Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZF01 - ZF05 Full Version

Effect of 30% Grape Seed Extract on the Shearbond Strength of Orthodontic Adhesive Resin: An In-vitro Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57337.17059
Arpitha Eshwar, Poornima R Jnaneshwar, Krishnaraj Rajaram, Ravi Kannan

1. Postgraduate, Department of Orthodontics, SRM Dental College, Chennai, Tamil Nadu, India. 2. Professor, Department of Orthodontics, SRM Dental College, Chennai, Tamil Nadu, India. 3. Professor, Department of Orthodontics, SRM Dental College, Chennai, Tamil Nadu, India. 4. Head, Department of Orthodontics, SRM Dental College, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Arpitha Eshwar,
Postgraduate, Department of Orthodontics, SRM Dental College,
Chennai, Tamil Nadu, India.
E-mail: dr.latika.dharmashi@gmail.com

Abstract

Introduction: Grape Seed Extract (GSE) contains Proanthocyanidins (PA) which have been shown to cross-link and strengthen demineralised dentin collagen. There is paucity of research to evaluate, if grape seed extract increases the Shearbond Strength (SBS) of orthodontic resin when bonding to enamel.

Aim: To evaluate the SBS and Adhesive Remnant Index (ARI) scores of enamel surface bonded with orthodontic resin after immersing in 30% of grape seed extract and compare the same with that of control group.

Materials and Methods: This in-vitro study was conducted in SRM Dental College, Ramapuram, Chennai, India, from January 2021 to August 2021, in which 72 extracted teeth samples were divided into two groups. The two groups, each with 36 specimens, included Group I (Control), Group II (Test). Teeth in the test group were soaked in 30% grape seed extract for 10 minutes before bonding and teeth in the control group were bonded directly without soaking in grape seed extract. SBS were measured using a universal testing machine. To evaluate the amount of resin left on the enamel surfaces after debonding, ARI scores were used. The samples were subsequently evaluated using Scanning Electron Microscope (SEM) to study the surface characteristics of enamel after immersion in grape seed extract. Student’s t-test was used to assess the difference between two groups in SBS and Chi-square test was used for ARI scores.

Results: Total of 72 teeth were analysed, 36 extracted teeth in each group. The mean SBS in group I was 78.9 Newton (N), 59.03 N in group II. There was a stastistically significant differences in the mean scores of SBS between the groups (p-value=0.0024). The SBS of control group was significantly higher than the test group. Significant difference (p-value=0.016) found in ARI scores between the two groups. In SEM analysis, after grape seed extract conditioning followed by acid etching, pronounced cobble stone appearance was noticed, indicating a type II etching pattern.

Conclusion: Adhesive failure occurred at the resin and bracket interface indicating that SBS reduces, when teeth were immersed in grape seed extract.

Keywords

Adhesive remnant index, Antioxidants, Enamel conditioning, Proanthocyanidin

Orthodontic mechanotherapy involves application of optimum force to achieve movement of teeth. Traditionally, this force is transmitted to the teeth by brackets bonded to them. This attachment necessitates a dimensionally stable bonding medium that can achieve adequate flow to penetrate the conditioned enamel surface and has exceptional bond strength. It is vital to carefully prepare the enamel surface, in order to get a good and stable bond (1).

To improve the dentin/resin interface properties, two key techniques were considered: the first was to improve and develop novel adhesive systems and the other method was to establish tissue engineering approach to improve the substrate’s intrinsic properties. (2). Srinivasulu S et al., concluded that proanthocyanidin, have been shown to crosslink collagen agent and increase the mechanical characteristics of collagen and its resistance to enzymatic degradation (3). Phenol is abundant in grapes, particularly in the skin and seeds. Grape seed extract contains a number of bioactive properties, but it is hypothesised that its high concentration of proanthocyanidins (PACs) contributes to its caries prevention ability. Grape seed extracts capacity to bind to proteins may also help with dental remineralisation (4). In restorative dentistry, grape seed extract has been shown to improve the bonding of composite to dentin (5).

Several factors influence SBS of resin used for bonding brackets to enamel during orthodontic treatment, which can be divided into enamel factors (fillings, hyperplastic or hypoplastic enamel), patient factors (biting on hard surfaces, unpleasant oral habits, poor oral cleanliness) and placement procedures used (2). There is a paucity of research on the effect of preconditioning agents like GSE on SBS of orthodontic resins when bonding brackets to enamel. Therefore, the goal of the present research was to explore, if conditioning enamel using GSE before bonding improves the SBS of orthodontic resin at bracket to enamel interface.

Study objectives:

• To evaluate SBS of orthodontic resin bonded to enamel preconditioned with immersion in 30% and to compare the same with control.
• To evaluate of Adhesive Remnant Index (ARI) score on enamel surface after debonding of brackets from specimens subjected to enamel preconditioning and compare with control.
• To assess the enamel and dentinal surface on teeth subjected to preconditioning with GSE and compare that with the control.
• The study considered null hypothesis as there is no difference in the SBS and ARI score between the GSE treated group and control group.

Material and Methods

This in-vitro study was conducted in SRM Dental College, Ramapuram, Chennai, India, from January 2021 to August 2021. The study protocol was approved by the Institutional Review Board of SRM Dental college, Ramapuram, Chennai (SRMDC/IRB/2019/MDS/105).

Sample size calculation: It was done using G power software version 3.1.9.7 and for a power of 80 and α error of 0.05, total sample size arrived at was 72 (6).

Inclusion criteria: Extracted premolar teeth collected after extraction from patients who required therapeutic extraction of premolars for orthodontic reasons were included in the study.

Exclusion criteria: Teeth with dental filling or loss of tooth structure on buccal side of tooth (the surface to be bonded with bracket), teeth with large cavity or decay/dental caries on the tooth surface, teeth with crack that can affect the strength of enamel, teeth that were pretreated with chemical agents and tooth morphologic abnormalities like hypocalcified, hyperfluorosis etc., were excluded from the study.

Study Procedure

The teeth were extracted and stored for one week in a 0.5% chloramine T solution for the purpose of disinfection before being transferred to distilled water and kept at room temperature until the experiment. The teeth were then mounted in acrylic blocks so that long axis of the tooth coincided with that of the acrylic. Debris or calculus on the tooth surface was removed by scaling, which was then polished for 15 seconds with non fluoridated pumice and rubber prophylactic cups, rinsed with water spray for 10 seconds, and dried with oil-free compressed air for 10 seconds.

Thirty-six extracted premolar teeth were used as control (Group1) and were labelled as (C1-C36). According to the manufacturer’s instructions, the buccal surfaces were etched with a 37% phosphoric acid solution for 30 seconds rinsed with water spray for 20 seconds, and then left to dry with oil-free compressed air for 20 seconds. Trans bond XT Primer (3M Unitek Pvt. Ltd.) was applied on the etched enamel and cured for 20 seconds and 3M Universal Gemini upper premolar brackets were bonded on the middle third of the enamel parallel to the long axis with the composite resin (Transbond XT 3M Unitek) and cured for 40 seconds.

The 30% GSE was made using the Soxhlet extraction process (6). Rest of the collected (36) premolar teeth were used as test (Group 2) and was labelled as (T1-T36). Teeth were soaked in GSE for 10 minutes (6). In the main chamber of the Soxhlet extractor, 40 g of grape seeds (Herabal Engine) were placed in a thimble (thick filter paper bag). In a distillation flask, the Soxhlet extractor was inserted with 40 mL N-hexane as the extraction solvent. The solvent was then heated to reflux temperature. The container was gradually filled with warm solvent while the solid substance was heated. The Soxhlet chamber was automatically emptied, when it was nearly full, with the solvent running back down to the distillation flask through a syphon side arm. Over the period of five hours, this cycle was repeated numerous times. During each cycle, a component of the non volatile chemical was dissolved in a solution. After several cycles, the needed component was concentrated in the distillation flask. After extraction, the solvent was removed using a rotary evaporator. 30 mL of this extract was diluted in 70 mL ethanol to make a 30% GSE solution and preserved in a tightly sealed bottle (6).

Thirty-six teeth of the test group were soaked in 30% GSE for ten minutes before etching and rinsed in running water for five seconds (5). After cleaning, teeth were washed and dried using oil-free compressed air. The buccal surfaces then were etched with a 37% phosphoric acid solution for 30 seconds, washed with water spray for 20 seconds, and dried with oil-free compressed air for 20 seconds, as directed by the manufacturer. Transbond XT Primer was applied on the etched enamel and cured for 20 seconds and 3M Universal Gemini upper premolar brackets placed on the middle-third of the enamel parallel to the long axis with the composite resin (Transbond XT) and cured for 40 seconds. Excess composite was removed from around the bracket margins with the tip of a probe, and each of the five directions was photopolymerised for 20 seconds: above the bracket, occlusal, cervical, mesial, and distal surfaces.

Debonding force was tested using an Instron Universal Testing Machine with a cross head speed of 0.5 mm/min and 50 kg load cell. The acrylic blocks were attached onto the Instron testing machine’s attachment, sample was secured tight and brackets were delivered with a shear force to debond them with an upper crosshead blade that glides upwards or downwards with a configurable speed. The debonding force at failure was recorded in Newton (N). The SBS, in Megapascal (MPa), was then calculated as follows: (7)

• The SBS was calculated using the formula, SBS=Force/surface Area of the bracket base
• The surface area of the bracket base is depicted as A. the surface area of Gemini series (3M Unitek, Monrovia, Calif.), MBT prescription 0.022 slot, upper premolar brackets is 10.5 mm2.
• F is the recorded force [by the Instron machine].

After debonding the bracket, the enamel surface was evaluated based on the modified ARI score to determine the type of fracture, whether it was an adhesive or cohesive fracture.

The following criteria were used to assign the scores: (8),(9)

Score 0=No adhesive left on the tooth surface

Score 1=1-25% of the adhesive left on the tooth surface

Score 2=26-50% of the adhesive left on the tooth surface

Score 3=51-75% of the adhesive left on the tooth surface

Score 4=76-99% of the adhesive left on the tooth surface

Score 5=100% of the adhesive left on the tooth surface

Two teeth were randomly selected for SEM study, one of them was used as a control and while the other tooth was soaked with GSE for 10 minutes. Teeth were sectioned with rotary handpiece, cut being 3 mm lingual to the tip of the buccal cusp to ensure that buccal surface enamel was untouched and free for conditioning along with exposed dentin. Teeth were sectioned before soaking in GSE so that dentinal tubules can also be studied. After sectioning, the test tooth was soaked in 30% GSE followed by acid etching for 30 seconds of both specimens. The samples were then kept isolated and dried for 24 hours to remove all moisture, which could interfere with the vacuum needed for metallisation. All samples were then conventionally metallised (Gold sputtering JEOL JFC 1100E) and observed under SEM. The SEM device works on principle of conducting current through the sample of interest, as tooth is a biological entity, it had to be coated with the conducting agent to prevent burn out of the sample; hence, gold sputtering was carried out. Samples were examined under different magnification to show surface properties at 200X and 1000X.

Statistical Analysis

Data was assessed for normality using Shapiro-Wilk test. Descriptive statistics for the SBS, including the mean, standard deviation and minimum and maximum values were calculated for each of the two groups of teeth tested for SBS. Since the data was normally distributed Student’s t-test was used to determine the differences in SBS existed between the groups. Since ARI Scores were obtained as categorical data Chi-square test was done to compare the ARI scores.

Results

The mean debonding force in group I (control) was 78.9 N, 59.03 N in group II (Test) (Table/Fig 1). The mean SBS in test group was 5.62 Mpa and 7.51 Mpa in control group (Table/Fig 2). There was a statistically significant difference in the mean scores of SBS between the groups (p-value=0.024). Null hypothesis was, therefore, rejected. The SBS of control group was significantly higher than the test group. This indicates that immersing in GSE reduces the SBS of composite resin used on enamel.

Comparison of qualitative ARI scores between the groups was done using Chi-square test (Table/Fig 3). None of the samples in the test group had score of 1 or 2 (n=0) whereas in the control group there were few samples showing score 1 and 2 (n=5 for 1 and n=3 for score 2) in the control group. Number of samples with score 4 were 8 (22.2%) in control group and 5 (13.9%) in test group. When samples in score 5 were compared, both the groups had maximum number of samples (n=23 for test group and 12 for control group). Though both the groups had maximum number of samples in score 5, it was statistically high for test group (p=0.016) which indicates adhesive was left behind on the tooth in increased number of samples in test group than control.

In the present study, SEM analysis of enamel etched with phosphoric acid showed ill-defined prisms in both 200x (Table/Fig 4)(a) and 1000x magnification (Table/Fig 4)a. In contrast, cobble stone appearance (type II etching pattern) of enamel was noticed when the sample was conditioned with GSE before etching at 200X (Table/Fig 4)(c) and 1000X (Table/Fig 4)(d) (10). When studying dentin using SEM, it was found that the test tooth immersed in GSE showed well-defined dentinal tubules when, compared to the control tooth (Table/Fig 5)a, (Table/Fig 5)b.

Discussion

Many researchers have studied the importance of enamel surface preparation prior to the attachment of orthodontic brackets, as well as SBS during bracket debonding (11),(12). Grape seed is a phenolic substance with the potential to cross-link collagen, which helps to maintain the durability of dentin collagen matrix and thus improving biodegradation resistance, but its effect on enamel has not yet been investigated. Proanthocyanidin could be included in an orthodontic adhesive system, as it can increase the collagen cross linkage (5).

Xie Q et al., used 6.5 wt % of GSE to study its remineralising capacity in artificial root caries and detected a positive effect on remineralisation (4). Green B et al., studied the morphological difference in hybrid layer created by Bisphenol A-glycidyl Methacrylate (Bis-GMA)/ 2-Hydroxylethyl Methacrylate (HEMA) with and without 5% GSE and found out that collagen fibril degradation was prevented by the antioxidants in grape seed extract (2). Mirkarimi M et al., performed an experiment of human primary molars using GSE and found out that there was an increase in microhardness of enamel in 12 wt% grape extract group and there was an enhanced remineralisation of artificially created lesions (13). A study by Generosa DM et al., proved that 2.9 wt% of GSE improved the SBS of composite resin bonded to dentin (5) Shahi M et al., compared the effect of guava seed extract solutions in various concentrations (10%, 20%, 30%) on the SBS of composite resin to bleached enamel and concluded that Guava seed extract showed a complete reversal of the compromised bond strength with increased concentration (6). In the present study, concentration of 30% was arrived to extract the maximum benefits of antioxidants present in grape seed extract. Shahi M et al., investigated the efficacy of guava seed extract in concentrations of 10, 20 and 30% in reversing the bonding abilities of composite resin on bleached enamel (6). They found out that samples immersed in 30% of the extract yielded highest SBS regardless of the time of immersion. As both grape seed and guava seed belong to the same group of PA, the same concentration of 30% was tested using GSE in this study (2),(6) .

Reynolds IR and Von Fraunhofer JA suggested the clinically acceptable bond strength of brackets to enamel to be 6-8 MPa (14). The SBS of control group was significantly higher than the test group. This indicates that preconditioning with GSE reduces the SBS of orthodontic resins bonded to enamel. This observation is in contradiction to various studies that have tested the effect of preconditioning agents like antioxidants on the SBS of restorative adhesive resins bonded to dentin (2),(3),(4),(5). Generosa DM et al., reported highest mean value of the SBS with 2.9% GSE before etching the dentinal surface for 10 minutes to be 3.34 Mpa and 6.9 Mpa in control group (5). Subramonian R et al., compared the shearbond of composite resin bonded to bleached enamel after pre conditioning with 10% pine bark extract application that yielded the highest SBS among the test groups (10.8±1.25 Mpa) (15). (Table/Fig 6) depicts the comparative analysis of concentration of GSE and its effects observed in past studies with that of present study (2),(3),(4),(5),(13),(15).

Hybrid layer is a resin, collagen, and dentin intermediate layer created by acid etching the dentin and resin infiltration into the conditioned dentin. Adhesive monomers are unable to fully encapsulate the collagen matrix, leaving behind exposed collagen fibrils at the bottom of the hybrid layer, which are not protected by polymerised resin which leads to increase in susceptibility of demineralised collagen fibrils, and they become susceptible to hydrolytic breakdown over time (16). Tooth restoration methods causes activation of Matrix Metalloproteinase (MMP) enzyme by the total etch technique, which reduces the resin bond strength and GSE has been shown to improve this bond strength in various studies (2),(3),(4),(5). It is evident from this study that, the same is not applicable for enamel.

Proanthocyanidin (PA), a powerful antioxidant cross-linking agent found in fruits, vegetables, nuts, seeds, and flowers, has a wide range of biological actions. The use of a grape seed extract, which is mostly made up of PA, has been demonstrated to improve the mechanical qualities of dentin by improving collagen cross-linking and thereby, resisting biodegradation (2).

Proanthocyanidins have both hydrophobic and hydrophilic properties, enhancing their ability to irreversibly connect to a number of substances, including minerals, proteins, and carbohydrates. GSE’s binding to carbohydrate substrates required for bacterial development may reduce biofilm formation on the tooth surface. GSE’s capacity to bind to proteins may also help with dental remineralisation (4). Prior to bonding treatments on bleached enamel, the application of GSE entirely neutralises the bleaching effects and considerably improves bond strength (15),(17).

A modified ARI score index as given by Cehreli was utilised to grade the proportion of residual adhesive left behind on the enamel after the SBS test (8). In the current study, there was a significant difference in ARI scores between the two groups. A total of 77.7% of control group participants was spread across all the scores with increased incidence of scores 1-3. The results of ARI scores indicate that adhesive failure between bracket base and resin surface was the reason for bond failure in the test group. It is evident from the study, that GSE definitely has an effect on reducing the bond strength of orthodontic resin on enamel and the mechanism is by adhesive failure between resin and bracket interface rather than resin enamel interface. Role of the antioxidants in GSE in causing adhesive failure between bracket and resin is still unclear and has to be studied further. A similar study by Bulut H et al., compared SBS of bleached enamel against unbleached enamel with and without antioxidant application. They found that unbleached enamel had the highest bond strength with high ARI scores followed by bleached enamel immersed in artificial saliva and antioxidant (17).

In the present study, SEM analysis of enamel etched with phosphoric acid showed ill-defined prisms in 1000X magnification. But after GSE conditioning followed by acid etching, pronounced cobble stone appearance was noticed indicating a type II etching pattern (10). The dentinal tubules also showed well-defined tubules when preconditioned with GSE more than the conventional group, which indicated that GSE had better ability to remove the smear layer (5). similar studies have been tabulated in (Table/Fig 6) (2),(4),(5),(13),(15).

In the current study, there was reduction in SBS of orthodontic brackets bonded to enamel after preconditioning with grape seed extract. This indicates that the effect of GSE on the bond strength of adhesives is different, when treated on enamel and dentin. Hence, the use of GSE as a preconditioning agent to increase the SBS in orthodontic bonding is questionable.

Orthodontists are concerned with the bond strength of the attachments because they have to be intentionally removed upon completion of treatment. Excessive bond strength has the potential to harm enamel surfaces. An appropriate bond strength range should be high enough to prevent bracket debonding issues. With the findings of the present study, the previously stated null hypothesis was rejected. Hence, the conditioning of 30% GSE on enamel surface for a duration of 10 minutes show significant decrease in SBS, though ARI scores and SEM images show favourable results.

Limitation(s)

Preconditioning of enamel was done using GSE in the present study and other reagents like guava seed extract, green tea extract etc., could have been used for comparative purpose.

Conclusion

Immersion of teeth in GSE before bonding reduces the SBS of orthodontic resins bonded to enamel surface. ARI scores were were significantly lower in treated enamel, thus adhesive failure occurred at the resin and bracket interface and not at enamel. SEM images indicated a perfect cobble stone appearance of etched enamel surface in the test tooth. There is a need for further research in the same topic to understand the bonding behaviour of resins on enamel surface preconditioned with reagents. Further research needed to assess the effectiveness of proanthocyanidin by incorporating it into adhesives in different concentration. It is an in-vitro study, further research using the same reagent can be done on enamel that, is affected by fluorosis and hypoplastic tooth to determine whether there is any effect on orthodontic bonding. Other concentrations like 10, 20% can be tested, to find out if, there is reversal of results.

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DOI and Others

DOI: 10.7860/JCDR/2022/57337.17059

Date of Submission: Apr 25, 2022
Date of Peer Review: Jun 13, 2022
Date of Acceptance: Aug 25, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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