Displaying all 11 publications

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  1. Purmal K, Sukumaran P
    Aust Orthod J, 2010 Nov;26(2):184-8.
    PMID: 21175030
    To investigate the shear bond strengths of buccal tubes and to determine the sites of failure.
  2. Khan, A., Mohd Noor, N.S., Sukumaran, P., Sheikh Aladin, S.H.A., Wai Ying, Y.
    Ann Dent, 2016;22(2):1-8.
    MyJurnal
    This clinical audit is aimed to provide an insight into the performance of dental technicians in rendering
    fixed prosthodontics services at Faculty of Dentistry, University of Malaya. A retrospective audit was
    carried out between 1st of November 2014 and 31st January 2015 using data derived from records and
    monthly returns of the technicians, which are kept at the ceramic laboratory. Retrospective data on
    cases of diagnostic wax-ups, full metal crowns, metal ceramic crowns, all ceramic crowns and bridges
    that were sent to ceramic laboratory for fabrication from 1st of September 2013 to 31st of August 2014
    was systematically extracted from the record and tabulated categorically in SPSS version 22.0. The
    turnaround time in workings day for diagnostic wax-ups and the prostheses was calculated by deducting
    exit date from entry date. Subsequently, the turnaround time and the complexity of cases were categorized
    accordingly. The association of turnaround time and the complexity of the cases was analysed using
    Fisher Exact test with p value < 0.05. Within this time frame, a total of 102 cases of diagnostic waxups,
    36 cases of crown and 18 cases of bridges were fabricated. 57.8% of diagnostic wax-ups were
    completed within 3 days. 100% of 1 unit crown were completed within 7 days and 94.4% of bridges were
    completed within 14 days. There was a significant association of turnaround time and the complexity of
    the cases for diagnostic wax-ups and crowns with p value
  3. Sukumaran P, Fenlon MR
    J Indian Prosthodont Soc, 2017;17(2):207-211.
    PMID: 28584424 DOI: 10.4103/0972-4052.203194
    This paper describes a method used for the fabrication of a two-piece denture obturator for a patient who had surgical removal of the premaxilla due to squamous cell carcinoma. The patient had been wearing a two-piece obturator but encountered difficulty in inserting the prosthesis. In this case report, a lock-and-key mechanism was used to easily assemble the two-piece prosthesis intraorally. A keyhole was designed on the obturator to act as the lock while the denture was used as the key that fitted into the keyhole. This mechanism facilitated insertion and provided retention for the prosthesis. Heat-cured resilient acrylic material (Molloplast B®), which was used to fabricate the obturator, was a nonirritant, nontoxic, tissue-compatible material. It also did not contain plasticizers, therefore eliminating the problems associated with leaching out of plasticizers. The use of this flexible and resilient material allowed the obturator to engage in the undercuts without causing trauma and irritation to the soft tissues in the region of the defect. To conclude, the "lock-and-key" mechanism used in the fabrication of the two-piece denture obturator provided the patient with a lightweight, comfortable, and user-friendly form of prostheses.
  4. Purmal K, Alam MK, Sukumaran P
    Dent Res J (Isfahan), 2013 Jan;10(1):81-6.
    PMID: 23878568 DOI: 10.4103/1735-3327.111805
    BACKGROUND: Bonding of molar tubes is becoming more popular in orthodontics. Occasionally, these bonding are done on posterior porcelain crowns or bridges. The purpose of this study was to evaluate the shear bond strength of buccal tubes on feldspathic porcelain crowns with two different methods.

    MATERIALS AND METHODS: Forty porcelain right molar crowns were fabricated for this study. The crowns were randomly divided into two groups. In group 1, the crowns were etched with 9.6% hydrofluoric acid, silane coupling agent applied, coated with bonding primer and bonded with Transbond XT (3M Unitek, Monrovia, Calif). In group 2, the crowns were etched with phosphoric acid 37%, silane coupling agent applied, coated with bonding primer and bonded with Transbond XT. All the crowns were stored for 24 hours at 37°C and thermo-cycled before the shear bond test. The analysis of variance (ANOVA) was used to determine whether significant difference were present between the groups.

    RESULTS: The results of the analysis of variance (F = 0.23) indicated the shear bond strength of group 1 (3.57 ± 0.87 MPa) was not significantly different (P > 0.05) from group 2 (3.46 ± 0.65 Mpa). Fisher's exact test for the adhesive remnant index (ARI) revealed significant difference between both groups (P < 0.05). Eighty percent of group 1 buccal tubes failed at buccal tube/resin interface and eighty percent of group 2 mostly failed at porcelain/resin interface.

    CONCLUSION: Etching with phosphoric acid with the use of silane coupling agent would be safer and should make it easier for clinicians to clean the adhesive on the porcelain surface after debonding.

  5. Sukumaran P, Sakroni SN, Abu Bakar NA
    Saudi Dent J, 2019 Apr;31(2):270-276.
    PMID: 30983839 DOI: 10.1016/j.sdentj.2019.01.013
    PURPOSE: The aim of this study was to assess the effectiveness of minimal intervention via fluoride therapy in management of early caries lesion with the aid of SoproLife®.

    MATERIALS AND METHODS: A total of 40 patients were recruited, (mean age = 23 years) and were assigned to low and moderate caries risk groups (n = 20). Eighty occlusal surfaces of posterior teeth were examined for early caries lesion visually and using SoproLife® at baseline and at a recall visit six months later. At baseline visit, patients were given oral hygiene education, fluoridated toothpaste for homecare and topical fluoride application. SoproLife® images acquired were analysed using Image J software version 1.50. Difference in the mean value of intensity of the red wavelength spectrum between baseline and recall visits, (ΔI), were analysed for both risk groups. ΔI for upper and lower first molar teeth were also analysed.

    RESULTS: Results show no statistical difference for ΔI between low and moderate risk groups (p = 0.13). There is no statistical difference in ΔI within the low caries risk group (p = 0.42) but there is significant difference in the moderate risk group (p = 0.02). No statistically significant difference in ΔI value between upper first molars (UFM) (p = 0.80) and lower first molars (LFM) (p = 0.07) were detected. There was also no statistically significant difference in ΔI value within the upper and lower first molars (UFM: p = 0.31, LFM: p = 0.27).

    CONCLUSION: SoproLife® generated images did not show significant differences in remineralisation of early caries between low and moderate caries risk patients and between the upper first and lower first permanent molars in these patients.

  6. Mohamad Saberi FN, Sukumaran P, Ung NM, Liew YM
    Biomed Eng Online, 2022 Dec 03;21(1):83.
    PMID: 36463182 DOI: 10.1186/s12938-022-01055-x
    Tooth demineralization is one of the most common intraoral diseases, encompassing (1) caries caused by acid-producing bacteria and (2) erosion induced by acid of non-bacterial origin from intrinsic sources (e.g. stomach acid reflux) and extrinsic sources (e.g. carbonated drinks). Current clinical assessment based on visual-tactile examination and standardized scoring systems is insufficient for early detection. A combination of clinical examination and technology is therefore increasingly adapted. This paper reviews various procedures and technologies that have been invented to diagnose and assess the severity of tooth demineralization, with focus on optical coherence tomography (OCT). As a micron-resolution non-invasive 3D imaging modality, variants of OCT are now available, offering many advantages under different working principles for detailed analytical assessment of tooth demineralization. The roles, capabilities and impact of OCT against other state-of-the-art technologies in both clinical and research settings are described. (139 words).
  7. Saberi FNM, Liew YM, Sukumaran P, Ung NM
    Photodiagnosis Photodyn Ther, 2023 Sep;43:103715.
    PMID: 37481146 DOI: 10.1016/j.pdpdt.2023.103715
    Head and neck cancer patients are prone to dental caries after radiotherapy. An ex-vivo study was conducted to assess the feasibility of optical coherence tomography (OCT) to detect tooth demineralization due to caries in irradiated teeth. Thirty-nine human molar teeth were subjected to caries lesion induction through irradiation (Group 1), pH cycling (Group 2-1), and both (Group 2-2). The OCT signal attenuation coefficient, µR was assessed and validated against microhardness test and scanning electron microscope (SEM). The µR for Group 1 increased from 10 Gy to 40 Gy, and subsequently decreased after irradiated to 50 Gy and 60 Gy due to damaged enamel microstructure. In Group 2-1, the µR decreased with duration of pH cycling from day 1 to day 14 due to the increase of porosity in enamel layer. However, the µR showed decreasing trend from day 14 to day 28 of pH cycling, resulted from mineral deposition in the enamel layer. Although no significant difference was found in the µR between Group 2-1 and 2-2, SEM of Group 2-2 demonstrated visually higher porosity and larger gaps between microstructures. Irradiation may accelerate caries damage to tooth microstructure by increasing its porosity and brittleness, but larger sample size may be needed to further prove the effect. OCT could potentially be used for early detection of tooth demineralization in vivo based on the measurable µR changes for all groups which are shown negatively correlated with microhardness value (p 
  8. Gan SC, Fok ASL, Sedky RA, Sukumaran P, Chew HP
    Dent Mater, 2020 11;36(11):1379-1387.
    PMID: 32907752 DOI: 10.1016/j.dental.2020.08.003
    OBJECTIVE: The aim of this research was to determine the association between sorptivity of water and the state of mineralization in carious enamel of different stages of severity.

    METHODS: As a preliminary work, water droplets of 1.5 μL were placed on the surfaces of hydroxyapatite (HA) discs of different densities. The water droplet profile was dynamically recorded every second over a period of 10 s using a contact angle meter to determine the relationship between sorptivity and density. To measure and calculate sorptivity on enamel surfaces, varnish was painted on the labial surface of 96 extracted caries-free human teeth, leaving two 1.4 ± 0.1 mm diameter circular exposed test sites. The specimens were randomly divided into 6 groups (n = 16) and subjected to 0(G0), 7(G7), 14(G14), 21(G21), 28(G28) and 35(G35) days of pH cycling, respectively. A 0.7 μL water droplet was placed on each exposed site and Optical Coherence Tomography was used to measure its height every 10 seconds for 2 min. Sorptivity was computed by considering sorption equations and Washburn's analysis of capillary kinetics and correction for evaporation was also performed. Micro-Computed Tomography scans of the specimens were obtained and delta Z (ΔZ) is the parameter used to measure mineral loss. ΔZ at 10 μm (ΔZ10) and 50 μm (ΔZ50) from the surface were calculated. One-way ANOVA and Post-hoc Tukey tests were used to compare sorptivity between groups and bivariate correlations were used to analyze the association between sorptivity and ΔZ.

    RESULTS: Sorptivity was found to be inversely and linearly correlated with HA density with R2 value of 0.95. With enamel, there is a general trend of increase in mean sorptivity from G0 to G35, except for a decrease in G21. The same trends were observed for both ΔZ10 and ΔZ50. The decrease in sorptivity in G21 coincided with the presence of a surface hypermineralized layer in G21 samples. Post-hoc Tukey showed significant differences in mean sorptivity between G0 and G14, G0 and G21 as well as G14 and G21. Post-hoc Dunnett's T3 showed significant differences for ΔZ10 between G0 and G14 as well as G14 and G21. Significant correlation between mean sorptivity and ΔZ10 was detected with Pearson correlation coefficient of 0.461. For ΔZ50, post-hoc Tukey showed significant differences between G0 and G14 but no significant difference was detected between G14 and G21. No correlations were detected between mean sorptivity and ΔZ50.

    SIGNIFICANCE: Sorptivity was found to be inversely and linearly correlated with HA density with R2 value of 0.95. With enamel, there is a general trend of increase in mean sorptivity from G0 to G35, except for a decrease in G21. The same trends were observed for both ΔZ10 and ΔZ50. The decrease in sorptivity in G21 coincided with the presence of a surface hypermineralized layer in G21 samples.

  9. Ramanathan A, Srijaya TC, Sukumaran P, Zain RB, Abu Kasim NH
    Arch Oral Biol, 2018 Jan;85:23-39.
    PMID: 29031235 DOI: 10.1016/j.archoralbio.2017.09.033
    OBJECTIVES: Homeobox genes are a group of conserved class of transcription factors that function as key regulators during the embryonic developmental processes. They act as master regulator for developmental genes, which involves coordinated actions of various auto and cross-regulatory mechanisms. In this review, we summarize the expression pattern of homeobox genes in relation to the tooth development and various signaling pathways or molecules contributing to the specific actions of these genes in the regulation of odontogenesis.

    MATERIALS AND METHODS: An electronic search was undertaken using combination of keywords e.g. Homeobox genes, tooth development, dental diseases, stem cells, induced pluripotent stem cells, gene control region was used as search terms in PubMed and Web of Science and relevant full text articles and abstract were retrieved that were written in English. A manual hand search in text books were also carried out. Articles related to homeobox genes in dentistry and tissue engineering and regenerative medicine of odontogenesis were selected.

    RESULTS: The possible perspective of stem cells technology in odontogenesis and subsequent analysis of gene correction pertaining to dental disorders through the possibility of induced pluripotent stem cells technology is also inferred.

    CONCLUSIONS: We demonstrate the promising role of tissue engineering and regenerative medicine on odontogenesis, which can generate a new ray of hope in the field of dental science.

  10. Shoaib LA, Safii SH, Naimie Z, Ahmad NA, Sukumaran P, Yunus RM
    Eur J Dent Educ, 2018 Feb;22(1):e26-e34.
    PMID: 27995730 DOI: 10.1111/eje.12252
    OBJECTIVES: This study was conducted in University of Malaya to evaluate student perceptions on the contribution and role of an effective clinical teacher based on the cognitive apprenticeship model in clinical practice.

    METHODS: Self-administered questionnaires were distributed to 233 undergraduate dental students involved with clinical teaching. This modified and validated questionnaire focusing on students' learning environment was used in order to gain relevant information related to dental clinical teaching. Six domains with different criteria applicable to clinical teaching in dentistry were selected consisting of modelling (four criteria), coaching (four criteria), scaffolding (four criteria), articulation (four criteria), reflection (two criteria) and general learning environment (six criteria). Data analyses were performed using IBM SPSS Statistics 20.

    RESULTS: Majority of the students expressed positive perceptions on their clinical learning experience towards the clinical teachers in the Faculty of Dentistry, University of Malaya, in all criteria of the domains. Few negative feedbacks concerning the general learning environment were reported.

    CONCLUSION: Further improvement in the delivery of clinical teaching preferably by using wide variety of teaching-learning activities can be taken into account through students' feedback on their learning experience.

  11. Asif MK, Nambiar P, Mani SA, Ibrahim NB, Khan IM, Sukumaran P
    J Forensic Leg Med, 2018 Feb;54:53-61.
    PMID: 29324319 DOI: 10.1016/j.jflm.2017.12.010
    The methods of dental age estimation and identification of unknown deceased individuals are evolving with the introduction of advanced innovative imaging technologies in forensic investigations. However, assessing small structures like root canal volumes can be challenging in spite of using highly advanced technology. The aim of the study was to investigate which amongst the two methods of volumetric analysis of maxillary central incisors displayed higher strength of correlation between chronological age and pulp/tooth volume ratio for Malaysian adults. Volumetric analysis of pulp cavity/tooth ratio was employed in Method 1 and pulp chamber/crown ratio (up to cemento-enamel junction) was analysed in Method 2. The images were acquired employing CBCT scans and enhanced by manipulating them with the Mimics software. These scans belonged to 56 males and 54 females and their ages ranged from 16 to 65 years. Pearson correlation and regression analysis indicated that both methods used for volumetric measurements had strong correlation between chronological age and pulp/tooth volume ratio. However, Method 2 gave higher coefficient of determination value (R2 = 0.78) when compared to Method 1 (R2 = 0.64). Moreover, manipulation in Method 2 was less time consuming and revealed higher inter-examiner reliability (0.982) as no manual intervention during 'multiple slice editing phase' of the software was required. In conclusion, this study showed that volumetric analysis of pulp cavity/tooth ratio is a valuable gender independent technique and the Method 2 regression equation should be recommended for dental age estimation.
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