Showing papers in "European Journal of Dentistry in 2016"

Failure of endodontic treatment: The usual suspects

Abstract: Inappropriate mechanical debridement, persistence of bacteria in the canals and apex, poor obturation quality, over and under extension of the root canal filling, and coronal leakage are some of the commonly attributable causes of failure. Despite the high success rate of endodontic treatment, failures do occur in a large number of cases and most of the times can be attributed to the already stated causes. With an ever increasing number of endodontic treatments being done each day, it has become imperative to avoid or minimize the most fundamental of reasons leading to endodontic failure. This paper reviews the most common causes of endodontic failure along with radiographic examples.

A review of computer-aided design/computer-aided manufacture techniques for removable denture fabrication.

Abstract: The aim of this review was to investigate usage of computer-aided design/computer-aided manufacture (CAD/CAM) such as milling and rapid prototyping (RP) technologies for removable denture fabrication. An electronic search was conducted in the PubMed/MEDLINE, ScienceDirect, Google Scholar, and Web of Science databases. Databases were searched from 1987 to 2014. The search was performed using a variety of keywords including CAD/CAM, complete/partial dentures, RP, rapid manufacturing, digitally designed, milled, computerized, and machined. The identified developments (in chronological order), techniques, advantages, and disadvantages of CAD/CAM and RP for removable denture fabrication are summarized. Using a variety of keywords and aiming to find the topic, 78 publications were initially searched. For the main topic, the abstract of these 78 articles were scanned, and 52 publications were selected for reading in detail. Full-text of these articles was gained and searched in detail. Totally, 40 articles that discussed the techniques, advantages, and disadvantages of CAD/CAM and RP for removable denture fabrication and the articles were incorporated in this review. Totally, 16 of the papers summarized in the table. Following review of all relevant publications, it can be concluded that current innovations and technological developments of CAD/CAM and RP allow the digitally planning and manufacturing of removable dentures from start to finish. As a result according to the literature review CAD/CAM techniques and supportive maxillomandibular relationship transfer devices are growing fast. In the close future, fabricating removable dentures will become medical informatics instead of needing a technical staff and procedures. However the methods have several limitations for now.

Halitosis: Current concepts on etiology, diagnosis and management.

Abstract: Halitosis or oral malodor is an offensive odor originating from the oral cavity, leading to anxiety and psychosocial embarrassment. A patient with halitosis is most likely to contact primary care practitioner for the diagnosis and management. With proper diagnosis, identification of the etiology and timely referrals certain steps are taken to create a successful individualized therapeutic approach for each patient seeking assistance. It is significant to highlight the necessity of an interdisciplinary method for the treatment of halitosis to prevent misdiagnosis or unnecessary treatment. The literature on halitosis, especially with randomized clinical trials, is scarce and additional studies are required. This article succinctly focuses on the development of a systematic flow of events to come to the best management of the halitosis from the primary care practitioner's point of view.

Role of Salvadora persica chewing stick (miswak): A natural toothbrush for holistic oral health.

Abstract: From an ancient tool to a modern way of improving oral health, miswak (chewing stick) has proven to be an effective tool for oral health. The miswak removes the bacterial plaque by mechanical and chemical actions. It provides a cheap and easily accessible way of improving oral health of the individuals and populations. The use of miswak was promoted centuries ago by Prophet Muhammad (Peace be Upon Him). In the modern era, the beneficial role of using miswak such as antiseptic, antimicrobial, anticariogenic and analgesic effects have been proven scientifically. This article reviews the various oral health benefits of miswak in the light of religious, scientific and social evidences.

Morse taper dental implants and platform switching: The new paradigm in oral implantology.

Abstract: The aim of this study was to conduct a literature review on the potential benefits with the use of Morse taper dental implant connections associated with small diameter platform switching abutments. A Medline bibliographical search (from 1961 to 2014) was carried out. The following search items were explored: "Bone loss and platform switching," "bone loss and implant-abutment joint," "bone resorption and platform switching," "bone resorption and implant-abutment joint," "Morse taper and platform switching." "Morse taper and implant-abutment joint," Morse taper and bone resorption," "crestal bone remodeling and implant-abutment joint," "crestal bone remodeling and platform switching." The selection criteria used for the article were: meta-analysis; randomized controlled trials; prospective cohort studies; as well as reviews written in English, Portuguese, or Spanish languages. Within the 287 studies identified, 81 relevant and recent studies were selected. Results indicated a reduced occurrence of peri-implantitis and bone loss at the abutment/implant level associated with Morse taper implants and a reduced-diameter platform switching abutment. Extrapolation of data from previous studies indicates that Morse taper connections associated with platform switching have shown less inflammation and possible bone loss with the peri-implant soft tissues. However, more long-term studies are needed to confirm these trends.

Patient-centered evaluation of microsurgical management of gingival recession using coronally advanced flap with platelet-rich fibrin or amnion membrane: A comparative analysis.

Abstract: Objective: To evaluate the efficacy of coronally advanced flap (CAF) procedure under microsurgical approach for the management of Miller's Class I and II gingival recession defects with the use of either platelet-rich fibrin (PRF) or amnion membrane (AM) in comparison to CAF alone. Materials and Methods: A total of 45 sites with Miller's Class I or II gingival recession defect were randomly distributed for: Experimental Group I (CAF with PRF) sites (n = 15) which were treated with the microsurgical approach using CAF along with PRF; experimental Group II (CAF with AM) sites (n = 15) were treated with the microsurgical approach using CAF along with AM; control Group III (CAF alone) sites (n = 15) were treated with the microsurgical approach using CAF alone. Vertical gingival recession (VGR), horizontal gingival recession (HGR), gingival thickness (GT) (using transgingival probing [TGP] and ultrasonography [USG]) and patients' response and acceptance were documented at baseline, 3 months and 6 months after surgical interventions. Results: CAF alone and in combination with PRF or AM, were effective techniques for root coverage with average VGR values of 1.47 ± 0.92 mm (56%), 0.67 ± 1.23 mm (36%) and 0.60 ± 1.06 mm (33%) in Group I (CAF with PRF), Group II (CAF with AM), and Group III (CAF alone), respectively. Complete coverage (100%) was obtained in 33.3% sites of Group I (CAF with PRF), 26.6% sites of Group II (CAF with AM) and 13.3% in Group III (CAF alone). Patients' response and acceptance for surgical treatment modality in terms of patient esthetic score and decrease in hypersensitivity score was highest for Group I (CAF with PRF), whereas patient comfort score was highest for Group II (CAF with AM). At 6 months follow-up, significant increase in GT measurements (using TGP and USG) in Group I (CAF with PRF), whereas, nonsignificant increase for Group II (CAF with AM) and no change or decrease for Group III (CAF alone) as compared to baseline was observed. Conclusion: The present study observed enhancement in root coverage when PRF or AM are used in conjunction with CAF as compared to CAF alone. These results are based on 6-month follow-up. Therefore, the long-term evaluation may be necessary to appreciate the clinical effect of autologous PRF and AM.

Patient satisfaction in Dental Healthcare Centers.

Abstract: Objectives: This study aimed to (1) measure the degree of patient satisfaction among the clinical and nonclinical dental services offered at specialty dental centers and (2) investigate the factors associated with the degree of overall satisfaction. Materials and Methods: Four hundred and ninety-seven participants from five dental centers were recruited for this study. Each participant completed a self-administered questionnaire to measure patient satisfaction with clinical and nonclinical dental services. Analysis of variance, t -tests, a general linear model, and stepwise regression analysis was applied. Results: The respondents were generally satisfied, but internal differences were observed. The exhibited highest satisfaction with the dentists' performance, followed by the dental assistants' services, and the lowest satisfaction with the center's physical appearance and accessibility. Females, participants with less than a bachelor's degree, and younger individuals were more satisfied with the clinical and nonclinical dental services. The stepwise regression analysis revealed that the coefficient of determination ( R 2 ) was 40.4%. The patient satisfaction with the performance of the dentists explained 42.6% of the overall satisfaction, whereas their satisfaction with the clinical setting explained 31.5% of the overall satisfaction. Conclusion: Additional improvements with regard to the accessibility and physical appearance of the dental centers are needed. In addition, interventions regarding accessibility, particularly when booking an appointment, are required.

Socket preservation by beta-tri-calcium phosphate with collagen compared to platelet-rich fibrin: A clinico-radiographic study

Abstract: Objectives: This study was primarily designed to determine the clinico-radiographic efficacy of platelet-rich fibrin (PRF) and beta-tri-calcium phosphate with collagen (β-TCP-Cl) in preserving extraction sockets. Materials and Methods: For Group I (PRF), residual sockets ( n = 15) were filled with autologous PRF obtained from patients' blood; and for Group II (β-TCP-Cl), residual sockets ( n = 15) were filled with β-TCP-Cl. For the sockets randomly selected for Group II (β-TCP-Cl), the reshaped Resorbable Tissue Replacement cone was inserted into the socket. Results: Clinically, there was a significantly greater decrease in relative socket depth, but apposition in midcrestal height in Group II (β-TCP-Cl) as compared to Group I (PRF), whereas more decrease in buccolingual width of Group I (PRF) than Group II (β-TCP-Cl) after 6 months. Radiographically, the mean difference in socket height, residual ridge, and width (coronal, middle, and apical third of socket) after 6 months was higher in Group I (PRF) as compared to Group II (β-TCP-Cl). The mean density (in Hounsfield Units) at coronal, middle, and apical third of socket was higher in Group I (PRF) as compared to Group II (β-TCP-Cl). There were statistically significant apposition and resorption for Group I (PRF) whereas nonsignificant resorption and significant apposition for Group II (β-TCP-Cl) in buccal and lingual/palatal cortical plate, respectively, at 6 months on computerized tomography scan. Conclusion: The use of either autologous PRF or β-TCP-Cl was effective in socket preservation. Results obtained from PRF were almost similar to β-TCP-Cl; therefore being autologous, nonimmune, cost-effective, easily procurable regenerative biomaterial, PRF proves to be an insight into the future biofuel for regeneration.

Uses of electromyography in dentistry: An overview with meta-analysis.

Abstract: Objective: The purpose of this study was to review the uses of electromyography (EMG) in dentistry in the last few years in related research. EMG is an advanced technique to record and evaluate muscle activity. In the previous days, EMG was only used for medical sciences, but now EMG playing a tremendous role in medical as well as dental sector. Materials and Methods: Several electronic databases such as Google Scholar, PubMed, Science Direct, and Web of Science were systematically searched for studies published until July 2015. Results: EMG can be used in both diagnosis and treatment purpose to record neuromuscular activity. In dentistry, we can utilize EMG to evaluate muscular activity in function such as chewing and biting or parafunctional activities such as clenching and bruxism. In case of TMJ and myofascial pain disorders, EMG widely is used in the last few years. Conclusions: EMG is one of biometric tests that occur in the modern evidence-based dentistry practice.

In vitro comparison of antibacterial properties of bioceramic-based sealer, resin-based sealer and zinc oxide eugenol based sealer and two mineral trioxide aggregates

Abstract: Objective: Our goal of the study was to evaluate the antibacterial properties of endodontic sealers against the E. faecalis . Materials and Methods: Six millimeters wells were made for each material in all the preinoculated petri plates. Then, the petri plates were incubated for 24 h. The zones of inhibition appeared were measured, and the measurements were put to statistical analysis. Results: EndoSequence BC Sealer, MM-mineral trioxide aggregate (MTA), and ProRoot MTA showed maximum means of diameter of zones of inhibition, whereas MM-seal and Endoseal did not show any zones of inhibition. Conclusion: EndoSequence BC Sealer was found to be a better endodontic sealer as compared to resin-based and zinc oxide-eugenol-based sealer.

Gingival crevicular fluid periostin levels in chronic periodontitis patients following nonsurgical periodontal treatment with low-level laser therapy.

Abstract: OBJECTIVE Periostin is a matricellular protein highly expressed in periosteum, periodontal ligament and is essential for tissue integrity and maturation. It plays a role in collagen fibrillogenesis and is downregulated in periodontal disease. Biostimulation utilizing low-level laser therapy (LLLT) influences periodontal ligament fibroblast proliferation. This study was conducted with the objective of estimating periostin levels in chronic periodontitis (CP) patients following LLLT as an adjunct to root surface debridement (RSD). MATERIALS AND METHODS Thirty periodontally healthy participants (Group I) and sixty CP participants were recruited. Based on the therapeutic intervention, CP patients were allocated to either RSD (Group II) or to RSD with LLLT (Group III) group. Clinical parameters and gingival crevicular fluid (GCF) periostin levels were assessed at the baseline and at the 3rd month. RESULTS Periostin levels were significantly lower in CP patients when compared to healthy individuals at the baseline (P < 0.01). Following nonsurgical periodontal treatment (NSPT), periostin levels significantly increased in both Group II and III, when compared to baseline values (P < 0.001). Comparison of mean periostin levels between both the treatment groups showed a significant increase in LLLT group than RSD at the 3rd month (P < 0.05). CONCLUSION Within the limitations of the present study, LLLT application was found to have additional benefits over RSD with respect to clinical periodontal parameters and GCF periostin levels. Moreover, periostin may be used as a possible biomarker to evaluate the outcome following NSPT.

Frequency of sucrose exposure on the cariogenicity of a biofilm-caries model.

Abstract: Objective: Although sucrose is considered the most cariogenic carbohydrate in the human diet, the question of how many exposures are needed to induce damage on the hard dental tissues remains unclear. To approach this question, different frequencies of daily sucrose exposure were tested on a relevant biological caries model. Materials and Methods: Biofilms of the Streptococcus mutans were formed on enamel slabs and exposed to cariogenic challenges with 10% sucrose for 5 min at 0, 1, 3, 5, 8, or 10 times per day. After 5 days, biofilms were retrieved to analyze biomass, protein content, viable bacteria, and polysaccharide formation. Enamel demineralization was evaluated by percentage of microhardness loss (percentage surface hardness loss [%SHL]). Results: Biomass, protein content, polysaccharide production, acidogenicity of the biofilm, and %SHL proportionally increased with the number of daily exposures to sucrose (P 0.05). Conclusions: Higher sucrose exposure seems to increase cariogenicity, in a frequency-dependent manner, by the modification of bacterial virulent properties.

Prevalence of C-shaped mandibular molars in the Portuguese population evaluated by cone-beam computed tomography

Abstract: OBJECTIVE The purpose of this study was to evaluate the prevalence of first and second C-shaped mandibular molars in a Western European population of Portuguese Caucasians. MATERIALS AND METHODS Patients having both routine panoramic radiograph and presurgical cone-beam computed tomography (CBCT) exams were selected. The CBCT examination was performed at five different axial levels and the mandibular molars were classified as C-shape according to the Fan criteria. Differences between genders, age groups, left and right side, type of tooth, and root concavity side were determined. The molars were classified as nonfused roots (NFRI-II), FRI-III, or single root with single canal (SS) groups, using the panoramic radiograph. The prevalence of C-shaped anatomy was calculated to each group. RESULTS A total of 1783 teeth (695 first molars and 1088 second molars) from 792 patients were included in the study. The prevalence of C-shaped configurations was 0.6% and 8.5% to mandibular first and second molars, respectively. The differences between gender, teeth, and root concavity direction were considered statistically significant (P < 0.05). The FR had a significantly higher rate of C-shapes when compared to NFR (P < 0.05). Intrarater reliability was 93.6%. CONCLUSIONS The FR radiographic appearance may be considered a predictor of this anatomy. Second mandibular molars and females had a higher incidence ratio. Apparently, the mandibular C-shaped anatomy is more common in the population of this study than that has been previously reported for the European population.

Dental anomalies in children with cleft lip and palate in Western Australia

Abstract: Objective: The purpose of this paper was to describe the prevalence and type of dental anomalies in the primary and permanent dentition in children with a cleft condition at Princess Margaret Hospital in Perth, Western Australia. Materials and Methods: The details of 162 current dental patients extracted from the main dental database through their year of birth for the period 1998–2001 were selected consecutively. Dental records and X-rays were examined by one examiner (WN) and verified by a second examiner (RB) to determine dental development. The mean age of the subjects was 10.8 years with equal numbers of males and females. Subjects were further divided into cleft type; unilateral cleft lip (UCL) and palate, bilateral cleft lip (BCL) and palate, UCL, BCL, and cleft palate. Results: One hundred sixty-two subjects were grouped into 21 categories of anomaly or abnormality. Prevalence rates for the categories were calculated for the overall group and for gender and cleft type. Conclusion: Overall, 94% of patients were found to have at least one dental anomaly, with fifty-six (34%) patients having more than one anomaly or abnormality.

A review of ethanol wet-bonding: Principles and techniques.

Abstract: Conventional water wet-bonding technique has been advocated by many scientists, but the excess water will induce suboptimal polymerization of dental adhesives, phase separation, and nanoleakage, which will influence the longevity of resin-dentin interfaces. Recent studies have put forward a new concept, ethanol wet-bonding. This technique can increase in dentin bond durability. This review focuses on the principles of ethanol wet-bonding, its surface treatment methods.

Evaluation of the bond strength of root-end placed mineral trioxide aggregate and Biodentine in the absence/presence of blood contamination.

Abstract: Objective: Mineral trioxide aggregate (MTA) has been accepted as an appropriate root-end filling material in endodontic microsurgery because of setting ability in the wet environment. The aim of this study was to assess the bond strength of root-end placed MTA and Biodentine (Septodont, Saint Maur des Fosses, France) in the absence/presence of blood contamination. Materials and Methods: Forty-eight single-rooted maxillary incisors were used. subsequent to root-end resection and apical preparation using ultrasonic retro-tips, the specimens were randomly separated into two groups according to the root-end filling materials: MTA (Cerkamed Medical Company, Stalowa, Poland) or Biodentine. The specimens were then separated into two subgroups according to storage condition (absence/presence of blood) ( n = 12). After obtaining 2.0 ± 0.1 mm slices, push-out tests were performed. Each slice was examined under a stereomicroscope to evaluate the failure mode. The data were analyzed using two-way analysis of variance and Tukey's post hoc test for multiple comparisons. The failure modes were analyzed using the Chi-square test ( P = 0.05). Results: The bond strength was significantly affected by the presence of blood contamination and root-end filling material type ( P P P = 0.394). Conclusions: Biodentine had better bond strength values compared to MTA, and the bond strength of both MTA and Biodentine as root-end filling materials was negatively affected by the presence of blood.

Effect of at-home bleaching with different thickeners and aging on physical properties of a nanocomposite

Abstract: Objective: To evaluate the influence of 16% carbamide peroxide (CP) containing different thickeners on the physical characteristics of a nanocomposite resin submitted or not to accelerated artificial aging (AAA). Materials and Methods: One hundred samples were randomly distributed into two groups ( n = 50) according to AAA. Each group was divided into 5 subgroups ( n = 10) depending on the bleaching/thickener treatment: CP + carbopol, CP + natrosol, carbopol, natrosol, and no treatment (control). The physical properties tested were color (ΔE), gloss (GU), mean roughness (Ra), and Knoop microhardness (KHN). The resin surface was performed with atomic force microscopy (AFM). Statistical Analysis: The color (variable Δ E) was assessed with two-way analysis of variance (ANOVA) and additionally with Tukey's and Dunnett's tests, the roughness values were submitted to Kruskal–Wallis, Dunn's, and Mann–Whitney's tests. Data on gloss and KHN were submitted to two-way ANOVA and Tukey's test (α = 0.05). Results: Among the physical properties evaluated, CP + carbopol promoted a reduction in composite microhardness only, thus differing statistically from the controls. As for CP + natrosol, such a change was not observed. The aging process reduced all the physical properties, thus differing statistically from the nonaging group. CP + carbopol increased the roughness and decreased the gloss of aged resins, whereas natrosol reduced gloss only, which differed statistically from the controls. Conclusions: AFM showed evidence of the loss of organic matrix and exposure to load particles in the aged samples. Therefore, the replacement of carbopol with natrosol provided maintenance of the composite microhardness following bleaching. The aging process reduced the physical properties evaluated, and some changes were enhanced by the application of bleaching.

Efficiency of gaseous ozone in reducing the development of dry socket following surgical third molar extraction.

Abstract: Objective: The objective of this study was to assess the efficacy of ozone gas (O 3 ) on the reduction of dry socket (DS) occurrence following surgical extraction of lower jaw third molars, influence of the indication for the extraction, and the difficulty of extraction on the incidence of DS. Materials and Methods: This study included thirty patients with bilaterally impacted third molars of mandible requiring surgical procedure for extraction. Following extraction, in the control group, saline solution was used for irrigation of extraction sockets and in the experimental group, intra-alveolar O 3 was applied for 12 s (Prozone, W and H, UK, Ltd.). The surgeries were performed by the same oral surgeon. The follow-up visits were performed at 48 h and on day seven, postsurgery where the symptoms of DS were evaluated and intensity of pain has been recorded using visual analog scale 0–100. Results: In this pilot study, DS was present in 16.67% and 3.33% of cases in the control and experimental groups, respectively ( P = 0.20). Conclusion: The application of O 3 may reduce the incidence of DS and accelerates the recovery period after the surgery. Prophylactic use of O 3 may be suggested in all patients, especially in the patients at a risk of development of DS.

Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: A comparative study

Abstract: Objective: The present comparative study was aimed to determine the effectiveness of Th US and TENS in the management of myofascial pain in TMD patients. Materials and Methods: The present randomized comparative study was on 90 patients who were further assigned in three different groups each having 30 patients; Group I was healthy control patients, Group II was receiving Th US therapy, and Group III was receiving TENS therapy. All the 90 patients were further evaluated for maximum inter incisor subjective evaluation regarding muscle pain, impediment to daily life, massage impression on visual analog scale (VAS) scale, and intensity and duration used in Th US massage. Results: The masseter muscle thickness in control group was 12.00 (standard deviation [SD] ±1.1) mm when compared with TMD patient of 13.00 (SD ± 1.1) mm before treatment. Statistical significant findings on VAS score of muscle pain, impediment to daily life, and massage impression were observed in Th US. After treatment, the anechoic areas disappeared or were reduced in Th US group by 95.6% and in TENS by 74.4%. Conclusion: Th US appeared to be subjectively better which was related to VAS score of massage impression, muscle pain, and impediment to daily life after treatment as well as sonographically related to existence of anechoic areas.

Fracture resistance of simulated immature teeth after apexification with calcium silicate-based materials.

Abstract: Objective: To compare the fracture resistance of simulated immature teeth filled with an apical barrier of mineral trioxide aggregate (MTA), Biodentine, and calcium-enriched mixture (CEM). Materials and Methods: Fifty-two single-rooted human maxillary central incisors were used. For standardization, the teeth were sectioned 6 mm above and 9 mm below the cementoenamel junction to simulate immature apex. Simulations of roots into immature apices were carried out using 1.5 mm diameter drills. The specimens were then randomly divided into three experimental groups ( n = 13) and one control group ( n = 13). In experimental groups, MTA, Biodentine, and CEM were placed to apical 4 mm of the simulated immature roots. The samples were stored at 37° C and 100% humidity for 1 week. A load was applied on the crown of all teeth at 135° to their long axis until fracture. The data were analyzed using one-way analysis of variance and Tukey post-hoc tests. Results: No statistically significant differences were found among MTA, CEM, and Biodentine ( P > 0.05), and these groups demonstrated higher fracture resistance than control group ( P Conclusions: Using any of the MTA, Biodentine, and CEM as an apical plug and restoring with fiber post and composite resin increases the fracture resistance of immature teeth.

The Effect of Surface Sealants With Different Filler Content on Microleakage of Class V Resin Composite Restorations

Abstract: Objective: Microleakage is still one of the most cited reasons for failure of resin composite restorations. Alternative methods to prevent microleakage have been investigated increasingly. The aim of this study is to evaluate the microleakage in Class V resin composite restorations with or without application of surface sealants with different filler content. Materials and Methods: Ninety-six cavities were prepared on the buccal and lingual surfaces with the coronal margins located in enamel and the cervical margins located in dentin. The cavities restored with an adhesive system (Clearfil SE Bond, Kuraray, Tokyo, Japan) and resin composite (Clearfil Majesty ES-2, Kuraray, Tokyo, Japan). Teeth were stored in distilled water for 24 h and separated into four groups according to the surface sealants (Control, Fortify, Fortify Plus, and G-Coat Plus). The teeth were thermocycled (500 cycles, 5–55° C), immersed in basic fuchsine, sectioned, and analyzed for dye penetration using stereomicroscope. The data were submitted to statistical analysis by Kruskal–Wallis and Bonferroni–Dunn test. Results: The results of the study indicated that there was minimum leakage at the enamel margins of all groups. Bonferroni–Dunn tests revealed that Fortify and GC-Coat groups showed significantly less leakage than the Control group and the Fortify Plus group at dentin margins in lingual surfaces ( P Conclusion: The all surface sealants used in this study eliminated microleakage at enamel margins. Moreover, unfilled or nanofilled surface sealants were the most effective in decreasing the degree of marginal microleakage at dentin margins. However, viscosity and penetrability of the sealants could be considered for sealing ability besides composition.

Biomechanics of cervical tooth region and noncarious cervical lesions of different morphology; three-dimensional finite element analysis.

Abstract: Objective: The present study aims to investigate the influence of presence and shape of cervical lesions on biomechanical behavior of mandibular first premolar, subjected to two types of occlusal loading using three-dimensional (3D) finite element method (FEM). Materials and Methods: 3D models of the mandibular premolar are created from a micro computed tomography X-ray image: model of sound mandibular premolar, model with the wedge-shaped cervical lesion (V lesion), and model with saucer-shaped cervical lesion (U lesion). By FEM, straining of the tooth tissues under functional and nonfunctional occlusal loading of 200 (N) is analyzed. For the analysis, the following software was used: CTAn program 1.10 and ANSYS Workbench (version 14.0). The results are presented in von Mises stress. Results: Values of calculated stress in all tooth structures are higher under nonfunctional occlusal loading, while the functional loading is resulted in homogeneous stress distribution. Nonfunctional load in the cervical area of sound tooth model as well as in the sub-superficial layer of the enamel resulted with a significant stress (over 50 [MPa]). The highest stress concentration on models with lesions is noticed on the apex of the V-shaped lesion, while stress in saucer U lesion is significantly lower and distributed over wider area. Conclusion: The type of the occlusal teeth loading has the biggest influence on cervical stress intensity. Geometric shape of the existing lesion is very important in the distribution of internal stress. Compared to the U-shaped lesions, V-shaped lesions show significantly higher stress concentrations under load. Exposure to stress would lead to its progression.

The maxillary molar endodontic access opening: A microscope-based approach.

Abstract: This article reviews the basic clinical techniques of performing a maxillary molar endodontic access opening, starting from the initial access opening into the pulp chamber, to the point where a size #10 file has been advanced to the apices of all three or four (or more) canals. The article explains how the use of the dental surgical operating microscope or microscope-level loupes magnification of ×6-8 or greater, combined with head-mounted or coaxial illumination, improve the ability of a dentist to identify microscopic root canal orifices, which facilitates the efficient creation of conservative access openings with adequate straight-line access in maxillary molars. Magnified photos illustrate various microscopic anatomical structures or landmarks of the initial access opening. Techniques are explored for implementing an access opening for teeth with vital versus necrotic pulpal tissues. The article also explores the use of piezoelectric or ultrasonic instruments for revealing root canal orifices and for removing pulp stones or calcified pulpal tissue inside the pulp chamber.

Shear bond strength of bulk-fill and nano-restorative materials to dentin.

Abstract: Objectives: Bulk-fill composite materials are being developed for preparation depths of up to 4 mm in an effort to simplify and improve the placement of direct composite posterior restorations. The aim of our study was to compare shear-bond strength of bulk-fill and conventional posterior composite resins. Materials and Methods: In this study, 60 caries free extracted human molars were used and sectioned parallel to occlusal surface to expose midcoronal dentin. The specimens were randomly divided into four groups. Total-etch dentine bonding system (Adper Scotchbond 1XT, 3M ESPE) was applied to dentin surface in all the groups to reduce variability in results. Then, dentine surfaces covered by following materials. Group I: SonicFill Bulk-Fill, Group II: Tetric EvoCeram (TBF), Group III: Herculite XRV Ultra, and Group IV: TBF Bulk-Fill, 2 mm × 3 mm cylindrical restorations were prepared by using application apparatus. Shear bond testing was measured by using a universal testing machine. Kruskal–Wallis and Mann–Whitney U-tests were performed to evaluate the data. Results: The highest value was observed in Group III (14.42 ± 4.34) and the lowest value was observed in Group IV (11.16 ± 2.76) and there is a statistically significant difference between these groups ( P = 0.046). However, there is no statistically significant difference between the values of other groups. In this study, Group III was showed higher strength values. Conclusion: There is a need for future studies about long-term bond strength and clinical success of these adhesive and bulk-fill systems.

Comparative evaluation of superoxide dismutase, alpha-tocopherol, and 10% sodium ascorbate on reversal of shear bond strength of bleached enamel: An in vitro study

Abstract: Objective: The aim of this study was to investigate the neutralizer effect of antioxidant agents on the bond strength of bleached enamel. Materials and Methods: Sixty enamel slabs were prepared from 60 freshly extracted maxillary central incisors and were divided into six groups. The negative control group received no bleaching treatment and the other groups were bleached with 35% carbamide peroxide (Opalescence Quick; Ultradent, South Jordan, USA). In Group II, composite was built immediately after bleaching and cured without any antioxidants. In Group III, bleached specimens received composite build ups delayed by 1 week. In Groups IV, V, and VI bleached specimens received applications of superoxide dismutase (SOD), sodium ascorbate (SA), and tocopherol solutions, respectively, for 10 min. Following composite bonding, the micro shear bond strength (μSBS) was measured at a speed of 1 mm/min in universal testing machine. Statistical Analysis Used: The μSBS values of all the groups were analyzed using the analysis of variance followed by Tukey honestly significant difference post - hoc test. Results: Bonding of composites to unbleached group (Group I) exhibited the highest mean SBS values and among the antioxidant-treated groups, the highest SBS values were seen with SOD (Group IV) treated samples (23.0040 ± 4.30565 MPa). Conclusions: Application of SA, alpha-tocopherol, and SOD can effectively reverse the bond strength with bleached enamel. SOD gave a comparatively more promising reversal of bond strength than SA and alpha-tocopherol, and deserves further studies.

Patients' satisfaction and maintenance of fixed partial denture.

Abstract: Objectives: The aims of this study were to evaluate patient satisfaction with fixed prosthesis following placement and to assess the oral health and oral hygiene practices awareness by survey questionnaire. Materials and Methods: One hundred and ninety-two questionnaires were filled by patients wearing fixed prosthesis; the questionnaire included the subjective perception of treatment with fixed prosthesis, patients’ perception of clinical outcome, regarding esthetics, masticatory function, speech, and together patient's attitude toward oral hygiene measures. Results: Results showed that 84% of the patients were satisfied with their fixed prosthesis, while only 46.4% of patients were satisfied with the chewing ability. In concern, with esthetic outcome, 80% of patients showed that they were satisfied with the esthetic. The results showed that a high significantly number of patients did not use any form of interdental aids’ to clean their fixed prosthesis (94%). The main reason for not using any dental aids’ (91.1%) was a lack of post fixed prosthodontics instructions and not been informed by the dentist. Conclusion: High percentages of patients were satisfied with their fixed prosthesis. The most important finding of this study was that majority of patients showed a lack of knowledge regarding post fixed prosthodontics instructions and the significance of maintenance of fixed prosthesis using dental aids’. Of particular concern was the majority of dentists did not pay attention to the post treatment instructions concerning the maintenance of fixed prosthesis.

Dental prosthetic status and treatment needs of adult population in Jizan, Saudi Arabia: A survey report.

Abstract: Objectives: The study aimed to evaluate and compare the dental prosthetic status and treatment needs of adult population in Jizan, Saudi Arabia, in relation to the age. Materials and Methods: A total of 1779 people aged 35–74 years from 4 survey areas ( Hay al matar, Mahata khams, Dara ut tawhid, and Suq ad dakhili ) selected through convenient sampling, around Jizan University, were surveyed, using the WHO survey criteria, 1997. Statistical Analysis: Number and percentages were calculated, and univariate analysis was performed using Chi-square test at 5% level of significance. Results: Different forms of prosthesis were present among patients in the upper (19.9%) and lower (19%) arches, respectively. Prosthetic treatment need was recognized in subjects, 56.4% for the upper and 57.2% for the lower arches, respectively. The prosthetic status and treatment needs differed statistically with respect to age. Conclusion: More than half of the surveyed adult populations were in need of some or the other forms of prosthesis. This study provides data for an oral health-care provider program for Jizan.

Comparing the effects of manual and ultrasonic instrumentation on root surface mechanical properties.

Abstract: Objective: The aim of the current study is to analyze the surface profiles of healthy and periodontal-treated roots. In addition, manual and ultrasonic instrumentation methods have been compared in terms of surface mechanical properties of root surfaces including surface roughness, hardness, and elastic modulus. Materials and Methods: This study was conducted using extracted teeth that were randomly divided into two study groups (1 and 2). Root planing was performed using either Gracey curettes (Group 1) or ultrasonic scaler (Group 2). The noncontact profilometer was used to analyze surface roughness before and after root planing. A nanoindenter was used to analyze the surface mechanical properties. Results: The root planing treatment reduced the peak and valley heights hence decreasing the surface roughness. The average maximum height of peaks (Sp) and average maximum height of valleys (Sv) for control groups remain 83.08 ± 18.47 μm and 117.58 ± 18.02 μm. The Sp was reduced to 32.86 ± 7.99 μm and 62.11 ± 16.07 μm for Groups 1 and 2, respectively. The Sv was reduced to 49.32 ± 29.51 μm for Group 1 and 80.87 ± 17.99 μm Group 2. The nanohardness and modulus of elasticity for cementum of the control group remain 0.28 ± 0.13 GPa and 5.09 ± 2.67 GPa, respectively. Conclusions: Gracey curettes and ultrasonic scalers are capable of significantly reducing the roughness following root planing. Although Gracey curettes produced smoother surfaces than ultrasonic scalers, there was no significant difference.

Effect of platelet-rich plasma concentrations on the proliferation of periodontal cells: An in vitro study.

Abstract: Objective: The purpose of this study was to evaluate the effect of different concentrations of platelet-rich plasma (PRP) on the proliferation of undifferentiated periodontal ligament (PDL) fibroblasts. Materials and Methods: The undifferentiated PDL fibroblasts were obtained from two healthy human premolar teeth and cultured in Dulbecco's modified Eagle's medium. Cell wells were divided into five groups. Experimental groups received 0.1%, 5%, or 50% PRP; the positive and negative control groups were cultured in fetal bovine serum (FBS) 12% and in a medium without FBS 12%, respectively. The plates were incubated at 37°C for 1, 2, 3, 4, and 7 days. PDL cell viability was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide proliferation assay. Statistical analysis of the data was accomplished using repeated measure ANOVA and Tukey's test. P Results: The 5% PRP had the greatest effect on undifferentiated fibroblast proliferation, which was significant on the 3 rd day. There was no significant difference between 0.1% PRP and positive control during the first 3 days. The group with 50% PRP presented significantly lower proliferation, compared to other experimental and control groups. Conclusions: It may be concluded that the growth-stimulating effect of PRP is dose dependent with the best results in low concentrations.

Advancements in all-ceramics for dental restorations and their effect on the wear of opposing dentition.

Abstract: Tooth wear is a process that is usually a result of tooth to tooth and/or tooth and restoration contact. The process of wear essentially becomes accelerated by the introduction of restorations inside the oral cavity, especially in case of opposing ceramic restorations. The newest materials have vastly contributed toward the interest in esthetic dental restorations and have been extensively studied in laboratories. However, despite the recent technological advancements, there has not been a valid in vivo method of evaluation involving clinical wear caused due to ceramics upon restored teeth and natural dentition. The aim of this paper is to review the latest advancements in all-ceramic materials, and their effect on the wear of opposing dentition. The descriptive review has been written after a thorough MEDLINE/PubMed search by the authors. It is imperative that clinicians are aware of recent advancements and that they should always consider the type of ceramic restorative materials used to maintain a stable occlusal relation. The ceramic restorations should be adequately finished and polished after the chair-side adjustment process of occlusal surfaces.