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Almalki MA. Regenerative Endodontic Procedure on an Immature Necrotic Molar: A Case Report with a 5-Year Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e944179. [PMID: 38915185 PMCID: PMC11334097 DOI: 10.12659/ajcr.944179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/05/2024] [Accepted: 05/03/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND The regenerative endodontic procedure (REP) for managing necrotic immature permanent teeth has the advantage of promoting root growth over the traditionally used apexification techniques. However, there is limited evidence on the long-term outcome of standardized REPs performed on immature molars. This case report presents the 5-year clinical and radiographic outcomes of REP performed on an immature mandibular first molar. CASE REPORT A healthy 7-year-old girl with a carious right mandibular first molar was referred to the endodontic clinic for evaluation and treatment. Clinical examination showed large occlusal caries, no tenderness to palpation and percussion tests, and no response to cold and electric pulp tests. Radiographic examination showed deep caries, apical radiolucency related to the open apices, and wide root canal space. Accordingly, the tooth was diagnosed with necrotic pulp and asymptomatic apical periodontitis. The REP was performed following the American Association of Endodontics guidelines, which comprise minimal instrumentation, disinfection with sodium hypochlorite irrigant, use of triple antibiotic paste, induced intracanal bleeding, and application of a coronal mineral trioxide aggregate plug. The patient missed the scheduled follow-up appointments but presented at the clinic 5 years later with an asymptomatic tooth. Clinical and radiographic examination revealed no tenderness to percussion and palpation test, no response to cold test, positive response to electric pulp test, apical healing, apical closure, root lengthening, and canal wall thickening and calcification. CONCLUSIONS While true pulp regeneration is unachievable, the REP, following the current protocol, is clinically successful in achieving root maturation and tooth retention.
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Abdellatif D, Iandolo A, De Benedetto G, Giordano F, Mancino D, Euvrard E, Pisano M. Pulp regeneration treatment using different bioactive materials in permanent teeth of pediatric subjects. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:458-484. [PMID: 38939542 PMCID: PMC11205167 DOI: 10.4103/jcde.jcde_140_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 06/29/2024]
Abstract
Background and Objectives The present systematic review aims to assess the success rate of the pulp regeneration treatment, according to the American Association of Endodontists (AAE) criteria, using different bioactive materials in permanent teeth of pediatric subjects (6-17 years of age). Materials and Methods The study protocol was registered on PROSPERO and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The question formulation was accomplished using the PICO model, and an electronic search was carried out on Scopus, MEDLINE/PubMed, Web of Science, and Cochrane databases till April 1, 2023. A total of 30 studies were established to fulfill the inclusion criteria of this systematic review. Results A total of 273 teeth have been treated with pulp regeneration treatment. By comparing different biomaterials and the success criteria defined by the AAE, the material associated with a higher success rate was found to be the white mineral trioxide aggregate. However, the overall success rate of pulp regeneration treatment was reported for 248 out of 273 teeth (91.20%). Conclusions Data obtained support the potential that regenerative endodontics aids in continuing root development in permanent immature teeth. Further studies are needed for a more extensive evaluation of the use of different biomaterials and the success rate in regenerative endodontics.
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Affiliation(s)
- Dina Abdellatif
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfredo Iandolo
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Francesco Giordano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Davide Mancino
- Faculty of Dental Surgery, Federation of Medicine Translational of Strasbourg and Federation of Materials and Nanoscience of Alsace, University of Strasbourg, Strasbourg, CHU Besançon, France
| | - Edouard Euvrard
- Service of Maxillofacial Surgery, Stomatology and Hospital Odontology, CHU Besançon, France
- Laboratoire Sinergies EA 4662, University of Franche-Comté, Besançon, France
| | - Massimo Pisano
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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Sabeti M, Ghobrial D, Zanjir M, da Costa BR, Young Y, Azarpazhooh A. Treatment outcomes of regenerative endodontic therapy in immature permanent teeth with pulpal necrosis: A systematic review and network meta-analysis. Int Endod J 2024; 57:238-255. [PMID: 37966465 DOI: 10.1111/iej.13999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023]
Abstract
AIM The aim of this study was to assess which treatment modality regarding scaffold selection for immature permanent teeth with pulpal necrosis will be the most successful for regenerative endodontic treatment (RET). METHODOLOGY PubMed, Cochrane, Web of Science and Embase, and additional records until August 2022 were searched providing a total of 3021 articles, and nine of these articles were included for quantitative synthesis. The reviewers selected eligible randomized controlled trials and extracted pertinent data. Network meta-analysis was conducted to estimate treatment effects for primary outcomes (clinical and radiographic healing) and secondary outcomes (apical closure, root length and root wall thickness increase) following RET [mean difference (MD); 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. The quality of the included studies was appraised by the revised Cochrane risk of bias tool, and the quality of evidence was assessed using the GRADE approach. RESULTS Six interventions from nine included studies were identified: blood clot scaffold (BC), blood clot scaffold with basic fibroblast growth factor, blood clot scaffold with collagen, platelet pellet, platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). The PRP scaffold showed the greatest increase in root lengthening at 6-12 months (MD = 4.2; 95% CrI, 1.2 to 6.8; SUCRA = 89.0%, very low confidence). PRP or PRF achieved the highest level of success for primary and secondary outcomes at 1-6 and 6-12 months. Blood clot scaffold (with collagen or combined with basic fibroblast growth factor (bFGF)) achieved the highest level of success for secondary outcomes beyond 12 months follow-up. A very low to low quality of evidence suggests that both PRP and PRF exhibit the greatest success evaluating primary and secondary outcomes within 12 months postoperatively compared to the traditional blood clot scaffold protocol. CONCLUSION Limited evidence suggests both PRP and PRF exhibit success in the short-term, not long-term. The value of this information stems in its recommendation for future randomized trials prioritizing both of these materials in their protocol.
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Affiliation(s)
- Mohammad Sabeti
- Department of Preventive and Restorative Dental Science, UCSF School of Dentistry, San Francisco, California, USA
| | - Daniel Ghobrial
- PG Endodontic Resident, UCSF School of Dentistry, San Francisco, California, USA
| | - Maryam Zanjir
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Bruno R da Costa
- Clinical Epidemiology & Health Care Research, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Yating Young
- UCSF School of Dentistry, San Francisco, California, USA
| | - Amir Azarpazhooh
- Head Division of Endodontics and Research, Director, Department of Dentistry, Faculty of Advanced Training Program in Orofacial, Faculty of Dentistry, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
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Jiang X, Liu H. Analysis of the achievement of primary and secondary goals and influencing factors in single-rooted immature permanent teeth after regenerative endodontic procedures: a retrospective study. BMC Oral Health 2023; 23:851. [PMID: 37951858 PMCID: PMC10640728 DOI: 10.1186/s12903-023-03553-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE This study explored the achievement of primary and secondary goals and factors influencing their achievement in regenerative endodontic procedures (REPs) for immature permanent teeth. METHODS Dental records of all patients who received REPs for immature permanent teeth at the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology between January 2012 and January 2023 were retrieved. The evaluation of the primary goal was based on medical and radiographic records. The achievement of the primary goal was defined as the absence of clinical signs and symptoms, such as pain, swelling, or sinus tract and the absence of periapical radiolucency, as assessed on postoperative periapical radiographs. The achievement of secondary goal represented increased root wall thickness and/or increased root length, that is, continued root development. Periapical radiographs before and after treatment were used to evaluate the achievement of the secondary goal. The secondary goal was required to be achieved alongside the achievement of primary goal. RESULTS A total of 436 teeth (136 anterior and 300 posterior teeth) were included in this study, 96.1% of which demonstrated achievement of the primary goal. Signs of failure (17 teeth) included crown fracture and uncontrolled and recurrent periapical lesions. In addition, 77.8% of teeth demonstrated achievement of the secondary goal, and more than half of the teeth exhibited a complete root development. Evaluation factors included patients' age, sex, tooth type, etiology, preoperative periapical lesion, duration of clinical signs and symptoms, follow-up period, and stage of root development. The achievement of the primary and secondary goals were significantly related to age and tooth type (p < 0.05). CONCLUSIONS Children with a younger initial visit age are more likely to achieve primary and secondary goals. Additionally, posterior teeth had an advantage over anterior teeth in achieving primary and secondary goals.
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Affiliation(s)
- Xijun Jiang
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - He Liu
- Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.
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Van Gorp G, Declerck D. Long-term Outcome of Endodontically Treated Traumatized Immature Upper Incisors. J Endod 2023; 49:1106-1119. [PMID: 37385539 DOI: 10.1016/j.joen.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION In a growing child, preservation of traumatized immature permanent upper incisors is challenging. This study aimed to evaluate the long-term outcome of endodontically treated traumatized immature upper incisors and associated variables. METHODS A total of 183 traumatized immature upper incisors treated with pulpotomy, apexification, or regenerative endodontic procedure (REP), with follow-up between 4 and 15 years, were assessed for presence of pulpal responses or periodontal/bone responses using standardized clinical and radiologic criteria. Logistic regression, including stage of root development, type and complexity of traumatic event, type of endodontic intervention, and history of orthodontic management, were used to estimate impact on tooth survival and occurrence of tissue responses. Study approved by Ethics Committee Research UZ/KU Leuven (S60597). RESULTS After a median follow-up of 7.3 years (interquartile range, 6.1-9.2), 159 teeth (86.9%) were still functional. From these teeth, 58 (36.5%) developed tissue responses. This was significantly associated with stage of root development at moment of trauma (root length <¾) and type of endodontic intervention (REP presenting worst outcome). Tooth loss (24 teeth, 13.1%) occurred after a mean time span of 3.2 years (±1.5) and was significantly associated with type and complexity of the traumatic event and type of endodontic intervention, with apexification showing better results than REP (odds ratio, 0.30; 95% confidence interval, 0.11-0.79). CONCLUSIONS A large number of endodontically treated traumatized immature teeth could be kept functional. Very immature teeth, teeth with periodontal tissue damage, and teeth treated with REP were at highest risk for an unfavorable outcome.
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Affiliation(s)
- Gertrude Van Gorp
- Unit of Paediatric Dentistry and Special Dental Care, KU Leuven Department of Oral Health Sciences and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium.
| | - Dominique Declerck
- Unit of Paediatric Dentistry and Special Dental Care, KU Leuven Department of Oral Health Sciences and Department of Dentistry, University Hospitals Leuven, Leuven, Belgium
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Usta SN, Eymirli A, Arias-Moliz MT. Evaluation of the removal of 2-Hydroxyisocaproic acid from the root canal and its effect on the bond strength of MTA. AUST ENDOD J 2023; 49:311-317. [PMID: 35852919 DOI: 10.1111/aej.12660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/26/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to evaluate the removal of 2-hydroxyisocaproic acid (HICA) from the root canal system and its effect on the bond strength of the mineral trioxide aggregate (MTA). 126 single-rooted teeth were divided into 3 experimental groups (n = 36) that were treated with double antibiotic paste (DAP), HICA and calcium hydroxide (CH) and one control group (n = 18). In the first part, 18 teeth from each experimental group (n = 54) were examined to remove HICA from the root canal. In the second part, 72 teeth (3 experimental groups (n = 54) and one control group (n = 18)) were used for the evaluation of the push-out bond strength of MTA. There was no statistically significant difference between HICA, DAP and CH residues (p > 0.05). HICA group showed significantly less push-out bond strength (p < 0.05). DAP, HICA and CH could not be removed entirely from the root canal. HICA significantly reduced the bond strength of the MTA.
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Affiliation(s)
- Sıla Nur Usta
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
| | - Ayhan Eymirli
- Department of Endodontics, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey
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Tirez E, Pedano MS. Regeneration of the Pulp Tissue: Cell Homing versus Cell Transplantation Approach: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8603. [PMID: 36500098 PMCID: PMC9736993 DOI: 10.3390/ma15238603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The main objective of this systematic review was to compare the apical healing, root maturation and histological characteristics of teeth treated with cell-based versus cell-free techniques. METHODS The methodology of this review was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search strategy was carried out on PubMed, EMBASE and the Web of Science databases. The last search was done on 1 August 2021. Articles written in languages other than English were excluded. Two researchers independently selected the studies and extracted the data. As no randomized clinical trials were available, animal studies were included. RESULTS In total, 26 studies were included in the systematic review: 22 articles only researched the cell-free technique, 3 articles compared the cell-based to the cell-free technique, and 1 article compared the cell-based technique to apexification. In terms of apical healing, qualitative analysis of the data suggested that there seems to be no significant difference between cell-free and cell-based techniques. The results regarding tooth maturation are contradictory. The main difference between the cell-free and the cell-based techniques seems to be the histology of the treated tooth. The cell-free technique seems to result in cementum-like, bone-like or periodontal ligament-like tissue. One study, on the other hand, found that the cell-based technique resulted in regeneration of the whole pulp with an odontoblast layer, connective tissue, blood vessels and neuronal tissue. CONCLUSIONS Currently, the number of randomized clinical trials on this topic are very scarce. This is probably due to the limited infrastructure and lack of resources to apply the cell-based technique. Even though both techniques seem to be promising for clinical application, long-term data need to be provided regarding the healing and reparative patterns.
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Cushley S, McLister C, Lappin MJ, Harrington M, Nagendrababu V, Duncan HF, El karim I. Outcomes reporting in systematic reviews on revitalization: A scoping review for the development of a core outcome set. Int Endod J 2022; 55:1317-1334. [PMID: 36065159 PMCID: PMC9828673 DOI: 10.1111/iej.13829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/19/2022] [Accepted: 08/26/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Revitalization is a type of regenerative endodontic treatment (RET) that offers the exciting prospect of revitalizing damaged tissue, therefore improving outcomes for non-vital immature teeth. To evaluate its potential, there needs to be consistency in outcome reporting of clinical studies investigating revitalization to allow for evidence synthesis and inform clinical decision making. OBJECTIVES The aim of this scoping review was to identify outcomes that are reported in systematic reviews on revitalization including how and when these outcomes are measured. Additionally, evidence of selective reporting bias in the reviews was assessed. METHODS A comprehensive electronic search of healthcare databases and grey literature was conducted to identify systematic reviews published in the English language reporting outcomes of revitalization in permanent immature teeth. There was no restriction on the date of publication. Outcome data was extracted by four reviewers independently and mapped with a healthcare taxonomy into five core areas: survival, clinical/physiological changes, life impact, resource use and adverse events. Selective reporting bias and how it was measured was assessed independently by two reviewers. RESULTS Twenty-six systematic reviews were included in this scoping review. There was lack of standardization in reporting and significant heterogeneity across reviews in outcome endpoints. The outcomes reported could be aligned within the five core areas of the taxonomy including tooth survival which was reported in nine reviews. Patient-reported outcomes were generally limited and no review reported on Oral Health Related Quality of Life. Many of the reviews reporting on randomized control trials were at low risk of selective reporting bias whilst other study designs were at higher risk. DISCUSSION Consistency in outcome reporting is necessary to realize the benefits of old but particularly novel therapies. Data from this review confirmed heterogeneity in reporting outcomes of revitalization and the need for development of a core outcome set (COS). CONCLUSIONS Several important outcomes including survival, root development, tooth discolouration and periapical healing have been identified in this review which could inform the development of a COS in this area. REGISTRATION Core Outcome Measures in Effectiveness Trials (COMET) database (registration no. 1879).
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Affiliation(s)
- Siobhan Cushley
- School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Conor McLister
- School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Mark J. Lappin
- School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Marc Harrington
- School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental MedicineUniversity of SharjahSharjahUAE
| | - Henry F. Duncan
- Division of Restorative Dentistry & PeriodontologyDublin Dental University Hospital, Trinity College DublinDublinIreland
| | - Ikhlas El karim
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical SciencesQueen's University BelfastBelfastUK
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Expert consensus on regenerative endodontic procedures. Int J Oral Sci 2022; 14:55. [PMID: 36450715 PMCID: PMC9712432 DOI: 10.1038/s41368-022-00206-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 12/05/2022] Open
Abstract
Regenerative endodontic procedures (REPs) is a biologic-based treatment modality for immature permanent teeth diagnosed with pulp necrosis. The ultimate objective of REPs is to regenerate the pulp-dentin complex, extend the tooth longevity and restore the normal function. Scientific evidence has demonstrated the efficacy of REPs in promotion of root development through case reports, case series, cohort studies, and randomized controlled studies. However, variations in clinical protocols for REPs exist due to the empirical nature of the original protocols and rapid advancements in the research field of regenerative endodontics. The heterogeneity in protocols may cause confusion among dental practitioners, thus guidelines and considerations of REPs should be explicated. This expert consensus mainly discusses the biological foundation, the available clinical protocols and current status of REPs in treating immature teeth with pulp necrosis, as well as the main complications of this treatment, aiming at refining the clinical management of REPs in accordance with the progress of basic researches and clinical studies, suggesting REPs may become a more consistently evidence-based option in dental treatment.
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Harish, Kumar P, Soni A, Chakinala AG, Singhal R, Joshi RP, Mukhopadhyay AK. Effect of Molarity on Methylene Blue Dye Removal Efficacy of Nano Ca(OH)
2. ChemistrySelect 2022. [DOI: 10.1002/slct.202200393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Harish
- Manipal University Jaipur Jaipur 303007 Rajasthan India
| | | | - Anshu Soni
- Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Anand Gupta Chakinala
- Department of Chemical Engineering Manipal University Jaipur Jaipur 303007 Rajasthan India
| | - Rahul Singhal
- Department of Physics Malaviya National Institute of Technology Jaipur 302017 India
| | | | - Anoop Kumar Mukhopadhyay
- Manipal University Jaipur Jaipur 303007 Rajasthan India
- Department of Physics Biyani Girls College, Vidhyadhar Nagar Jaipur 302039 Rajasthan India
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