by using t-test. Results: The occlusal plane inclination in the non-extraction group increased slightly, while the inclination in the extraction group increased significantly (p = 0.017, p-value < 0.05). However, there was no correlation found in the occlusal plane inclination between the extraction and non-extraction groups (p = 0.07, p-value < 0.05). Conclusion: Class II malocclusion correction with either extraction or non-extraction of the maxillary first premolar increased the inclination of the occlusal plane. This study indicated that control of the occlusal plane inclination is highly essential.
Bramita Beta Arnanda, Sri Suparwitri, Pinandi Sri Pudyani
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 164-169; doi:10.20473/j.djmkg.v53.i3.p164-169

Background: The benefits of chocolate have attracted significant attention from clinicians, especially the active compound of caffeine on bone metabolism. The bone density significantly affected the rate of tooth movement. Purpose: This study aims to analyse the effect of the dose and the duration of caffeine consumption in chocolate on alveolar bone mineral density in orthodontic tooth movement. Methods: Forty-eight male guinea pigs (Cavia cobaya) aged between 3-4 months and weighing 300-350 grams were divided into four groups (group A control, group B caffeine dose of 2.3 mg, group C caffeine dose of 3.45 mg, and group D caffeine dose of 4.6 mg). An open coil spring was applied to the mandibular inter-incisor with an orthodontic force of 35 grams. Guinea pigs were sacrificed using lethal doses of anaesthetics on days 0, 1, 7, and 14 after an orthodontic appliance installation. Mandibular alveolar bone mineral density in compression sites was analysed with an atomic absorption spectrophotometer (AAS). Experiment data results were analysed using two-way ANOVA with a 95% degree of confidence. Results: Caffeine consumption with a dose of 4.6 mg on day 7 had the lowest alveolar bone mineral density and the highest was at a dose of 2.3 mg on day 14, but there were no differences between the dose groups, the duration groups and interactions between both of them (p>0.05). Conclusion: The consumption of caffeine in chocolate did not decrease the bone mineral density in the compression site of orthodontic tooth movement.
Birgitta Dwitya Swastyayana Subiakto, Utari Kresnoadi
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 126-132; doi:10.20473/j.djmkg.v53.i3.p126-132

Background: Telescopic overdenture is a prosthesis consisting of a primary coping, or an inner crown, that is attached to a supporting tooth in the oral cavity, and a secondary coping, or an outer crown, attached to a denture, which must be compatible with the primary coping. Purpose: The purpose of this study was to restore function and aesthetics and uplift the psychological status of the patient by fabrication of a fixed removable prosthesis using the existing abutment teeth as a telescopic overdenture. Case: A 36-year-old female came to the Prosthodontic RSGM UNAIR speciality clinic on her own volition to make front dentures for her upper and lower jaws after a traffic accident one and a half years ago. The patient had an arch bar installed two months after the accident, which was removed after two months. The patient wanted new dentures to improve both her ability to eat and her appearance. Case Management: Preliminary treatments performed were; maxillary and mandibular scaling and root planing; crown lengthening of tooth 15; extraction of teeth 16, 41, 42, and 43; and alveolectomy of the mandibular anterior region. Before the definitive treatment to improve the aesthetic appearance could be carried out, the first step was to make maxillary and mandibular transitional dentures. These were to be used while waiting for healing to occur, following the socket preservation in the mandibular area. Then, for the definitive restoration, we used telescopic overdenture for the maxilla and a removable partial denture for the mandible. Conclusion: Telescopic overdenture is recommended for patients who need good aesthetics for anterior tooth loss. Telescopic overdenture uses double crowns as the retentive elements, which give better aesthetic results compared to clasps, thereby improving the psychological status of the patient. In addition, they have better retention and stability compared to conventional complete dentures.
Darmawan Setijanto, Taufan Bramantoro, Nanissa Dyah Anggraini, Ardhyana Dea Maharani, Dwita Angesti, Dani Susanto Hidayat, Aulia Ramadhani
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 122-125; doi:10.20473/j.djmkg.v53.i3.p122-125

Background: Oral health is important for general health and quality of life. One of the oral diseases with a high prevalence in Indonesia is dental caries. Dental caries can cause limiting disturbances of daily activities such as biting, chewing, smiling and talking, and of psychosocial well-being, including development and general health of children. Purpose: This study aims to analyse the correlation of dental caries incidence rate with general health conditions and daily performance of children aged 2–5 years. Methods: This was an analytical observational cross-sectional study. The study sample was 103 pairs of children and their mothers, selected using cluster random sampling technique. Intra-oral examination was conducted on the children to obtain decay, missing, filled-teeth (DMF-T) index score. Information about oral impacts on daily performance (OIDP) of the children was collected through a questionnaire distributed to the mothers. The data obtained were statistically analysed with a regression test (p < 0.05). Results: It was found that dental caries had a significant correlation with general health (p = 0.00) and daily performance, including chewing function disorder (p = 0.00), difficulties in maintaining oral health (p = 0.039), sleep disorders (p = 0.00), and emotional instability (p = 0.00). Conclusion: The incidence rate of dental caries has a significant effect on the general health conditions and daily performance of children aged 2–5 years.
Yuli Fatzia Ossa, Anandina Irmagita Soegyanto, Diah Rini Handjari, Endah Ayu Tri Wulandari
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 159-163; doi:10.20473/j.djmkg.v53.i3.p159-163

Background: Oral potentially malignant disorder (OPMD) was defined by the World Health Organization (WHO) as an oral lesion which shows abnormalities with potential to become malignant. Leukoplakia is one such OPMD that may present in patients with human immunodeficiency virus (HIV), with the condition of HIV presenting a heightened risk of malignancy. Purpose: This case report aims to describe the initial finding and case management of an oral lesion that was suspected as leukoplakia in an HIV-positive patient on antiretroviral therapy (ART). Case: A 34-year-old male patient was referred to the Oral Medicine Division from an HIV clinic at Dr. Cipto Mangunkusumo General Hospital, Jakarta, with a chief complaint of dental caries. The patient was HIV and hepatitis C positive and already undergoing ART. Case Management: During the intraoral examination, we found multiple caries, poor oral hygiene and a single thin white plaque lesion on the right buccal mucosa around the second and third mandibular molar region. The white plaque was painless, irregular, clearly demarcated, could not be rubbed off and did not disappear when stretched. History of trauma in this area was non-contributory and the lesion had gone unnoticed prior to oral examination. The patient had an existing smoking habit of 25 years. As clinical examination suggested leukoplakia, a biopsy was arranged. Conclusion: Leukoplakia is defined as a potentially malignant lesion. The risk of shifting into malignancy can be higher for patients who are HIV positive. Especially in HIV-positive patients, special measures are needed to prevent shifting into malignancy, such as early detection, elimination of risk factors, performing excisional biopsy and regular intraoral examination.
Hilda Fitria Lubis, Tiopan Beltsazar Sinurat
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 149-152; doi:10.20473/j.djmkg.v53.i3.p149-152

Background: Cast analysis is the measurement of the upper and lower arch in a 3-dimensional occlusal relationship. Howe’s Analysis can be used to observe total tooth material, arch length, and basal arch width. Howe’s Analysis was conducted to analyse abnormalities of both teeth and the jaw to help diagnose and plan dental care. Purpose: To analyse the difference in total tooth material, arch length, basal arch width, and Howe’s Index between male and female undergraduate students from the University of Sumatera Utara who are of Proto-Malay origin. Methods: Ninety-six samples comprised of 48 male and 48 female students were recruited through the purposive sampling method. All samples were undergraduate students at the University of Sumatera Utara and of Proto-Malay origin, aged between 18 to 26, and have met the exclusion and inclusion criteria. We measured the variables using a digital caliper to measure basal arch width and arch length and Moorrees’ method to measure total tooth material. Data were analysed statistically using an independent t-test to compare means between groups (p
S. Sularsih
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 115-121; doi:10.20473/j.djmkg.v53.i3.p115-121

Background: Pore size of scaffolds affects cellular activity, stimulates angiogenetic factors of vascular endothelial growth factor (VEGF), synthesises new blood vessels to regulate migration and proliferation, and accelerates alveolar bone healing of tooth extraction. Purpose: This study aims to analyse the pore size of chitosan-Aloe vera scaffold and its effects on VEGF expression and woven alveolar bone healing of tooth extraction of Cavia cobaya. Methods: 36 male Cavia cobaya, aged 3-3.5 months were divided into six groups: negative control groups (without scaffold), positive control groups (chitosan scaffold), and treatment groups (chitosan-Aloe vera scaffold) on 7- and 14-day observations. Histopathological examination was performed to account the woven alveolar bone areas, and immunohistochemical examination was conducted to examine VEGF expressions on endothelial cells. Data was analysed using a one-way analysis of variance (ANOVA) and least significant difference (LSD) test (p
Dian Mulawarmanti, Rima Parwati Sari
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 111-114; doi:10.20473/j.djmkg.v53.i2.p111-114

Background: Long bleeding time is a risk factor in dental treatment, especially in patients who consume aspirin or other antithrombotic drugs. Holothuria scabra (H. scabra) are mostly echinodermata and have been studied in Indonesia; they contain omega-3 and glycosaminoglycans, with an influence of an antithrombotic drug. Purpose: This study aimed to investigate the thrombocyte counts during the post-administration of aspirin and the H. scabra extract in Wistar rats (Rattus norvegicus). Methods: This study was true experimental with a post-test control group design. The sample consisting of 30 healthy male Wistar rats (R. norvegicus) with a bodyweight of 150–250 g was divided into three groups (n = 10). The rats in Group 1 were given sodium carboxymethyl cellulose (Na CMC). The rats in Group 2 were given aspirin, and the rats in Group 3 were given the H. scabra ethanol extract with a 25 mg/200 g dose as per their body weight (BW). Oral administration was given for seven days. The rats’ blood was taken on the eighth day. The amount of thrombocyte was measured using Wright’s stain methods. The analysis of variance (ANOVA) and the Least Significant Difference (LSD) tests were conducted for data analysis (p < 0.05). Results: The thrombocyte counts (179.00 ± 10.56) in aspirin administration were lower than those in H. scabra (265.00 ± 18.54) and control groups (334.17 ± 13.9), with a significant difference between the groups (p = 0.0001; p < 0.05). Conclusion: This study indicates that the oral administration of aspirin and H. scabra decreases thrombocyte counts, whereas the administration of aspirin reduces thrombocyte counts to levels lower than those in H. scabra in Wistar rats (R. norvegicus).
Sri Budi Barunawati, Wayan Tunas Artama, Suparyono Saleh, Siti Sunarintyas, Yosi Bayu Murti
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 99-106; doi:10.20473/j.djmkg.v53.i2.p99-106

Background: Abalone (Haliotis varia Linnaeus) shells possess a high arginine content and are expected to be an alternative desensitisation material that is both insoluble and able to properly close dentinal tubules. Different methods of manufacturing abalone gel affect the molecular weight, hydrophilic or hydrophobic properties and protein content of the lysis. Purpose: This study aimed to determine the effects of different manufacturing methods on the dentinal tubule closure of abalone desensitisation gel. Methods: This study involved the extraction of abalone shells followed by preparative and thin-layer chromatography. The drying of the samples was carried out by the precipitation, drying, and addition methods. The research was divided into eight treatment groups, each consisting of three samples (F1, F2, F3). Each sample was applied to two study subjects’ post-extracted third molars, which were cut into disc shapes and subsequently etched with 6% citric acid. The percentage of dentinal tubule occlusion was calculated by Image J (NIH, USA) software. Data were analysed using three-way ANOVA. Results: The results showed that there were significant differences (p < 0.05) both in terms of the effects of the samples with deposition and addition on the occlusion of the dentinal tubules and in terms of the interactions between the samples with drying and addition. There was no significant difference (p > 0.05) in terms of the interactions of the samples’ three manufacturing methods. Conclusion: The manufacture of abalone gel as a desensitisation material requires a minimum of two interactions between the sample-making method and the addition, deposition, and drying methods. The best method was deposition.
Vania Syahputri, Theresia Indah Budhy, Bambang Sumaryono
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 107-110; doi:10.20473/j.djmkg.v53.i2.p107-110

Background: Oral cancer is the sixth most common malignancy that occurs in the world, with more than 330,000 deaths a year. In cancer, mutations occur in proteins, accompanied by unfolding proteins, caused by the unstable micro-environment in cells. To stabilise this condition, protein protectors called heat shock proteins (HSPs) are needed. HSPs are activated by a group of transcription factors known as heat shock factor 1 (HSF1). HSF1 is a considered target in cancer therapy. Moringa oleifera leaves are known to have anti-cancer properties because of bioactive compounds called flavonoid and isothiocyanate and are used as herbal therapy for cancer. Purpose: To investigate the potential effect of ethanolic extract of Moringa oleifera on HSF1 expression in oral cancer induced by benzo[a]pyrene. Methods: This study used 25 male Wistar rats divided into five groups consisting of the negative control group (K-), which was only given aquadest; the positive control group (K+), which was induced with benzo[a]pyrene and given aquadest; and treatment groups that were induced with benzo[a]pyrene and given Moringa oleifera leaf extract at concentrations of 3.125% (P1), 6.25% (P2), and 9.375% (P3). Examination of HSF1 expression was carried out by immunohistochemistry staining. Data were analysed using the Kruskal–Wallis test and post-hoc Tukey HSD. Results: HSF1 expression in the P1, P2, and P3 groups decreased significantly compared to the K+ group. There were no significant differences between the P1, P2, and P3 groups (p > 0.005). Conclusion: Ethanolic extract of Moringa oleifera leaves in three concentrations can decrease expression of HSF1 in oral cancer induced by benzo[a]pyrene.
Rikko Hudyono, Taufan Bramantoro, Benni Benyamin, Irfan Dwiandhono, Pratiwi Soesilowati, Aloysius Pantjanugraha Hudyono, Wahyuning Ratih Irmalia, Nor Azlida Mohd Nor
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 81-87; doi:10.20473/j.djmkg.v53.i2.p81-87

Background: COVID-19 has been regarded as a new pandemic in the world. This disease is highly contagious and can be transmitted easily through droplets and air. This matter is considered as a red flag to all dentists all over the globe. Until today, there is only a few specific guideline in regards to dental practice during and after the pandemic. The protocol only revolves around the limitation of patients’ appointments and using level 3 personal protection equipment. There is no specific mention on the preparation method of the practice room especially in Indonesia. Purpose: This study aims to review literature on infection control in dental settings during COVID-19 pandemic and discuss possible recommendations based on available evidence. Review: The review also discussed the background of COVID-19, transmission, clinical findings, physicochemical properties, and cross infection in dental practice. Despite the usage of personal protective equipment, the rooms need to be set to specific requirement to reduce contamination inside the room. Until today, COVID-19 transmission must be prevented with the best method available. Conclusion: No single protocol may fully guarantee the safety of the patients and dental workers. We suggest to combine the protocol listed above to minimize to self and cross-contamination ’new normal’ practice.
Atiek Driana Rahmawati, Iwa Sutardjo Rus Sudarso, Dibyo Pramono, Eggi Arguni
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 93-98; doi:10.20473/j.djmkg.v53.i2.p93-98

Background: Dental arch form and dimension are fundamental factors in orthodontic diagnosis and treatment planning. Its dimension will increase, due to the eruption of teeth, and is also affected by ethnicity, nutrition, systemic disease, hormonal factors, and gender. Many teeth are erupting in 8–10-year-old children. Purpose: This study aimed to assess the correlation between age and dental arch dimension of Javanese children in good nutritional status for consideration of orthodontic treatment. Methods: This was a cross-sectional study with 66 children aged 8–10 years in a normal dentoskeletal relationship, grouped based on age as the subject. Each group consisted of 22 pairs of dental study models, male and female. Anterior and posterior size of dental arch length were measured by digital sliding calipers from the midpoint between the right and left permanent central incisors perpendicular to the inter-canines and inter-molars. The width was measured at the inter-canines and inter-molars. Results: Pearson’s correlation test showed that there were significant correlations between age and maxillary dental arch lengths (p = 0.01, r = 0.31 for anterior, and p = 0.043, r = 0.249 for posterior). Conclusion: Based on this study, it can be concluded that there was a positive correlation between age and dental arch length of 8–10-year-old Javanese children in good nutritional status, especially in maxillary dental arch length.
Kun Ismiyatin, Ari Subiyanto, Michelle Suhartono, Paramita Tanjung Sari, Olivia Vivian Widjaja, Ria Puspita Sari
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 88-92; doi:10.20473/j.djmkg.v53.i2.p88-92

Background: One cause of pulpitis is mechanical trauma such as pulp perforation. The emergency treatment of pulpitis in a clinic uses eugenol. Eugenol in a high concentration causes cytotoxicity, which causes local necrosis and inhibits the recovery process, while in lower doses it can cause oral mucosal hypersensitivity. Due to these side effects, it is worth considering other biocompatible materials with minimal side effects, such as epigallocatechin-3-gallate (EGCG) which is found in green tea. As a polyphenol, EGCG has a radical scavenging ability, which has an effect on reducing the number of neutrophils. The application of EGCG is expected to reduce neutrophils on the second day after injury so the rehabilitation process is completed more quickly and ongoing inflammation and pulp necrosis is prevented. Purpose: To analyse the efficacy of topical hydrogel EGCG in reducing the number of neutrophils after 48 hours in the perforated dental pulp of Wistar rats. Method: 20 Wistar rats were divided equally into four groups, which were designated control (C) and treatment groups (T1, T2, T3). The upper first molar teeth of each rat were perforated and then T1, T2, and T3 were given 60 ppm, 90 ppm and 120 ppm hydrogel EGCG respectively. On the second day, the rats were sacrificed. HPA preparations were made to calculate the number of neutrophils in each group. Data was analysed using Kolmogorov–Smirnov, Levene’s, one-way ANOVA and Tukey HSD test (p0.05). Conclusion: 90 ppm hydrogel EGCG is effective in reducing the number of neutrophils in the perforated dental pulp of Wistar rats.
Dyah Anindya Widyasrini, Siti Sunarintyas
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 57-61; doi:10.20473/j.djmkg.v53.i2.p57-61

Background: Composite resins are widely used in dentistry to restore dental caries. Recently, short fibre-reinforced composite (FRC) resins have been widely used for high-stress areas, especially in posterior teeth. Bombyx mori silk fibre is under research to reinforce dental composite resin as it has good mechanical properties. Purpose: This study aims to obtain the effects of alkalisation and silk fibre volume fraction on the flexural strength of FRC. Methods: Bombyx mori silk fibres were obtained from Perhutani, Pati, Indonesia. Samples were divided into two alkalisation groups (4% and 8%). Alkalisation of the silk fibres was conducted through the scouring process in NaOH, hydrolysis (30% H2SO4) and drying. Silk fibres were then reinforced in a resin matrix. The samples were subdivided based on the fibre volume fraction reinforcements, which were 0%, 5%, 10% and 15%. Each group of samples consisted of three specimens (n = 3). Flexural strength was measured using a universal testing machine. Data were analysed by two-way ANOVA (p < 0.05) and post-hoc least significant difference test (p < 0.05). Results: The results showed the flexural strength (MPa) means of the 4% alkalisation group were 169.31 ± 54.28 (0%), 76.08 ± 43.69 (5%), 107.86 ± 40.61 (10%) and 101.99 ± 10.61 (15%). The flexural strength (MPa) means of the 8% alkalisation group were 169.31 ± 54.28 (0%), 82.62 ± 22.41 (5%), 111.07 ± 32.89 (10%) and 153.23 ± 23.80 (15%). Statistical analysis by ANOVA indicated that the fibre volume fraction affected the flexural strength of composite resins. Conclusion: It can be concluded that the volume fraction of silk fibre increases the flexural strength of composite resins, although the strength is not as high as a composite resin without fibres. However, the alkalisation percentage did not affect the flexural strength of composite resins, and there was no interaction between alkalisation percentage and fibre volume fraction with the flexural strength of composite resins.
Hilda Fitria Lubis, Kholidina Imanda Harahap, Dina Hudiya Nadana Lubis
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 67-70; doi:10.20473/j.djmkg.v53.i2.p67-70

Background: Stainless steel is a material that can be used in orthodontics for components of dental braces, such as brackets, archwires and molar bands. Orthodontic archwires exposed to toothpaste can release nickel ions that cause hypersensitivity. The excessive use of sodium lauryl sulphate in detergent toothpaste can cause mouth irritation, severe ulceration, decreased salivary solubility and taste sensitivity changes. Purpose: The aim of this study is to compare the nickel ion released by stainless steel archwires after immersion in detergent and non-detergent toothpaste. Methods: Forty stainless steel archwires from Ortho Organizer (0.016 x 0.022in) were divided into two groups (n=20). Group 1 comprised stainless steel archwires immersed in detergent toothpaste. Group 2 consisted of stainless steel archwires immersed in non-detergent toothpaste. These archwires were immersed in 1.5g toothpaste then kept in an incubator at 37°C for around 24 hours. After that, the archwires were removed from the toothpaste, and the toothpaste was dissolved in 25ml of Aquadest. The amount of nickel ion released was examined by using inductively coupled plasma optical emission spectrometry (ICP-OES). After that, the structure of the sample surface was examined with a scanning electron microscope (SEM). A statistical analysis was done using the Shapiro–Wilk normality test (p>0.05). An independent t-test was carried out to compare the two groups (p0.05). The SEM images of the archwire surfaces showed that there were more corrosive contour changes in the archwire surface in group 1 than in group 2. Conclusion: There was no difference between the nickel ion released from stainless steel orthodontic archwires after immersion in detergent and non-detergent toothpaste. After immersion in detergent toothpaste, stainless steel archwire surfaces showed more corrosive contour changes than those immersed in non-detergent toothpaste.
Riski Setyo Avianti, Sri Kunarti, Ari Subiyanto
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 62-66; doi:10.20473/j.djmkg.v53.i2.p62-66

Background: Photosensitisers play a vital role for reactive oxygen species (ROS) production in diode laser 405 nm therapy. Curcumin, chlorophyll and riboflavin have been used and viewed in several studies as effective photosensitisers for the elimination of Enterococcus faecalis (E. faecalis), a persistent microorganism that may cause endodontic failure. While each has given valuable and promising results as an alternative endodontic irrigant, no study has compared the efficacy of these three natural dyes. Purpose: To prove that the photosensitiser curcumin in diode laser 405 nm therapy is more effective for E. faecalis biofilm degradation than chlorophyll and riboflavin, and that a duration of irradiation of 90 seconds is more effective than 60 seconds. Methods: The biofilm monospecies E. faecalis was divided into two microplates with 96-well according to the irradiation periods: 60 seconds (Group 1) and 90 seconds (Group 2). Each group contained one control (without a photosensitiser) and three treatments were carried out by adding the photosensitisers curcumin, chlorophyll and riboflavin, where each treatment contained eleven samples. After irradiation for 60 seconds and 90 seconds, a crystal violet assay was carried out for each group. Results: The one-way ANOVA test showed a significant difference between groups based on the irradiation period. Tukey’s test showed each treatment in each group also showed a significant difference (p
Ika Andriani, Edy Meiyanto, S. Suryono, Ika Dewi Ana
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 76-80; doi:10.20473/j.djmkg.v53.i2.p76-80

Background: Carbonate hydroxyapatite (CHA) is used as a scaffold to repair bone resorption. Alveolar bone resorption in periodontitis caused by an infection requires the presence of an antibacterial to support bone regeneration. Human β-defensin 3 (HBD3) is an antimicrobial peptide. The local application of the HBD3 antimicrobial is beneficial to inhibiting drug resistance and protecting tissue regeneration against invasive bacteria. Purpose: This study aims to investigate the effect of the administration of a combination of CHA with HBD3 on the collagen density of periodontitis rats (Sprague Dawley). Methods: This study was a true experimental study with a post-test control group design. Thirty-two Sprague Dawley animal models were randomly blind selected placed under anaesthetic, then a 2-mm silk ligature was attached as a ligation to the mandibular incisors for 14 days in order to generate periodontitis. The study subjects were divided into two groups, the group with CHA and CHA loaded HBD3 (CHA + HBD3) implantation. On days 7, 14, 21 and 28, four rats were taken randomly from each group for decapitation, followed by histological processing and examination with trichome Mallory staining. The data was analysed using the Kruskal Wallis test (p
Nanik Zubaidah, Agus Subiwahjudi, Dinda Dewi Artini, Karina Erda Saninggar
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 71-75; doi:10.20473/j.djmkg.v53.i2.p71-75

Background: A successful root canal treatment eliminates pathogenic bacteria from infected root canals. The most common bacteria in root canal infections is Enterococcus faecalis (E. faecalis), due to its resistance to medicament and root canal irrigation. A photodynamic therapy (PDT) is a method of root canal disinfection that uses a combination of photosensitisers and light activation to eliminate bacteria in the root canal. The duration of the PDT irradiation results in the production of singlet oxygen and reactive oxygen species (ROS) to eliminate the E. faecalis bacteria. Purpose: To analyse the differences in the duration exposure of photodynamic therapy against the E. faecalis bacteria. Methods: The E. faecalis bacteria culture was divided into seven eppendorf tubes. Group I was a control group, and group II, III, IV, V, VI and VII were treated using PDT consisting of Toluidine Blue O (TBO) photosensitiser and light source irradiation for ten, 20, 30, 40, 50 and 60 seconds, respectively. After incubation, the number of bacteria was calculated by the Quebec Colony Counter and analysed using the Kruskal–Wallis test and the Mann–Whitney test (p
, Fitranto Arjadi, Erlina Sih Mahanani
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 24-29; doi:10.20473/j.djmkg.v53.i1.p24-29

Background: Stress that is induced by sleep deprivation can modulate the damage of periodontal tissue by elevating the levels of proinflammatory cytokines (i.e. IL-1β and TNF-α). The effects of sleep deprivation can be resolved with sleep recovery. Gingival crevicular fluid (GCF) is fluid in sulcular gingiva which acts as an oral biomarker for evaluating periodontal abnormalities. Purpose: The aim of this study was to determine the effect of various induction methods of sleep deprivation stress on cytokine levels in GCF of white male Wistar strain rats (Rattus novergicus). Methods: The study method was true experimental with a posttest-only control group design. Thirty male Wistar rats were randomly divided into five groups: paradoxical sleep deprivation (PSD), total sleep deprivation (TSD), partial sleep deprivation with sleep recovery for five days (PSD+SR), total sleep deprivation with sleep recovery for five days (TSD+SR) and a healthy control group. Data were analysed via one-way ANOVA to determine differences between groups. Result: The results showed the highest level of IL-1β and TNF-α was found in the PSD group. One-way ANOVA analysis showed significant differences (p
Teguh Setio Yuli Prabowo, Utari Kresnoadi, Hanoem Eka Hidayati
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 40-44; doi:10.20473/j.djmkg.v53.i1.p40-44

Background: Maintaining a good ridge is required during prosthodontic treatment. Hence, adequate alveolar bone support is considered an important factor in pursuing successful dentures. Propolis extract combined with bovine bone graft is a recent and innovative material in the process of socket preservation, as the caffeic acid phenethyl ester (CAPE) it contains can suppress the inflammatory process. Purpose: This study aims to determine the effective dose of propolis extract combined with bovine bone graft on the number of osteoblasts and osteoclasts in socket preservation. Methods: Twenty-eight Cavia cobaya animals were divided into four groups of seven. Group I was given 25 grams of PEG, while Group II were given a propolis extract at a dose of 0.5% combined with bovine bone graft. Group III were given a propolis extract at a dose of 1% combined with bovine bone graft and Group IV were given a propolis extract at a dose of 2% combined with bovine bone graft. On day 30, the lower incisor of each subject was extracted and induced with PEG and propolis (dose 0.5%, 1%, 2%). Histopathological examinations of osteoblasts and osteoclasts were measured with a 400x magnification light microscope. One-way ANOVA and Tukey HSD tests were performed to analyse data statistically. Results: The propolis extract combined with bovine bone graft not only increased the number of osteoblasts but also reduced the number of osteoclasts. The most effective dose for the propolis extract combined with bovine bone graft was 2%. Conclusion: The propolis extract combined with bovine bone graft could be effective in tooth extraction socket preservation at a dose of 2%.
Ira Widjiastuti, Ari Subiyanto, Evri Kusumah Ningtyas, Rendy Popyandra, Michael Golden Kurniawan, Fauziah Diajeng Retnaningsih
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 1-5; doi:10.20473/j.djmkg.v53.i1.p1-5

Background: Propolis is a natural biocompatible material that has been widely studied in dentistry because of its inflammatory, anti-microbial and immunomodulatory properties. One of the active components is caffeic acid phenethyl ester (CAPE). CAPE is effective in stimulating collagen as well as inhibiting the inflammation and degeneration of dental pulp. Purpose: To investigate the post-administration of propolis extract as pulp capping material enhances odontoblast-like cell thickness and type 1 collagen expression in Wistar rats (Rattus Norvegicus) Methods: This research was a true experimental design with a posttest-only control group design. Sixty-three Wistar rats were randomly divided into three groups, with each group consisting of 21 rats: Group I: Positive control; no capping material was administered; Group II: CAPE was administered; Group III: 11% of the propolis extract was administered. All samples were filled with glass ionomer cement. Seven rats from each group were sacrificed after days 7, 14 and 28 of post-pulp capping administration, and their afflicted teeth were subsequently extracted for histologic analysis. Results: No significant difference was seen in odontoblast-like cell thickness after the application of CAPE and propolis on days 7 and 14 (p > 0.05). However, a significant difference was noticed on day 28 (p < 0.05), with the thickness of odontoblast-like cell in CAPE being thinner than that in propolis. A significant difference in the expression of type 1 collagen was observed on days 7, 14 and 28 after the application of the propolis extract compared with CAPE (p < 0.05). Conclusion: The post-administration of propolis extract as a pulp capping material could enhance odontoblast-like cell thickness and type 1 collagen expression in Wistar rats.
Nur Dianawati, Wahyu Setyarini, Ira Widjiastuti, Rini Devijanti Ridwan,
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 36-39; doi:10.20473/j.djmkg.v53.i1.p36-39

Background: The prevalence of dental caries is high worldwide and specifically in Indonesia, especially in children. Cariogenic bacteria are the major cause of dental caries. Streptococcus mutans (S. mutans) is one of the bacteria often associated with caries, due to its ability in producing acid and forming the biofilm for bacterial colonisation on the surface of oral cavities. In addition to S. mutans, Streptococcus sobrinus (S. sobrinus) bacteria are also thought to play an important role in the process of caries. Purpose: This study aims to analyse the distribution of S. mutans and S. sobrinus in children with seriously high dental caries levels. Methods: This study was an observational analytical study. Bacterial isolation was conducted in carious lesions of 50 paediatric patients 6-12 years old with superficial dental caries. Samples of caries lesions were put directly into a tube containing the Brain Heart Infusion Broth (BHI-B) and incubated at 37o C for 24 hours. The samples were sub-cultured on selective tryptone yeast cystine sucrose bacitracin (TYCSBHimedia) agar, and then incubated for two days. Bacterial identification was then performed using the polymerase chain reaction (PCR) Multiplex method. Statistical analysis with Chi-square. Results: The total number of children with dental caries included in this study was 50. Among these, 94% showed positive for S. mutans and 30% positive for S. sobrinus. The analysis of the prevalence of bacterial colonisation (S. mutans and S. sobrinus) based on caries severity and the Simplified Oral Hygiene Index (OHI-S), showed there was no significant difference (p> 0.05). Conclusion: This study showed that among 50 caries noted in the children, 94% were colonised S. mutans and 30% S. sobrinus. There was no significant difference between the colonisation of S. mutans and S. sobrinus among children from the severe to mild decayed exfoliated filling teeth (DEFT) category, and between bad and good OHI-S.
Nova Andriani Hepitaria, Indeswati Diyatri, Markus Budi Rahardjo,
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 20-23; doi:10.20473/j.djmkg.v53.i1.p20-23

Background: Pophyromonas gingivalis (P. gingivalis) bacteria are the main type of bacterium that cause chronic periodontitis. Immunoglobulin Y (IgY) is a type of immunoglobulin found in poultry, such as chickens and birds. IgY can be used as an alternative method of preventing the accumulation of plaque that causes chronic periodontitis. Purpose: To determine the ability of IgY anti P. gingivalis to inhibit adherence of P. gingivalis. Methods: The samples were divided into eight groups, each group containing 10 ml of IgY anti P. gingivalis and 50 ml of enterocyte cells. The control group contained 50 ml of IgY anti P. gingivalis, and 50 ml of enterocyte cells. Serial dilution was carried out to the first seven groups, with the first group containing 90 ml phosphate-buffered saline (PBS) and 10 ml IgY anti P. gingivalis, and the second to seventh groups containing 50 ml PBS before adding 50 ml of enterocyte cells and 50 ml of bacterial suspension per group. The number of bacteria was calculated as an adherence index value using a light microscope. Results: This study shows that IgY anti P. gingivalis significantly reduces the adherence index value of P. gingivalis. Conclusion: IgY anti P. gingivalis has potency to inhibit the adherence of P. gingivalis.
Much Nizar, , S. Soekobagiono
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 10-15; doi:10.20473/j.djmkg.v53.i1.p10-15

Background: Post-extraction alveolar bone height and width never reach the same dimensions as before extraction. A combination of propolis extracts and bovine bone graft (BBG) that are anti-inflammatory, antioxidant, osteoinductive and osteconductive is expected to improve bone regeneration. Purpose: Knowing the effect of the combination of propolis extracts and BBG on the number of osteoclast and osteoblast as an effort to preserve the socket after extraction of Cavia cobaya teeth. Methods: 56 Cavia cobaya was divided into eight groups: the lower left incisor was extracted, and the socket was filled with 2% poly ethylene glycol (PEG), propolis extract+PEG, BBG+PEG, and a combination of propolis extract+BBG+PEG. The incisors socket of animals models were executed on the 14th and 30th days. Using HE for histopathological examination, the number of osteoclasts and osteoblasts were counted with a 400x magnification light microscope with nine visual fields. The data were analysed via one-way ANOVA and Tukey HSD tests. Results: The highest mean number of osteoclasts occurred in the BBG+PEG 14th day group and the lowest occurred in the propolis extract+BBG+PEG 14th day group. The highest mean number of osteoblasts occurred in the propolis + BBG + PEG combination 30th day group, the lowest occurred in the control group (PEG) on the 14th day. Conclusion: The 2% combination of propolis extracts and BBG effectively reduces the osteoclast number and increases the osteoblast number in preserving the socket after extracting Cavia cobaya teeth.
Erawati Wulandari, Faiqatin Cahya Ramadhani, Nadie Fatimatuzzahro
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 16-19; doi:10.20473/j.djmkg.v53.i1.p16-19

Background: Acid etching is a stage in obtaining bonds between composites and enamel. The application of acid to the enamel surface, however, can cause dissolution of hydroxyapatite and demineralisation of the enamel surface. Phosphoric acid, a strong acid, is an etching material that can reduce enamel hardness. Excessively reducing hardness can interfere with attachment to the restorative material. One medicinal plant that can be used as an alternative material in acid etching is tamarind. Purpose: This study aims to determine the effect of 5% tamarind extract gel on the tensile strength of composite resins. Methods: This is an experimental research study with a post-test-only control-group design. The study used 14 mandibular incisors. The labial part of the incisor was prepared using a diamond fissure bur with a diameter of 4 mm and a depth of 2 mm. The control group was then etched with 37% phosphoric acid gel, while the experimental group was etched with 5% tamarind extract gel. Bonding resins and micro-hybrid composite resins were applied, based on the manufacturers’ instructions. Next, a tensile strength test and seeing formation resin tags by scanning electron microscope (SEM) were performed. Data were analysed using an independent t-test (p < 0.05). Results: The average tensile strength of composite resins in the group etched with 5% tamarind extract gel was the same as in the 37% phosphoric acid group (p > 0.05). SEM images also show that enamel etched with 5% tamarind extract gel produced a tag similar to that etched with 37% phosphoric acid gel. Conclusion: 5% tamarind extract as an etching material can generate tensile strength of composite resin and trigger formation of resin tags in the same way as 37% phosphoric acid.
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 30-35; doi:10.20473/j.djmkg.v53.i1.p30-35

Background: The normal vertical dimension of occlusion (VDO) results in orofacial and temporomandibular joint (TMJ) biomechanical balance. If the VDO changes due to attrition, full edentulism, accidents involving the lower third of the face and even improper denture manufacturing will result in the disruption of mastication, speech and aesthetic functions. Therefore, the right technique is needed to predict the correct VDO. Purpose: To identify the correlation values and regression equation of the VDO for five distances between facial landmarks among people of Batak Toba ethnicity. Methods: This research is an analytical study with a cross-sectional design. A purposive-sampling technique obtained 30 Batak Toba subjects, consisting of 15 males and 15 females aged 19–24 years. The data were analysed by an independent t-test, one-way ANOVA, the Pearson correlation, and linear regression (p
, Mieke Sylvia Margaretha Amiatun Ruth, Levina Gita Wangsa, Rodrigo Ernesto Salazar-Gamarra, Liciano Lauria Dib
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 50-56; doi:10.20473/j.djmkg.v53.i1.p50-56

Background: Forensic dentistry identification commonly involves using dental cast models as ante-mortem data. Here, dentists generally send the pictures as well as the dental records. However, in recent times, dentists – especially orthodontists and prosthodontists – are using 3D scanners in view of reducing the space for cast model storage as well as sending the 3D imaging for fabricating clear aligners and other items such as crowns and bridges. This new trend means data transmission and viewing has become more complicated since sophisticated laptops or personal computers are generally required. For more practical use, smartphones would be a better option, meaning various simple ideas for viewing 3D data must be explored. Furthermore, the conclusions must be evaluated in terms of the validity for forensic dentistry use. Purpose: To evaluate a number of smartphone applications that are simple, user friendly, scalable and capable of the measurement and superimposition of 3D imaging data. Review: Standard tessellation language (STL) is one of the 3D scan file formats that is also useful for 3D printing. Recently, several applications for 3D viewing have been made available for iPhones (iOS) and Android-based devices, which are able to view STL files. However, they have all received both positive and negative reviews in terms of various applications, including forensic dentistry, and they thus require further evaluation by forensic odontologists. Conclusion: Each application has advantages and disadvantages; however, in our experience as forensic odontologists, the CAD Assistant, exocad and Adobe Photoshop Mix, which are available for iOS and Android devices, are preferable for forensic dentistry needs
Yoeliani Budisidharta, , Sri Pramestri Lastianny
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 45-49; doi:10.20473/j.djmkg.v53.i1.p45-49

Background: Periodontal surgery forms a part of periodontal treatment that can sometimes cause open wounds, such as gingivectomy and depigmentation. Unfortunately, the healing process of open wounds can be inhibited due to bacterial infections and systemic factors. Thus, after surgery, the open wounds need to be closed with periodontal dressing. Purpose: This study aims to reveal the differences between using zinc oxide non-eugenol and cellulose periodontal dressings on open wounds after periodontal surgery. Methods: Thirty-two samples were divided into two groups. Group I consisted of 16 samples where zinc oxide non-eugenol was applied as a periodontal dressing. Similarly, Group II consisted of 16 samples where cellulose was applied as a periodontal dressing. The dressings were applied to open wounds after periodontal surgery using the split-mouth technique. Hence, zinc oxide non-eugenol was applied on the right side and cellulose was applied on the left side of the mouth. The patients’ healing index (HI) score was measured on day seven and their wound healing index (WHI) score was measured on days seven and twenty-one. Results: The day-seven HI score of the wounds applied with cellulose was higher than those applied with zinc oxide non-eugenol. Meanwhile, the WHI of the cellulose group was lower than that of the zinc oxide non-eugenol group, except on day twenty-one. Both the HI and WHI scores then were analysed using Mann Whitney. Conclusion: The application of cellulose is better than zinc oxide non-eugenol on the healing of open wounds after periodontal surgery.
, Irfan Dwiandhono, Dian N. Agus Imam
Dental Journal (Majalah Kedokteran Gigi), Volume 53, pp 6-9; doi:10.20473/j.djmkg.v53.i1.p6-9

Background: A composite resin is used as restorative material in dentistry because it has the same colour as dental enamel, is easy to use in an oral cavity and offers good biocompatibility. Based on the size of filler, composite resin is divided into types, one of which is a composite resin nanohybrid. An important mechanical property of restorative material is microhardness. The mechanical properties of restorative material is highly affected by both polymerisation and heating process. There are many methods to improve composite resin’s microhardness, including preheating and heat treatment. Purpose: The purpose of this study was to evaluate different effects of preheating and heat treatment on the microhardness of nanohybrid composite resin. Methods: This study is an experimental laboratory research with post-test-only group design. Samples were divided into six groups: preheating groups at temperatures of 37oC and 60oC, heat treatment groups at temperatures of 120oC and 170oC, a negative control group and a positive control group. Afterwards, the resulting data were analysed using one-way ANOVA. Results: The result based on the one-way ANOVA test indicated that there was a difference in microhardness in each group with a significance of 0.000 (p
, Ni Putu Mira Sumarta
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 204-208; doi:10.20473/j.djmkg.v52.i4.p204-208

Background: Peripheral ossifying fibroma is a rejuvenation of the reactive gingiva, usually occurring in the anterior maxillary gingiva. The condition is often clinically ambiguous when diagnosed on the basis of gingival hyperplastic lesions such as focal fibrous hyperplasia, peripheral giant cell granuloma, peripheral fibroma and pyogenic granuloma because peripheral ossifying fibroma has a tendency to recur with a ratio of around 20%. The literature on the subject predominantly classifies peripheral osifying fibroma as an epulis type, but it has also been identified as a peripheral mesenchymal tumor presenting similar clinical symptoms to ossified fibrous epulis. Purpose: The purpose of this article is to explain the rare case of peripheral ossifying fibroma in the anterior maxillary gingiva which can be clinically misdiagnosed as reactive gingival hyperplastic lesions. Case: A case report of peripheral ossifying fibroma in the left lateral incisor and canine of the maxillary gingiva in a 26 year-old male. The patient chiefly complained of a painless, slow growing gingival enlargement on the upper left jaw during the previous five years. Clinical examination confirmed it to be a single, hard swelling in the 21-24 region, pale in color and with a rough surface. Case management: The procedure constituted a complete surgical excision of the lesion together with the underlying periosteum curettage intended to prevent recurrence. The histopathologic examination results indicated tissue with squamous epithelial lining, stroma consisting of fibroblasts, and immature trabecula with osteoblastic rimming between collagen tissue without signs of malignancy. Osteoblastic rimming has specific features in histopathologic examination of ossifying fibroma. Conclusion: Peripheral ossifying fibroma is a rare solitary enlargement in the oral cavity frequently misdiagnosed as ossified fibrous epulis. A definitive diagnosis is made by means of histopathologic examination. The condition has a low reccurance rate.
, Rosita Rahmawati, Mandojo Rukmo, Adelina Kristanti Tandadjaja, Hendy Jaya Kurniawan, Ratna Puspita Hadi
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 172-176; doi:10.20473/j.djmkg.v52.i4.p172-176

Background: Enterococcus faecalis (E. faecalis) is the most common bacteria species in persistent endodontic infection of teeth undergoing root canal treatment at a prevalence of 38%. The virulence factor of this bacterium is Lipoteichoic acid (LTA) which can be recognized by Toll-like receptors-4 (TLR-4) that produce a stimulus and provoke an immune response. Inflammation results in bone defects that feature multiple cytokines and interactions between different cell types. Bone loss within a periapical tooth is characterized by osteoclast formation (osteoclastogenesis) in the bone. Purpose: This study aimed to determine the expression of nuclear factor of activated T cell c1 (NFATc1) and receptor activator of nuclear factor kappa β (RANK) which played a role in osteoclastogenesis at different time intervals. Methods: 36 upper molar teeth of the research subjects were induced with 106 CFU Enterococcus faecalis and subsequently observed for 7 and 21 days with the NFATc1 and RANK being counted microscopically at 1000X magnification across 20 viewing fields. Thereafter, the data was examined and analyzed by means of an independent T test using SPSS. Results: NFATc1 and RANK expression were higher in the group including E. faecalis on days 7 and 21 than in the control group. There were significant differences between the treatment group and control group with regard to NFATc1 and RANK expression (p
Tamara Yuanita, Latief Mooduto, Reinold Christian Lina, Fajar Agus Muttaqin, Ika Tangdan, Revina Ester Iriani Marpaung, Yulianti Kartini Sunur
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 215-218; doi:10.20473/j.djmkg.v52.i4.p215-218

Background: Root canal treatment constitutes a treatment sequence for infected pulp to eliminate the etiological factors of pulp necrosis and periapical lesion. Enterococcus faecalis (E. faecalis) is an organism commonly found in a high proportion of root canal failure because of its ability to form biofilm. Degradation of extracellular polymeric substance (EPS) by oxidizing agents such as sodium hypochlorite is the first step in removing biofilm. However, the toxicity of sodium hypochlorite constitutes the main concern and, therefore, the safest alternative irrigants possible are required. The use of fruits, herbs and plants is widespread, especially in the fields of medicine and dentistry. Food crops are known to be rich in bioactive compounds, especially polyphenols, which have antioxidant and antimicrobial properties. Cocoa pod husk extract can, therefore, represent an alternative irrigant. Purpose: This study aimed to determine the minimum inhibitory concentration of cocoa pod husk extract in relation to the thickness of E. faecalis EPS biofilm. Methods: Four groups of E. faecalis cultured biofilm samples were analysed: group one contained E. faecalis without cocoa pod husk as a positive control; group two contained E. faecalis with 1.56% cocoa pod husk extract; group 3 contained E. faecalis with 3.125% cocoa pod husk extract; and group 4 contained E. faecalis with 6.25% cocoa pod husk extract. The biofilm thickness of all groups was measured by confocal laser scanning microscopy with statistical analysis subsequently undertaken by means of a post hoc test and Tukey HSD. Results: The average values of EPS biofilm thickness were as follows: group 1: 9500 nm; group 2: 8125 nm; group 3: 8000 nm; and group 4: 6375 nm. A post hoc Tukey HSD test indicated a significant difference between group 1 and group 4, while in group 2 and group 3 compared to group 1, there were no significant differences with the values of each being p = 0.340 and p = 0.267 (p>0.05). Conclusion: 6.25% cocoa pod husk extract reduces E. faecalis EPS biofilm thickness.
, Sri Kunarti, Fauziah Diajeng Retnaningsih, Evri Kusumah Ningtyas, Debby Fauziah Suryani, Andrie Handy Kusuma
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 183-186; doi:10.20473/j.djmkg.v52.i4.p183-186

Background: One purpose of operative dentistry is the maintenance of healthy pulp by reducing the need for root canal treatment and the possibility of undesirable scenarios such as tooth loss. Propolis is a plant-derived substance that contains a resin produced by honeybees belonging to the Apis mellifera species. Purpose: This study aimed to investigate the effect of a combination of calcium hydroxide (Ca(OH)2) and propolis extract on odontoblast-like cell proliferation in Wistar rats (Rattus norvegicus). Methods: This research constituted a true experimental laboratory-based investigation with post-test control group design. Thirty Wistar rats were randomly divided into six groups. The first molar pulp of each sample was perforated on occlusal surfaces using a low speed round bur. On day 3, the samples were divided into six groups (n=10): Group I: control; Group II: Ca(OH)2 + 11%; propolis extract; Group III: Ca(OH)2 + aquadest, and on day 7: Group IV: control; Group V: Ca(OH)2 + 11% propolis extract; Group VI: Ca(OH)2 + aquadest. All samples were filled with restorative material. They were subsequently sacrificed after 3 and 7 days post-pulp capping administration and the afflicted tooth extracted for hematoxylin and eosin (H&E) staining. The resulting data was subjected to statistical analysis to ascertain the proliferation of odontoblast-like cells. The significance of differences between the groups was determined by a one-way ANOVA test followed by a post hoc Tuckey HSD. A p-value
Adriana Azlan, Endah Mardiati,
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 168-171; doi:10.20473/j.djmkg.v52.i4.p168-171

Background: Evaluation of dental arches is important for both diagnosis and treatment in the fields of orthodontics, prosthodontics, and forensics. The perimeter or circumference affects the gender-specific dimensions of the dental arch. Purpose: To identify the inter-gender difference between maxillary and mandibular intermolar width of the first molars in Indonesia. Methods: This retrospective and comparative analytical study involved a gender-based comparison of maxillary and mandibular intermolar width in the first molars. A purposive sampling technique was employed for data selection. Ninety dental cast models were selected according to the inclusion criteria of non-growing patients and perfect dental conditions, with any damaged dental models being rejected. After selection, the dental cast was marked at the maxillary and mandibular first molar central fossae before being measured three times with a digital vernier caliper. The data obtained was subsequently analyzed by means of a Kolmogorov-Smirnov test, an F-test-Snedecor (with p>0.05) and Independent Sample t-test (with p
Dian Mulawarmanti, Dwi Andriani, , Farizia Putri Khoirunnisa, Alifati Nita Juliatin
Dental Journal (Majalah Kedokteran Gigi), Volume 52, pp 209-214; doi:10.20473/j.djmkg.v52.i4.p209-214

Background: Periodontitis is an infection in tooth-supporting tissues caused by a specific microorganism, Porphyromonas Gingivalis (PG), which can trigger collagen destruction. Generally, periodontal therapy employs a combination of mechanical (scaling root planning/SRP) and chemical (antibiotics) remedies, the latter of which can cause bacterial resistance. On the other hand, shark liver oil contains active natural ingredients such as alkylglycerols, squalene, squalamine, and omega-3, which have antibacterial and antioxidant effects. Purpose: This study aims to determine the impact of shark liver oil on fibroblasts and collagen density in the periodontal ligament of Wistar rats induced with PG. Methods: This study represents a laboratory experiment with post-test only control group design. The research subjects consisted of 35 Wistar rats divided into five groups, namely; a negative control group (K-); a positive control group with PG induction (K+); and three treatment groups induced with PG and shark liver oil once a day for seven days at varying doses of 0.2 g/gBB (P1), 0.3 g/gBB (P2), and 0.4 g/gBB (P3). Following treatment, the subjects were euthanized. The number of fibroblasts was then histologically examined with Hematoxylin Eosin (HE). Meanwhile, the collagen density was histologically analyzed with Masson’s Tricrome. Fibroblast cells were observed through a microscope at 400x magnification. Data was statistically analyzed with a one-way ANOVA and post hoc LSD. Collagen Density scoring was then performed. The results were analyzed with a non-parametric Kruskal-Wallis test (p=0.05), and subsequently with a Mann-Whitney U test (p
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