Review Article

Year : 2025 | Volume : 16 | Issue : 3 | Page : 17-34

Long-Term Evaluation of White Spot Lesion Treatment with Resin Infiltration in Orthodontic Subjects- A Systematic Review And Meta- Analysis

Daphane Anishya1, Ravindra Kumar Jain2, Arthi Balasubramaniam3 

1-Post Graduate Resident, 2-Professor and Head, Department of Orthodontics, 3-Associate Professor, Department of Public Health Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600 077, India

Address for Correspondence:

Dr Ravindra Kumar Jain

Professor and Head,

Department of Orthodontics, Saveetha Dental College and Hospitals,

Saveetha Institute of Medical and Technical Sciences,

Chennai, India.

E-mail: ravindrakumar@saveetha.com

ABSTRACT

Background: Resin infiltration (RI) has been used to treat white spot lesions (WSLs) and minimize caries development. The non-cavitatedinitial carious lesions can be filled with resin to prevent further caries progression. Long-term effects of RI have been reported but there is a need to systematically review the literature.

Aim and objectives: To systematically search, collate, and assess the literature on treatment effectiveness and stability with RI technique for the management of WSLs in orthodontic patients over a six to twenty-four-month follow-up period.

Materials and methods: A literature search was performed from January 2019 to December 2023 in four electronic databases (PubMed, Cochrane library, Google Scholar and Scopus). Studies including patients with permanent dentition treated for WSLs during or after orthodontic treatment, with at least 6 months of follow-up were only included in the review. Risk of bias assessment was done using the Cochrane ROB-2 tool forrandomized clinical trials (RCTs) and the ROBINS-I tool for non- RCTs. GRADE assessment was done for the certainty of evidence of the included studies. A random effects model was used to perform the meta-analysis of the color change and area of lesion regression.

Results: Eight studies including six RCTs and two non- RCTs were included. Treatment with RI showed significant lesion area regressionand negligible color change over 6-24 months. The meta-analysis showed no significant difference in lesion area between RI and CPP-ACP at 12 months(effect size z = 1.42), and a significant improvement in color change at 6 months (effect size z=4.38, favoring RI over micro abrasion, with no heterogeneity. (I2 = 0%).

Conclusion: This systematic review based on strong evidence reports that RI is an effective treatment for WSLs, with significant improvement in color and lesion area regression. Moreover, its effectiveness was maintained over six months, hence it is stable and long-lasting.

Keywords: Composite Resins, Tooth Demineralization, Orthodontics, Treatment Outcome, Follow- Up Studies, color change, lesion regression, mask.

DECLARATION OF CONFLICTING INTERESTS

No potential conflicts of interest were disclosed by the author(s).

ETHICAL APPROVAL

Not applicable.

FUNDINGS

No fundings was given.
How to cite this article: Daphane Anishya, Ravindra Kumar Jain, Arthi Balasubramaniam. Long-Term Evaluation of White Spot Lesion Treatment with Resin Infiltration in Orthodontic Subjects- A Systematic Review And Meta- Analysis. Int J Orthod Rehabil 2025; 16 (3): 17-34.

Original Article

Year : 2025 | Volume : 16 | Issue : 1 | Page : 38-47

Evaluation of the Cytotoxicity and Anti-biofilm Activity Of A Novel Dentifrice Containing 4-Hydroxycinnamic Acid: An In-Vitro Study

Manjiri Bhate1, Ravindra Kumar Jain2, A.S. Smiline Girija3, Raghunandhakumar4

1-Post Graduate Resident, 2-Professor and Head, Department of Orthodontics, 3-Professor, Department of Microbiology, 4-Associate Professor, Cancer and Stem Cell Research Lab, Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600 077, India

Address for Correspondence:

Dr Ravindra Kumar Jain

Professor and Head,

Department of Orthodontics, Saveetha Dental College and Hospitals,

Saveetha Institute of Medical and Technical Sciences,

Chennai, India.

E-mail: ravindrakumar@saveetha.com

ABSTRACT

INTRODUCTION: Evaluating biocompatibility is critical for assessing the safety and therapeutic potential of compounds, often serving as a preliminary step in product development. This study aims to evaluate the biocompatibility and anti-biofilm activity of a novel dentifrice containing 4-hydroxycinnamic acid (4-HCA) against Streptococcus mutans (SM) and Lactobacillus acidophilus (LA).

MATERIALS AND METHODS: The present in vitro study involved three groups- Group 1- commercially available dentifrice as control, Group 2- 0.2% 4-HCA dentifrice, Group 3- 0.4% 4-HCA dentifrice. The antibiofilm efficacy of the test dentifrices was assessed using colony-forming unit (CFU) counts and the Crystal Violet assay. The cytotoxicity was evaluated using the MTT assay and microscopic examination of human gingival fibroblast (HGF) cells.

RESULTS:

ANTIBIOFILM ACTIVITY: The CFU counts for SM and LA were highest in the control group, followed by the 0.2% 4-HCA group, and lowest in the 0.4% 4-HCA group. Crystal Violet assay results showed significant inhibition of biofilm formation in both 4-HCA groups compared to the control.

BIOCOMPATIBILITY: The MTT assay indicated that Group 3 had the highest cell viability and proliferation rates 24 horse after a 2 minute exposure to the conditioned medium across the different dilutions (1:40, 1:100, and 1:1000), as compared to Groups 2 and 1, indicating better biocompatibility. Morphological analysis of HGF cells showed normal spindle-shaped morphology in cells treated with Groups 2 and 3.

CONCLUSION: The novel dentifrice containing 0.4% 4-HCA demonstrates significant anti-biofilm activity against SM and LA and is biocompatible with HGF cells. This study supports the development of 4-HCA-based dentifrices as safe and effective oral hygiene products.

KEYWORDS: Cytotoxicity, Antibiofilm, Dentifrice, Orthodontic, Hydroxycinnamic Acid

CONFLICT OF INTEREST

None.

SOURCES OF FUNDING

None

How to cite this article: Manjiri Bhate, Ravindra Kumar Jain, A.S. Smiline Girija, Raghunandhakumar. Evaluation of the Cytotoxicity and Anti-biofilm Activity Of A Novel Dentifrice Containing 4-Hydroxycinnamic Acid: An In-Vitro Study. Int J Orthod Rehabil 2025; 16 (1) 38-47.

Review Article

Year : 2024 | Volume : 15 | Issue : 2 | Page : 13-25

Self Assembling Peptide P11-4 for management of white spot lesions in subjects undergoing orthodontic treatment

Nazleen Valerie Vas1, Ravindra Kumar Jain2

1-Postgraduate Student, 2-Professor, Department of Orthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India.

Address for Correspondence:

Dr Ravindra Kumar Jain Professor, Department of Orthodontics, Saveetha Dental College and hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai-600077, TamilNadu, India.

Email id:ravindrakumar@saveetha.com

Phone No:+919884729660

Abstract

White Spot Lesions (WSLs) are early signs of enamel demineralization, often occurring during orthodontic treatment due to hindered oral hygiene maintenance. Traditional treatment methods include resin infiltration or remineralization using fluoride-based agents. However, self-assembling peptides (SAPs), such as Curodont ™ Repair (P11-4), have emerged as potential alternatives for WSL management. This review comprehensively examines the chemistry, mode of action, clinical safety, and efficacy of SAP P11-4 in remineralizing enamel lesions. It synthesizes findings from studies investigating SAP P11-4's remineralizing potential using various assessment methods, including pH cycling models, laser fluorescence, digital subtraction radiography, and confocal microscopy. SAP P11-4, with its ability to mimic the enamel matrix and promote hydroxyapatite nucleation, demonstrates promising outcomes in reducing WSL size and progression. Clinical studies report significant improvements in lesion remineralization with SAP P11-4 treatment, often surpassing the efficacy of fluoride-based interventions. Moreover, SAP P11-4 shows compatibility with bonding procedures and potential for reducing dentin hypersensitivity. They offer a promising alternative or adjunct to traditional fluoride-based treatments for WSL management, providing clinicians with a valuable tool in promoting enamel health and preventing caries progression. Further research is warranted to explore long-term outcomes and optimize treatment protocols for maximum efficacy.

CONFLICT OF INTEREST

No conflict of interest among the authors of this study.

SOURCES OF FUNDING

Nil

How to cite this article: Vas, N. V., & Jain, R. K. (2024). Self Assembling Peptide P11-4 for management of white spot lesions in subjects undergoing orthodontic treatment: Review Article. International Journal of Orthodontic Rehabilitation, 15(2), 13–25. https://doi.org/10.56501/intjorthodrehabil.v15i2.1031

Original Article

Year : 2023 | Volume : 14 | Issue : 3 | Page : 11-19

Evaluation of Antibacterial and Antibiofilm Activity of Cucurbita Maxima Leaf Extract Against Streptococcus Mutans Isolated from Orthodontic Patients

Ravindra Kumar Jain1 , Mathew Thomas Maliael2 , Pitchaipillai Sankar Ganesh3

1Professor, 2Post Graduate, Department of Orthodontics, 3Professor, Department of Microbiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai – 77

Address for Correspondence:

Dr. Ravindra Kumar Jain

Professor and Head Department of Orthodontics and Dentofacial Orthopedics Saveetha Dental College and Hospital Saveetha Institute of Medical and Technical Sciences Chennai – 77.

Mail: ravindrakumar@saveetha.com

Abstract

Aim

The aim of this investigation was to evaluate the antimicrobial activity and anti-biofilm activity of Cucurbita Maxima leaf extract on Streptococcus mutans isolated from dental plaque of subjects undergoing orthodontic treatment.

Methodology

Dental plaque samples were collected from out patients undergoing orthodontic treatment. From the plaque samples Biochemical Characterisation of Streptococcus mutans then Collection of Medicinal Plants was done followed by Preparation of Solvent Extract and stock Solution. Evaluation of Minimum Inhibitory Concentration (MIC) of the plant extract and Biofilm Inhibition Assay with Gas Chromatography-Mass Spectrum Analysis (GCMS) was carried out.

Results

The MIC was identified to be 1.25mg/ml. The biofilm inhibition assay showed that the extract did not inhibit the formation of the biofilm. The GCMS analysis identified twenty-five constituent compounds from the crude extract. 

Conclusion 

The C. maxima leaf extract showed antibacterial activity against S. mutans and the minimum inhibitory concentration was identified at 1.25mg/ml. The extract did not inhibit the formation of biofilm.

Keywords: Antibacterial, Biofilm, Extract, Leaf, Plant.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

FUNDING

No funding was obtained for this study

How to cite this article: Evaluation of Antibacterial and Antibiofilm Activity of Cucurbita Maxima Leaf Extract Against Streptococcus Mutans Isolated from Orthodontic Patients. Int J Orthod Rehabil 2023; 14 (3) 11 -19. Doi: 10.56501/intjorthodrehabil.v14i3.763.

Systematic Review

Year : 2022 | Volume : 13 | Issue : 1 | Page : 01-09

MANDIBULAR ARCH CHANGES FOLLOWING EXPANSION WITH SCHWARZ APPLIANCE IN GROWING PATIENTS – A SYSTEMATIC REVIEW.
Mathew Thomas Maliael1, R Navaneethan2, Ravindra Kumar Jain3
Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Technical and Medical Sciences, Chennai – 600 077.

ABSTRACT

Aim and Objectives

The aim of this review is to systematically evaluate and assess the available evidence on arch dimensional changes in the mandible following expansion using Schwarz Appliance in growing patients.

Materials and Methods

The protocol for the review was registered with the PROSPERO database. A systematic search was done on the following scientific databases PubMed, Cochrane Central, LILACS and Google Scholar to identify articles of relevance published until April 2021. Articles that satisfied the inclusion criteria were included in the review. The review was performed based on the PRISMA guidelines. MINORS tool was used to evaluate the Risk of Bias and quality of evidence of the included studies.

Results

243 trials were identified after implementing the search strategy. After eliminating duplicates 196 trials remained. After screening the titles and abstracts for the eligibility criteria, 190 trials were eliminated from further review. Full text was sought for the remaining six articles and one study was eliminated after review of the full text. Four the included studies showed low Risk of Bias in their methodologies and one study showed a low risk of Bias in its methodology. Qualitative analysis was performed on the remaining five trials. The studies significant increase in the Intermolar, intercanine, interpremolar and arch perimeter and also observed significant up righting of the permanent mandibular first molar.

Conclusion

Arch dimensional changes in the mandible of growing patients after expansion using Schwarz Appliance are dento-alveolar in nature. No skeletal Expansion is seen.

Key Words: Expansion, Schwarz Appliance, Growing Patients.

CONFLICT OF INTEREST

The authors of this review have no conflict of interest to declare.

FUNDING

The authors of this review have no funding sources to declare.

How to Cite This Article:

R Navaneethan, Ravindra Kumar Jain, & Mathew Thomas Maliael. (2022). MANDIBULAR ARCH CHANGES FOLLOWING EXPANSION WITH SCHWARZ APPLIANCE IN GROWING PATIENTS – A SYSTEMATIC REVIEW.: Original Article. International Journal of Orthodontic Rehabilitation, 13(1), 1–9. https://doi.org/10.56501/intjorthodrehabil.v13i1.15

Original Article

Year : 2016 | Volume : 7 | Issue : 3 | Page : 85-88

Patient pain response and discomfort during self ligation mechanotherapy

Priyangaa Sathasivam1, Ravindra Kumar Jain2

1 Department of Orthodontics and Dentofacial Orthopedics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India, 2 Department of Orthodontics, Saveetha Dental College and Hospitals, Chennai, Tamil Nadu, India

Correspondence Address:

Priyangaa Sathasivam

Saveetha Dental College and Hospitals, Chennai - 600 077, Tamil Nadu, India.

Abstract:

Aim:

The aim of this research is to assess the patient's pain response and discomfort in patients treated with self-ligating bracket system.

Objective:

Patients undergoing orthodontic treatment quite often complain about pain and discomfort during various stages of orthodontic treatment, and hence, sufficient precaution should be taken to minimize them.

Materials and Methods:

The study was conducted on a sample size of 15 patients who were reported to the Department of Orthodontics. The patients were undergoing orthodontic treatment with self-ligating brackets. The patients were requested to complete a questionnaire about duration of treatment, pain, or discomfort experienced after regular monthly activation of brackets, duration, onset and severity of pain, difficulty in brushing or chewing food, and food accumulation between the teeth.

Results:

Out of 15 patients, only six patients were aware of that they are wearing self-ligation bracket while nine other patients do not know that they are wearing self-ligation bracket. Almost 80% of the patients experienced pain and discomfort after regular monthly activation of brackets, whereas 20% of the patients did not experience any pain and discomfort after regular monthly activation of brackets. Thirteen percent experienced slight pain, 47% experienced mild pain, 7% experienced moderate pain, 7% experienced severe pain, and 7% experienced very severe pain. A great majority of patients (67%) stated that the pain started few hours after activation while 13% of patients stated that the pain started few minutes after activation. Seventy-three percent of the patients stated that the pain lasted for the whole day and 7% patients stated that the pain lasted for hours. Fifty-three percent of the patients reported difficulty in brushing and chewing food while remaining 47% did not have any difficulty in brushing and chewing food. Most of the patients about 87% reported food accumulation in between the teeth.

Conclusion:

This study highlighted the pain and discomfort experienced by the patient during self-ligation bracket system. Pain and discomfort caused in the initial stage of fixed orthodontic treatment can be moderate to severe and might last for few days. Brushing teeth might cause mild discomfort and pain can be minimized by consuming soft food. Most of the patients undergoing self-ligating bracket system experienced pain and discomfort after regular monthly activation of brackets.

Source of Support: 

None

Conflict of Interest: 

None

DOI: 10.4103/2349-5243.192527

How to cite this article: Sathasivam P, Jain RK. Patient pain response and discomfort during self ligation mechanotherapy. Int J Orthod Rehabil 2016;7:85-8.