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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 11 | Issue 2
Page Nos. 105-207

Online since Friday, August 7, 2020

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GUEST EDITORIAL  

‘Covido-dontics’ to confront the ‘Covidi-fied’ dental education p. 105
Eachempati Prashanti
DOI:10.4103/ccd.ccd_567_20  
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REVIEW ARTICLE Top

Ozone therapy in periodontics: A meta-analysis p. 108
R Deepthi, Shivaprasad Bilichodmath
DOI:10.4103/ccd.ccd_79_19  
Gingival and periodontal diseases constitute a major distress in the field of dentistry. The greater part of the contributing and etiologic factors are diminished or treated with all forms of ozone. Ozone which is well known for its antimicrobial and tissue regenerative properties is indicated in all the stages of gingival and periodontal diseases. The aim of this study was to review literature on the effects of ozone as an adjunct to mechanical therapy in periodontitis patients. A search of literature was conducted to identify articles of ozone therapy in periodontitis published during the period from January 1, 2010, to July 30, 2018. PubMed, Medline, Embase, Cochrane, and Google Scholar search and hand searching of journals were conducted to identify relevant articles. The search strategy employed both dental subject headings and free-text terms. Out of a total of 123 studies that fit the initial inclusion criteria, 117 studies were further excluded. Only six studies were included in the meta-analyses. A high level of heterogeneity in the selected studies was found as demonstrated by Q-value of 10.241 and I2 value of 80.49%. However, the funnel plots showed symmetrical shape, with prevalence studies indicating absence of publication bias. Ozone therapy can be used effectively as an adjunct to scaling and root planing in the treatment of periodontitis.
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ORIGINAL ARTICLES Top

Evaluation of psychological stress marker in partially edentulous Indian adults restored with fixed dental prosthesis – A prospective cohort study Highly accessed article p. 116
Srividyadevi Rajagopal, Naveen Gopi Chander, Kuttae Viswanathan Anitha, Muthukumar Balasubramaniam
DOI:10.4103/ccd.ccd_63_20  
Background: Clinical studies have established mastication as a stress relaxation behavior in humans. Absence of teeth compromises mastication, increasing psychologic stress in individuals depicted by many physiologic changes in body. Quantitative level of psychologic stress bio-markers serve as indicators of underlying physical ailment. Lesser literatures are available in determining the role of alpha amylase stress bio marker in partially edentulous clinical situations. Aim: The purpose of this clinical study was to evaluate the levels of salivary alpha-amylase (sAA) stress biomarker in partially edentulous subjects before and after restoration with fixed dental prosthesis. Material and Methods: Forty partially edentulous patients with missing mandibular first molar were selected for this study. Two questionnaires, state trait anxiety inventory (STAI) and perceived stress scale (PSS) was used to evaluate stress and anxiety levels of participants. The recruited participants were treated with metal ceramic fixed dental prosthesis (FDP). A visual analog scale (VAS) was used to determine the patient satisfaction .Unstimulated salivary samples were collected preoperative, 3rd and 6th month post FDP placement. Level of sAA was estimated. Data obtained in the form of mean ± SD was subjected to statistical analysis using paired sample t-test (α=.05). Results: The salivary alpha amylase level was highest with mean of 36.73 μM/min/mg ptn before restoration with FDP. In the third month after prosthesis placement, the enzyme values decreased to16.62 μM/min/mg ptn and least value of 8.58 μM/min/mg ptn was detected in sixth month (P < 0.05). Conclusion: The salivary alpha amylase stress biomarker decreased after tooth replacement with FDP.
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Evaluation of the role of propolis and a new herbal ointment in promoting healing of traumatic oral ulcers: An animal experimental study p. 121
Aditya S Patel, Shraddha A Patel, Puneet R Fulzele, Swapnil C Mohod, Manoj Chandak, Satyawan S Patel
DOI:10.4103/ccd.ccd_128_19  
Most of the currently used medications for the treatment of oral ulcers focus primarily on providing symptomatic relief and preventing secondary infections. Not much attention has been paid in the past on agents that can promote healing of these lesions. In the current study, we have tested and compared the efficacy of such wound healing promoting agents i.e. Propolis (product obtained from Bees) and a newly developed herbal ointment (containing extracts of Azadirachta indica (Neem), Linum usitatissimum L.(Linseed) oil, and resin of Shorea robusta) in experimental rabbits. Methodology: Traumatic oral ulcers were inflicted in experimental rabbits (New Zealand white) with the help of a punch biopsy instrument. The animals were then divided into three groups each group consisted of 12 animals (n = 12), Group I was the untreated control group and Group II was topically treated with nonalcohol extract of propolis and Group III was treated with newly developed herbal ointment. Histological healing scores of the ulcers were evaluated on day 7 and day 14. Data were statistically analyzed using descriptive and inferential statistic methods. Results: In Group III treated with newly developed herbal ointment, significantly higher healing scores, in comparison to the untreated control group (Group I) and propolis (Group II) was observed on day 7 and 14. Improved healing scores in prapolis-treated group were observed than the untreated control group. However, the difference was not statistically significant on both day 7 and day 14. Conclusion: With the newly developed herbal ointment, superior healing of traumatic oral ulcers was observed.
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Caries activity and ph level changes after fluoride varnish and casein phosphopeptides-amorphous calcium phosphate application on children's saliva p. 126
Anie Apriani, Armelia Sari Widyarman, E Arlia Budiyanti, Boedi Oetomo Roeslan
DOI:10.4103/ccd.ccd_167_20  
Background: Caries is a disease affecting the hard tissue of the tooth wherein the demineralization process caused by Streptococcus mutans decreases saliva pH faster than the remineralization process can maintain it. Topical fluoridation, such as fluoride varnish and casein phosphopeptides-amorphous calcium phosphate (CPP-ACP) is the most common preventive therapy for the disease. Aims: The aim of this study is to assess the difference between fluoride varnish and CPP-ACP in reducing saliva pH and caries activity. Materials and Methods: This is an experimental study with a sample population of 60 children (aged 8–9 years old), divided into two groups of 30. Group 1 was treated with fluoride varnish, Group 2 with CPP-ACP. A t-test was used to measure the effects of the different treatments. Results: The result showed that the average difference in saliva pH before and after application was −0.12933 in Group 1 and −0.14033 in Group 2 (P = 0.256). The average difference in caries activity before and after application was 3.189 log colony-forming units (CFUs)/mL in Group 1 and 2.237 log CFUs/mL in Group 2 (P = 0.275). Conclusion: The most effective treatment for increasing saliva pH and reducing caries activity can be achieved by using the varnish for 1 month. However, there is no difference between fluoride varnish and CPP-ACP with regard to altering saliva pH and reducing caries activity statistically. Future study is needed to explore this result.
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Ratio of salivary sialic acid to fucose as tumor markers in potentially malignant disorders and oral cancer p. 131
Anandhi Sekar Arthisri, Asokan Sathiyamoorthy, Bhagavatham Meenakshi, Chitraa R Chandran
DOI:10.4103/ccd.ccd_336_20  
Background: Lack of noninvasive and economically feasible laboratory investigations in the early detection of cancer is a set-back in the prognosis of oral cancer (OC) patients. sAims: The aim of the study was to evaluate the ratio of sialic acid to fucose in salivary samples of OC and oral potentially malignant disorder (OPMD) patients. Materials and Methods: A total of 60 participants were selected and divided into three groups based on clinical and histopathological diagnosis: OC patients (n = 20), OPMD patients (n = 20), and healthy patients (n = 20). Unstimulated whole saliva of 1.5 ml was collected from the selected individuals for evaluating the salivary levels of sialic acid and fucose using the biochemical assay. Results: The difference in mean salivary sialic acid and fucose among the study groups was statistically significant (P = 0.001); one-way analysis of variance. The mean sialic acid to fucose ratio in the control group, OPMD group, and OC group were 0.34 mg/dl, 0.88 mg/dl, and 0.89 mg/dl, respectively. OC patients had significant elevation in the levels of salivary sialic acid, fucose, and their ratios (P = 0.001, P = 0.001, P = 0.003, respectively); Tukey's post hoc test. Conclusions: The ratio of salivary sialic acid to fucose is a predictable tumor marker for the diagnosis of OC. Further investigations are required to evaluate the influence of OC grading on this diagnostic marker.
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Apical sealing ability of calcite-synthesized hydroxyapatite as a filler of epoxy resin-based root canal sealer p. 136
Ema Mulyawati, Marsetyawan H N E Soesatyo, Siti Sunarintyas, Juni Handajani
DOI:10.4103/ccd.ccd_447_19  
Background: The success of root canal treatment is influenced by hermetic root canal obturation. This study was conducted to analyze the apical sealing ability after the addition of calcite-synthesized hydroxyapatite (HA) as an epoxy resin sealer filler. Methods: Calcite-synthesized HA powder was prepared using the microwave hydrothermal process. HA resin sealer powder and epoxy resin paste (3:1) were mixed, and concentrations of 10%, 20%, 30%, 40%, and 50% were prepared. A sample of thirty maxillary incisors were prepared in the root canal and then, the crown was cut to leave 13 mm of the root and a working length of 12 mm. The root canal was prepared using the crown-down technique and irrigated using 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid alternately. The samples were divided into six groups, with each group consisting of five roots. Group I was obturated with gutta percha using an epoxy resin sealer without HA (HA-0%) as a control group. In each of the Groups II, III, IV, V, and VI, 10% HA resin sealer, 20% HA, 30% HA, 40% HA, and 50% HA were used. All the samples were incubated in a 10-ml simulated body fluid solution at 37°C for 4 weeks. Apical closure density measurement was done using a scanning electron microscope, and the results were analyzed using the Kruskal–Wallis and Mann–Whitney U-tests. Results: A significant increase in the apical sealing ability was observed in the HA-20% sealer group and the HA-30% and HA-40% groups compared to that in the control group. However, the HA-50% sealer group showed a decrease in the apical sealing ability, whereas the HA-10% sealer group showed no difference. The HA-30% had the highest sealing ability than other concentrations. Conclusion: The addition of calcite-synthesized HA as a filler at concentrations of 20%, 30%, and 40% increased the apical sealing ability of the epoxy resin sealer.
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The tooth size discrepancy among orthodontic patients and normal occlusion individuals from Saudi Arabia: A three-dimensional scan analysis of diagnostic casts p. 141
Abdulaziz Abdullah Alshahrani, Ibrahim Alshahrani, Mohamed Khaled Addas, Sharaz Shaik, Faris Mohammed Binhomran, Jaber AlQahtani
DOI:10.4103/ccd.ccd_455_19  
Background/Purpose: Tooth size discrepancy is one of the causative factors of malocclusion. This study aimed to establish the TDS among various malocclusion classes and normal occlusion subjects in a Southern Saudi population. Materials and Methods: The study casts of orthodontic patients from Southern Saudi Arabia (mean age: 19.6 years ± 2.45; n = 120) were randomly selected and grouped into eight equal classes based on Angle's classification and gender. An additional 30 study casts, devoid of malocclusion, having excellent intercuspation and class I occlusion, were grouped into two controls (n = 15) based on gender. The study casts were three-dimensional scanned to measure mesiodistal widths of all the teeth. The calculated anterior ratios (AR) and overall ratio (OR) were statistically analyzed with analysis of variance and t-tests. Results: There were no significant differences in "OR" and "AR" between the genders (P > 0.05) and among the malocclusion and control subgroups (P > 0.05). The mean "OR" (92.01 ± 0.18) and "AR" (78.60 ± 0.27) of the malocclusion group were significantly higher than that of Bolton's ratios (P > 0.05). The "AR" of the control group was significantly higher than Bolton's standards (P = 0.048). However, "OR" was no different (P = 0.105). Malocclusion patients displayed a discrepancy (±2 standard deviation) in "AR" of 22.5% and 'OR' of 6.7% from Bolton's mean (BM). Similarly, the control group displayed a discrepancy in "AR" of 20% and "OR" of 10% from BM. Conclusion: The mean "OR" and "AR" of the Southern Saudi population showed no sexual dimorphism and no significant difference among various malocclusion and control subgroups. The "AR" of the malocclusion and control subgroups did not comply with Bolton's standards.
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A comparative evaluation of the influence of three different vehicles on the antimicrobial efficacy of triple antibiotic paste against Enterococcus faecalis: An In vitro study p. 150
Shouvik S Mandal, Sumanthini V Margasahayam, Vanitha U Shenoy
DOI:10.4103/ccd.ccd_372_19  
Introduction: The root canal is a hub of numerous microorganisms. Routine endodontic procedures fail to remove the resistant microorganisms such as Enterococcus faecalis. Aim: The aim of the present study was to evaluate the influence of different vehicles on the antimicrobial efficacy of triple antibiotic paste (TAP) on E. faecalis infected root canals. Materials and Methods: Eighty single-rooted and freshly extracted human teeth were prepared in radicular portion, and pure culture of E. faecalis (ATCC® 29212™) inoculum was injected into canals of tooth blocks and incubated for 21 days. Tooth blocks were divided into five groups. Each experimental group was then medicated with 0.1 ml of TAP and no medication was added for control groups. After 21 days of incubation at 37°C, colony-forming units per milliliter (CFU/ml) were counted for each group. Results: Group II treated with TAP mixed with propylene glycol revealed a maximum reduction in CFU/ml, and that was followed by Group I and Group III, where TAP was mixed with 2% chlorhexidine (CHX) and 0.9% normal saline, respectively. Data were compared and analyzed using statistics software. The results were considered statistically significant for P < 0.05. There was a statistically significant difference in CFU/ml between propylene glycol and positive control group, between CHX and positive control group, between saline and positive control group. Conclusions: The propylene glycol group with TAP was the most effective vehicle for the elimination of E. faecalis from canals of tooth blocks, followed by 2% CHX solution as the second vehicle of choice over 0.9% normal saline.
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CASE REPORTS Top

Retaining and regaining esthetics in the anterior maxillary region using the socket-shield technique p. 158
Sreeprada Dash, Abhilash Mohapatra, Gunjan Srivastava, Gopal Krishna Choudhury, Pradyumna Kumar Sahoo
DOI:10.4103/ccd.ccd_16_20  
With the advancement in the implant in dentistry, improvement in the implant designs and placement protocol has enhanced the esthetics outcomes in the anterior zone. Yet the preservation of the peri-implant soft tissue and providing an appropriate emergence profile to the implant crown prosthesis, the tissue grafting procedures are necessary to overcome the ridge contour change. However through the socket-shield technique, the bone resorption process is preserved, and the contour of the buccal gingiva is maintained, thereby preventing its collapse and achieving good aesthetic results. This case report describes the placement of an implant in the upper anterior region and rehabilitation with a cement-retained crown prosthesis using the socket-shield technique and the patient being followed up for 6 months with good results.
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Oral myiasis of maxilla (palatal gingiva) p. 162
Vanmathi Vasanthakumar, Parasuraman R Varalakshmi, Ramya Vanmathi
DOI:10.4103/ccd.ccd_49_20  
Myiasis is an invasion of tissues and organs of humans or animals by fly larvae. Oral myiasis is a rare pathology associated with a medical condition, poor oral hygiene, mouth breathing, and incompetent lip. We present a case of oral myiasis of the maxillary anterior region of the palate, in a 12-year-old male with cerebral palsy and poor oral hygiene. The diagnosis was made on the presence of larvae. The mechanical removal of larvae with hemostat was carried out with ivermectin oral therapy.
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Management of fracture crown en masse in maxillary central incisors in a 13-year-old child – A multidisciplinary approach p. 165
Neha Jaiswal, Ajla Khan, Harsimran Kaur, Ramakrishna Yeluri
DOI:10.4103/ccd.ccd_98_19  
Traumatic dental injuries are the most common orofacial injuries sustained during play and sports. Injuries to anterior teeth with subgingival fractures present a clinical challenge for a predictable esthetic outcome. The treatment modalities of subgingival fractures are surgical crown lengthening and orthodontic extrusion. The purpose of this article is to report a case of a 13-year-old male patient with a subgingival fracture of maxillary anterior teeth managed by a multidisciplinary approach, utilizing orthodontic extrusion after endodontic treatment followed by prosthetic rehabilitation.
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Melanotic neuroectodermal tumor of infancy: A rare case report p. 168
Tejas Mukund Kulkarni, Deepak J Nagpal, Anagha V Shete, Pratik S Hande, Mrinal V Shete
DOI:10.4103/ccd.ccd_119_20  
A rare case melanotic neuroectodermal tumor of infancy occurring in 2-year-old girl affecting left maxilla is described. Computed tomography showed benign expansile type of lesion affecting left maxilla. The lesion was surgically excised completely. Histopathology confirmed the diagnosis of melanotic neuroectodermal tumor. Four months' follow-up showed no recurrence.
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Orthosurgical management of a patient with cleft lip and palate p. 171
Sergio Martires, Nandini V Kamat, Vikas Dhupar
DOI:10.4103/ccd.ccd_200_18  
A 31-year-old male patient reported with a chief complaint of a forwardly placed lower jaw. Oral examination revealed Angle's Class III relationship bilaterally and cephalometrically; the patient presented with a small-sized retrognathic maxilla and normal mandible. Orthosurgical treatment was carried out with 4 mm of maxillary advancement and 4 mm of mandibular setback to achieve ideal overjet, overbite, and intercuspation of teeth. The ANB angle showed a drastic change from −9.5° to 1° and a successful conversion of the skeletal profile from Class III to Class I. Orthosurgical treatment can thus be an effective means of treating a patient with cleft lip and palate but requires a detailed understanding of the case and a sound diagnosis to attain a successful outcome.
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Infected multilocular unicystic ameloblastoma involving ramus and coronoid process: A rare case report p. 179
Nikhil Saxena, Sneha H Choudhary, Sami D Aldhuwayhi, Amar Thakare
DOI:10.4103/ccd.ccd_315_20  
Ameloblastoma is a neoplasm that originates from the odontogenic epithelium. Unicystic ameloblastoma (UA) is a rare variant of ameloblastoma occurring usually in younger population. They are characterized by slow growth and are locally aggressive, with the main site of origin being the posterior portion of the mandible. Most commonly, UA appears on radiograph as a unilocular well-demarcated radiolucency present mostly in the mandibular posterior region. Here, we report a unique case of multilocular UA in a 22-year-old male patient involving the left side of whole length of the mandibular ramus and coronoid process with impacted third molar.
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Extrafollicular adenomatoid odontogenic tumor in the maxillary incisor region disguised as gingival swelling p. 184
Natasha Saini, Bindu Kadian, Tanu Rajain, Saurabh Narang, Ritu Namdev
DOI:10.4103/ccd.ccd_344_20  
Adenomatoid Odontogenic Tumor (AOT) is a benign, non-invasive tumor with slow but progressive growth, mainly affecting younger patients, predominantly females. It is more often located in maxilla, involving an unerupted or erupted tooth, mostly canine. There are three variants, namely follicular, extra-follicular and peripheral. Permanent cuspids account for 60% of all follicular and 89% of all extra-follicular AOT. This article discusses a unique case of extra-follicular AOT in 9 year old male patient associated with partially erupted maxillary central incisor.
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Semilunar papilla preservation flap technique in combination with chorion membrane for pocket reduction and gingival recession coverage p. 190
Poornima Rajendran, Subraya Bhat, Meena Anand
DOI:10.4103/ccd.ccd_354_19  
An unavoidable consequence of periodontal flap procedure is gingival recession (GR). Achieving both pocket depth reduction and GR coverage remains a challenge to periodontists. The present case report provides a new innovative technique that will enable all clinicians to achieve pocket depth reduction as well as recession coverage in esthetic zone. The clinical parameters that were assessed at baseline, 1 month, 3 months, and 6 months are probing depth (PD), clinical attachment level (CAL), height of GR (HGR), and gingival biotype. The patient reported with a faulty post and core with crown in relation to maxillary right central incisor with a PD of 8 mm and HGR of 2.5 mm. Following replacement of the crown with respect to the tooth, semilunar incision was made and flap was reflected to visualize the underlying bone. This technique does not involve the interdental papilla at the same time allows the coronal advancement of the flap. A chorion membrane was placed to accelerate the healing as well to provide stable clinical outcome. The patient was evaluated at 10 days, 1 month, 3 months, and 6 months. There was a considerable reduction in PD, GR, and thus gain in CAL. The results remained stable over a period of 6 months.
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Primary malignant melanoma of oral mucosa – Report of two cases p. 195
SN Chandan, Sahith Kumar Shetty, BV Deepa
DOI:10.4103/ccd.ccd_380_19  
Primary malignant melanoma of oral mucosa is a rare and aggressive tumor. It is usually seen in the 5th and 6th decades of life. Its mainstay of treatment is surgery. It has a very poor prognosis, which is attributed to its late detection and distant metastasis. Dentists are often the first clinicians to come across these lesions and need to be able to identify them at the earliest for a better prognosis. In this article, we present two cases of extensive primary malignant melanoma of the oral cavity. Clinically, both the cases had a similar appearance of grayish-black pigmented nodular swelling on the buccal aspect and grayish-black discoloration on the palatal aspect. There were no significant radiological changes in both cases, indicating the superficial spread of the lesion. A positron emission tomography scan was performed in the second patient, which did not show any distant metastasis. Surgery was advised as a treatment for both the patients.
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Full mouth rehabilitation by implant supported fixed prosthesis p. 199
Jitendra Bhandari, Prasad Adhapure, Nimisha N Barve, Nazish Baig, Vivek Jadhav, Snehal Vispute
DOI:10.4103/ccd.ccd_738_18  
The purpose of this study is to report a case of full-mouth rehabilitation on six endosseous implants loaded following the standard procedure. It was decided to insert six implants in the maxillary and six implants in the mandibular arch in a patient with no systemic disease. The surgery was performed with the patient under local anesthesia with lignocaine and 1:100,000 adrenaline. Implant stability was sufficient (35 N/cm measured with a torque spring) for all 12 implants. An impression is taken in the open tray with a silicone impression material. Vertical dimension for rest and occlusion was checked with wax occlusal rims placed in the mouth. Interocclusal records were made with the metal framework in place. The final restoration was realized with ceramic layering completed. Good impressions and meticulous attention to detail are crucial for a successful implant-supported fixed prosthesis.
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A SERIES OF CASES Top

Mucogingival surgery in the interdisciplinary management of patients with palato-alveolar cleft defects Highly accessed article p. 203
Francina Maria Escobar Arregocés
DOI:10.4103/ccd.ccd_118_18  
Here will present a mucogingival technique for interdisciplinary management in patients with palato-alveolar cleft defect sequelae. Mucogingival continuity is sought in these patients by means of an extended laterally positioned flap. Achieving a mucogingival seal in the cleft area would be of great value in interdisciplinary management, favoring the prognosis of subsequent treatments, such as alveolar bone grafts, orthodontics, and rehabilitation, to achieve more esthetic and functional and harmonious results for the patients' dentogingival complex.
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