Showing papers in "Clinical, Cosmetic and Investigational Dentistry in 2015"

Cariogram outcome after 90 days of oral treatment with Streptococcus salivarius M18 in children at high risk for dental caries: results of a randomized, controlled study.

Abstract: Dental caries is the most common chronic disease of childhood. Cariogram is a well-recognized algorithm-based software program based on different caries-related risk factors and intended to aid clinicians in performing more objective and consistent dental caries risk assessments. This type of approach precedes the diagnosis of caries and allows the dentist to identify at-risk patients and then take appropriate preventive measures before caries develop further. One of the etiological factors favoring the development of dental caries is the mutans streptococci. These acidogenic dental plaque inhabitants can be effectively antagonized by the activity of bacteriocins released by the probiotic Streptococcus salivarius M18 (salivarius M18). Moreover, salivarius M18 after colonizing the human oral mucosa produces the enzymes dextranase and urease that are able to counteract plaque formation and saliva acidity, respectively. Seventy-six subjects at high risk of dental caries were randomized and then either treated or not treated for 90 days with an oral formulation containing the oral probiotic salivarius M18 (Carioblis(®)). The results indicate that the use of salivarius M18 increases the chances of avoiding new dental caries development in children, and its application could be proposed as a new tool in the dentist's armory to be adopted in subjects considered at high risk on the basis of their Cariogram outcome.

Papillon-Lefèvre syndrome: clinical presentation and management options.

Abstract: Papillon-Lefevre syndrome (PLS) is a rare autosomal recessive disorder, characterized by diffuse palmoplantar keratoderma and precocious aggressive periodontitis, leading to premature loss of deciduous and permanent dentition at a very young age. Various etiopathogenic factors are associated with the syndrome, like immunologic alterations, genetic mutations, and the role of bacteria. Dentists play a significant role in the diagnosis and management of PLS as there are characteristic manifestations like periodontal destruction at an early age and an early eruption of permanent teeth. Here, we are presenting an elaborate review of PLS, its etiopathogenesis, clinical presentation, and management options.

Pediatric dental sedation: challenges and opportunities

Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

The perception of smile attractiveness among Saudi population.

Abstract: Parameters of dental beauty change across time for varying reasons. Thus, an understanding of the factors that help or harm the attractiveness of a smile is an important step in creating attractive smiles. This study aimed to identify factors that affect smile perception and attractiveness among the Saudi population. A cross-sectional study was conducted among the Saudi population. Questionnaires were distributed to 130 dentists and final-year dental students, and to 130 laypersons. The questionnaire contained six smile photographs created by Photoshop® software. There was a statistically significant difference in scale ratings, based on participant background, for the “gummy” smile picture (P-value =0.003), diastema picture (P-value =0.000) and the “Reverse” smile picture (P-value =0.004). As for sex, males significantly underscored the gummy picture (P-value =0.009). Older people accepted the gummy smile less than did younger people, but diastema was considered as one of the variations that spoiled the attractiveness of the smile. “Dental background” participants significantly identified the ideal smile better than the “nondental” group. The perception of diastema as a sign of beauty among Saudi population in the past has definitely changed, according to the results of our study, where diastema and reverse smile received the lowest score in this survey.

Scanning electron microscopy analysis of the growth of dental plaque on the surfaces of removable orthodontic aligners after the use of different cleaning methods.

Abstract: Background Advances in orthodontics are leading to the use of minimally invasive technologies, such as transparent removable aligners, and are able to meet high demands in terms of performance and esthetics. However, the most correct method of cleaning these appliances, in order to minimize the effects of microbial colonization, remains to be determined. Purpose The aim of the present study was to identify the most effective method of cleaning removable orthodontic aligners, analyzing the growth of dental plaque as observed under scanning electron microscopy. Methods Twelve subjects were selected for the study. All were free from caries and periodontal disease and were candidates for orthodontic therapy with invisible orthodontic aligners. The trial had a duration of 6 weeks, divided into three 2-week stages, during which three sets of aligners were used. In each stage, the subjects were asked to use a different method of cleaning their aligners: 1) running water (control condition); 2) effervescent tablets containing sodium carbonate and sulfate crystals followed by brushing with a toothbrush; and 3) brushing alone (with a toothbrush and toothpaste). At the end of each 2-week stage, the surfaces of the aligners were analyzed under scanning electron microscopy. Results The best results were obtained with brushing combined with the use of sodium carbonate and sulfate crystals; brushing alone gave slightly inferior results. Conclusion On the basis of previous literature results relating to devices in resin, studies evaluating the reliability of domestic ultrasonic baths for domestic use should be encouraged. At present, pending the availability of experimental evidence, it can be suggested that dental hygienists should strongly advise patients wearing orthodontic aligners to clean them using a combination of brushing and commercially available tablets for cleaning oral appliances.

An anthropometric study to evaluate the correlation between the occlusal vertical dimension and length of the thumb.

Abstract: Background Establishment of proper occlusal vertical dimension (OVD) is one of the important tasks for successful prosthodontic therapy. An ideal method for determining OVD in terms of cost, time, and instrument requirements has been sought in prosthodontics by various investigators. However, no such single method has been formulated. In the current anthropometric study, the relationship of the length of the thumb to the OVD was tested in two ethnic groups of Nepal, Aryans, and Mongoloids. The result of this study can be useful in determining proper OVD in edentulous patients.

Cytotoxicity of a novel nano-silver particle endodontic irrigant

Abstract: PURPOSE The aim of this study was to evaluate the cytotoxic effect of a novel nano-silver particle (25.2±6.5 nm) endodontic irrigant (0.2 mM) and compare it with 3% sodium hypochlorite. MATERIALS AND METHODS Two cell types, mouse fibroblast National Institutes of Health 3T3 (NIH 3T3) and primary human periodontal ligament stem cell (hPDLSCs) were used in a test for the effect of direct and indirect (by separating the agent and cell with a layer of agar) exposure to the two solutions. In the direct exposure experiment, ten groups of cell cultures were exposed to one dilution (3:1, 2:1, 1:1, 1:2, 1:3, 1:4, 1:5, 1:6 or 1:7) of a nano-silver irrigant for 48 hours; the concentration-response function was estimated by determining the number of viable cells in each group by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The 50% lethal dose of the testing irrigant for NIH3T3 and hPDLSCs were estimated. In the second part of the experiment, a modified agar overlaying technique was applied. Twelve culture wells (6-well plate) were divided into three groups (n=4). The cell lysis zone (cytotoxic range) created by the stock nano-silver solution, 3% sodium hypochlorite, and an isotonic phosphate buffering saline (control) was measured by two double blinded observers (Kappa score =100%). The cytotoxic score of specific irrigant was derived by modified Sjogren's method. RESULTS The 50% lethal doses of the testing nano silver irrigant for NIH 3T3 and hPDLSCs after 48 hours of direct exposure were 0.58 and 0.608 dilution of stock solution, respectively. The cytotoxic scores of nano-silver irrigant and control (phosphate buffered saline) on NIH 3T3 were 0.25 (95% confidence interval [CI] =0 to 1.04) and 0 (95% CI =0 to 0); and on hPDLSCs were 0.13 (95% CI =0 to 0.52) and 0.25 (95% CI =0 to 1.04), respectively. Toxicity of the test and control group on both mouse fibroblasts (P>0.05) and hPDLSCs (P=1.00) was not statistically different. CONCLUSION Our results showed that the nano-silver irrigant was non-cytotoxic to both NIH 3T3 and hPDLSCs.

Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report.

Abstract: Aim This case report describes a serious and life-threatening complication of the use of sodium hypochlorite as an irrigation solution in root canal therapy.

Does the use of a novel self-adhesive flowable composite reduce nanoleakage?

Abstract: Objective The aim of the study reported here was to evaluate the performance of a self-adhesive flowable composite and two self-etching adhesive systems, when subjected to cyclic loading, in preventing the nanoleakage of Class V restorations. Methods Wedge-shape Class V cavities were prepared (4×2×2 mm [length × width × depth]) on the buccal surfaces of 90 sound human premolars. Cavities were divided randomly into three groups (n=30) according to the used adhesive (Xeno(®) V [self-etching adhesive system]) and BOND-1(®) SF (solvent-free self-etching adhesive system) in conjunction with Artiste(®) Nano Composite resin, and Fusio™ Liquid Dentin (self-adhesive flowable composite), consecutively. Each group was further divided into three subgroups (n=10): (A) control, (B) subjected to occlusal cyclic loading (90N for 5,000 cycles), and (C) subjected to occlusal cyclic loading (90N for 10,000 cycles). Teeth then were coated with nail polish up to 1 mm from the interface, immersed in 50% silver nitrate solution for 24 hours and tested for nanoleakage using the environmental scanning electron microscopy and energy dispersive analysis X-ray analysis. Data were statistically analyzed using two-way analysis of variance and Tukey's post hoc tests (P≤0.05). Results The Fusio Liquid Dentin group showed statistically significant lower percentages of silver penetration (0.55 μ) compared with the BOND-1 SF (3.45 μ) and Xeno V (3.82 μ) groups, which were not statistically different from each other, as they both showed higher silver penetration. Conclusion Under the test conditions, the self-adhesive flowable composite provided better sealing ability. Aging of the two tested adhesive systems, as a function of cyclic loading, increased nanoleakage.

Piezosurgery in implant dentistry

Abstract: Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies.

Hard and soft tissue correlations in facial profiles: a canonical correlation study.

Abstract: Background The purpose of this study was to analyze the relationship between facial hard and soft tissues in normal Saudi individuals by studying the canonical correlation between specific hard tissue landmarks and their corresponding soft tissue landmarks. Methods A retrospective, cross-sectional study was designed, with a sample size of 60 Saudi adults (30 males and 30 females) who had a class I skeletal and dental relationship and normal occlusion. Lateral cephalometric radiographs of the study sample were investigated using a series of 29 linear and angular measurements of hard and soft tissue features. The measurements were calculated electronically using Dolphin(®) software, and the data were analyzed using canonical correlation. Results Eighty-four percent of the variation in the soft tissue was explained by the variation in hard tissue. Conclusion The position of the upper and lower incisors and inclination of the lower incisors influence upper lip length and lower lip position. The inclination of the upper incisors is associated with lower lip length.

Guided bone augmentation using ceramic space-maintaining devices : The impact of chemistry

Abstract: The purpose of the study was to evaluate histologically, whether vertical bone augmentation can be achieved using a hollow ceramic space maintaining device in a rabbit calvaria model. Furthermore, the chemistry of microporous hydroxyapatite and zirconia were tested to determine which of these two ceramics are most suitable for guided bone generation. 24 hollow domes in two different ceramic materials were placed subperiosteal on rabbit skull bone. The rabbits were sacrificed after 12 weeks and the histology results were analyzed regarding bone-to-material contact and volume of newly formed bone. The results suggest that the effect of the microporous structure of hydroxyapatite seems to facilitate for the bone cells to adhere to the material and that zirconia enhance a slightly larger volume of newly formed bone. In conclusion, the results of the current study demonstrated that ceramic space maintaining devices permits new bone formation and osteoconduction within the dome.

Calcifying cystic odontogenic tumor associated with an odontome - a diverse lesion encountered.

Abstract: The human jaw is an exclusive habitat for odontogenic lesions. Ghost cells associated odontogenic lesions are a diverse group with a variety of presentations in the jaws. Calcifying cystic odontogenic tumor is a benign cystic neoplasm of odontogenic origin which demonstrates ghost cells in the epithelial component. This tumor sometimes mimics the features of a cyst clinically and radiographically, but histopathologically as well as behavior-wise shows the features of a tumor. Many classification systems have been proposed and revised from time to time. Presently a dualistic concept is highlighted to classify this group of lesions. The present case highlights a case of calcifying cystic odontogenic tumor associated with a complex composite odontome, which appeared like a cyst clinically and radiographically.

Multi-disciplinary approach for enhancing orthodontic esthetics – case report

Abstract: Background In contemporary dental care, an increasing number of adult patients are now seeking orthodontic treatment with the primary motive of improvement in appearance and achievement of esthetic smile. Proper recognition of the dental and facial defects at the outset of treatment is the most important key to esthetic success and is essential in satisfying the patient’s needs. By following the rules of Golden proportion smiles can be made attractive, harmonious, symmetrical, and proportionate.

Progressive immediate loading of a perforated maxillary sinus dental implant: a case report

Abstract: The displacement of a dental implant into the maxillary sinus may lead to implant failure due to exposure of the apical third or the tip of the implant beyond the bone, resulting in soft tissue growth. This case report discusses dental implant placement in the upper first molar area with maxillary sinus involvement of approximately 2 mm. A new technique for progressive implant loading was used, involving immediately loaded implants with maxillary sinus perforation and low primary stability. Follow-up was performed with resonance frequency analysis and compared with an implant placed adjacent in the upper second premolar area using a conventional delayed loading protocol. Implants with maxillary sinus involvement showed increasing stability during the healing period. We found that progressive implant loading may be a safe technique for the placement of immediately loaded implants with maxillary sinus involvement.