Showing papers in "European Journal of Dentistry in 2019"

Comparison of the Efficacy of Three Different Bone Regeneration Materials: An Animal Study.

Abstract: Objective The proposed study aimed to evaluate and compare the bone regeneration between commercially available hydroxyapatite–β-tricalcium phosphate (Ossifi; Equinox, the Netherlands), powdered polylactic acid (powdered PLA; Sigma-Aldrich, United States), and three-dimensionally printed PLA (3D-printed PLA; Cubex, SC, United States) using 3D printer (Cube X trio) in an animal model. Materials and Methods Eighteen New Zealand rabbits were divided into three groups with six animals each. Platelet-rich fibrin (PRF) was collected from the venous blood and preserved. Bone defect (4 mm × 2 mm) without disturbing the bone marrow was created and filled with bone graft material (group 1–Ossifi, group 2–powdered PLA, and group 3–3D-printed PLA), over which PRF membranes were placed. The graft material and the barrier were stabilized using resorbable sutures, and all the animals were maintained for 4, 8, and 12 weeks, after which they were euthanized, and bone samples were retrieved. Retrieved bone samples were subjected to radiological and histological analysis. Results The radiographic and histological changes of 3D-printed PLA in comparison with other two materials (Ossifi and powdered PLA) seemed to have a significant difference. Conclusion 3D-printed PLA scaffolds showed positive signs of bone regeneration around the material in continuity defects. PLA material can be a promising alternative bone regenerative material.

From Platelet-Rich Plasma to Advanced Platelet-Rich Fibrin: Biological Achievements and Clinical Advances in Modern Surgery.

Abstract: In the past 20 years, the platelet concentrates have evolved from first-generation products, i.e., platelet-rich plasma (PRP) and plasma rich in growth factors to the second-generation products such as leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF). These autologous products with a higher leukocyte inclusion and flexible fibrin mesh act as a scaffold to increase cellular migration in the angiogenic, osteogenic, and antimicrobial potential of these biomaterials in tissue regeneration. In the second-generation platelet concentrates, the protocols are easier, cheaper, and faster with an entire physiological fibrin matrix, resulting in a tridimensional mesh, not as rigid as one of the first generations. This allows the slow release of molecules over a longer period of time and triggers the healing and regenerative process at the site of injury. The potential of A-PRF to mimic the physiology and immunology of wound healing is also due to the high concentration of growth factors released as follows: vascular endothelial growth factor, platelet-derived growth factor, transforming growth factor-β, and anti-inflammatory cytokines that stimulate tissue cicatrization, vessels formation, and bone cell proliferation and differentiation. Furthermore, the number of neutrophils and monocytes/macrophages is higher releasing important chemotactic molecules such as chemokine ligand-5 and eotaxin. Thus, L-PRF and A-PRF have been used, especially in implantology, periodontology, and maxillofacial surgery. Future clinical applications include tissue regeneration/grafts, ulcers/skin necrosis in the diabetic patient and others, plastic surgery, and even musculoskeletal lesions.

Potential of Distilled Liquid Smoke Derived from Coconut (Cocos nucifera L) Shell for Traumatic Ulcer Healing in Diabetic Rats.

Abstract: Objective Distilled liquid smoke (DLS) is a result of coconut processing by-product that not only serves as a natural food preservative but also has a promising therapeutic effect. The healing potential of DLS derived from coconut (Cocos nucifera L) shell was investigated on a traumatic ulcer with the diabetic rat. Materials and Methods DLS was analyzed the component by gas chromatograph mass spectrometry. Diabetic condition was induced by alloxan in 55 male Wistar rats. Ten mm of traumatic ulcer was made along the labial fornix incisive inferior after the diabetic condition was confirmed. Then DLS coconut shell, benzydamine hydrochloride, and sterile distilled water were applied topically for 3, 5, and 7 days. The potential healing was evaluated based on the expression of nuclear factor kappa beta (NFκB) and tumor necrosis factor alpha (TNF-α) on macrophages using immunohistochemical staining and the amount of collagen using Masson Trichome staining. The difference between each group was analyzed using one-way analysis of variance. The least significant difference test is used to determine the significant difference (p Results The major compounds found were phenol (36.6%), 2-methoxyphenol (guaiacol) (25.2%), furfural (17.8%), and 4-ethyl-2-methoxyphenol (3.5%) with 28 other minor constituents. The lowest NFκB and TNF-α expression on macrophage was observed by topical application of DLS derived from coconut shell for 3, 5, and 7 days of treatment. The amount of collagen was increased and indicated by the highest result of DLS compared to others. Conclusion The DLS derived from coconut (Cocos nucifera L) shell was able to improve traumatic ulcer healing in a person with diabetes.

Assessment of Extrusion and Postoperative Pain of a Bioceramic and Resin-Based Root Canal Sealer.

Abstract: Objectives The objective of this study was to compare a bioceramic and a resin-based endodontic sealer with regard to extrusion and postoperative pain. Materials and Methods Sixty-four patients requiring endodontic treatment of single-rooted maxillary teeth with necrotic pulps were included in this study. The root canal treatments were performed in a single visit using a size 40.06 single-file reciprocating system under 2.5% NaOCl irrigation. After irrigation with 17% ethylenediaminetetraacetic acid (EDTA) and 2.5% NaOCl, the canals were dried and randomly divided into two different groups (n = 32) depending on the sealer used: resin-based group (RG) in which the canals were filled with the AH Plus, and the bioceramic group (BG) in which the canals were filled with the Sealer Plus BC. Ibuprofen (600 mg) was prescribed every 6 hours if the volunteers experienced pain. The patients registered their pain sensation in a visual analog scale (VAS) card, ranging from 0 to 10 at 24-hour, 48-hour, 72-hour, and 1-week intervals. Statistical analysis For statistical analysis, the level of significance was set at p Results Sealer extrusion occurred in nine patients of the RG and in 19 patients of the BG (p 0.05). Conclusions The BG sealer presented significantly more extrusion than the RG sealer. Sealer extrusion was not associated with pain. The average pain level and the mean number of tablets taken for pain relief were similar in both groups.

Nuclear Magnetic Resonance Spectroscopy for Medical and Dental Applications: A Comprehensive Review.

Abstract: Nuclear magnetic resonance (NMR) spectroscopy is one of the most significant analytical techniques that has been developed in the past few decades. A broad range of biological and nonbiological applications ranging from an individual cell to organs and tissues has been investigated through NMR. Various aspects of this technique are still under research, and many functions of the NMR are still pending a better understanding and acknowledgment. Therefore, this review is aimed at providing a general overview of the main principles, types of this technique, and the advantages and disadvantages of NMR spectroscopy. In addition, an insight into the current uses of NMR in the field of medicine and dentistry and ongoing developments of NMR spectroscopy for future applications has been discussed.

Aspects of Clinical Malpractice in Endodontics.

Abstract: The clinical dentistry and endodontic procedures involve very technique-sensitive procedures, therefore exposing the operator to risks of causes not only damage to patients but also leads to malpractice. Among various disciplines of dentistry, endodontics-related cases witness the most frequently filed malpractice claims. This is due to the fact that the endodontic treatment procedures involve operative and surgical procedures, using a variety of medicaments and techniques. The endodontic procedural errors can be preoperative errors (such as incorrect diagnosis and misinterpretation), intraoperative errors including root canal and pulp chamber perforations, ledge formation leading to apical transportation or zipping, hypochlorite accidents, and fracture of instruments. More critically, failure to use rubber dam may result in inhalation or ingestion of endodontic instruments. Under such circumstances, the endodontist may have to face legal consequences. Due to the increased healthcare load and patients’ awareness, it is important to know the legal ramifications of adverse effects, failed restorations, or other complications, to avoid any legal ramifications of endodontic procedures and associated techniques. Therefore, precautions must be taken to prevent any postsurgical complications, patient complaints, and/or failures. For this purpose, the operator must consider ethical principles and adhere strictly to the standards of healthcare while performing the diagnosis and treatment. A referral toward a specialist or consultant endodontist is always an appreciable option and should be considered in the best interest of the patient. The aim of the article is to highlight various aspects of malpractice in clinical endodontics, and associated materials and challenges. In addition, commonly occurring operating errors during endodontic treatment, possible consequences, precautions, and management have been discussed.

Modifications of Glass Ionomer Cement Powder by Addition of Recently Fabricated Nano-Fillers and Their Effect on the Properties: A Review.

Abstract: The aim of this article is to provide a brief insight regarding the recent studies and their recommendations related to the modifications to glass ionomer cement (GIC) powder in order to improve their properties. An electronic search of publications was made from the year 2000 to 2018. The databases included in the current study were EBSCOhost, PubMed, and ScienceDirect. The inclusion criteria for the current study include publication with abstract or full-text articles, original research, reviews or systematic reviews, in vitro, and in vivo studies that were written in English language. Among these only articles published in peer-reviewed journals were included. Articles published in other languages, with no available abstract and related to other nondentistry fields, were excluded. A detailed review of the recent materials used as a filler phase in GIC powder has revealed that not all modifications produce beneficial results. Recent work has demonstrated that modification of GIC powder with nano-particles has many beneficial effects on the properties of the material. This is due to the increase in surface area and surface energy, along with better particle distribution of the nano-particle. Therefore, more focus should be given on nano-particle having greater chemical affinity for GIC matrix as well as the tooth structure that will enhance the physicochemical properties of GIC.

Evaluation of Marginal Adaptation and Microleakage of Three Glass Ionomer-Based Class V Restorations: In Vitro Study.

Abstract: Objective The aim of this study was to evaluate and compare the marginal adaptation and microleakage of class V cavities restored with conventional glass ionomer cement (GIC), resin-modified glass ionomer (RMGI), and bioactive ionic resin (BIR) restorative materials after 6 months of water storage. Materials and Methods One hundred twenty standardized class V cavities (2 mm deep, 4 mm in width, and 3 mm in height) were prepared in sound extracted human molar teeth, where the coronal margins were in enamel while the cervical margins were in dentin. Three glass ionomer-based restorations were tested (n = 40): GIC (Equia Fil), RMGI (Fuji II LC), and BIR (ACTIVA Bioactive Restorative). Half of the teeth from each group (n = 20) were evaluated for their marginal adaptation with scanning electron microscopy and the other half submitted to dye penetration test to examine microleakage. Further division for each subgroup (n = 10) occurred to be tested immediately, while the remaining teeth were examined after keeping for 6 months and thermocycling. Statistical analysis The outcomes were analyzed by Kruskal–Wallis and Mann–Whitney U tests. Results No statistically significant differences were observed among the three studied restorative materials. However, the differences were statistically significant in microleakage test between enamel and dentin and after water aging. Conclusion All tested restorative materials exhibited the same marginal adaptation and microleakage. Dentin substrate revealed greater microleakage than enamel, especially with BIR restorative material. Water aging had a negative effect on RMGI with respect to microleakage.

Effect of Silver Diamine Fluoride and Proanthocyanidin on Mechanical Properties of Caries-Affected Dentin

Abstract: Objectives Inner carious dentin is specified with decreased minerals and collagen cross-links but without protein denaturation. Current minimally invasive dentistry concepts recommend removal of only the outer layer of carious dentin and biomodification of repairable inner carious dentin. The present study aims to investigate the possibility of functional repair of this layer using silver diamine fluoride (SDF) and grape seed extract (GSE). Materials and Methods Molar teeth with occlusal caries were used to prepare caries-affected dentin specimens for hardness and elastic modulus measurements. The specimens of each test were divided randomly into four equal groups. In the GSE group, the specimens were immersed in 6.5% GSE solution for 10 minutes. In the SDF group, the specimens underwent a topical application of a 30% SDF. In the GSE+SDF group, first the specimens were immersed in GSE and then exposed to SDF. In the SDF+GSE group, first SDF was applied and then the specimens were immersed in GSE. Microhardness measurements were taken at baseline and after treatment. A control group with distilled water treatment was also prepared for elastic modulus measurements. Statistical Analysis One-way analysis of variance and post-hoc tests were used for statistical analysis. Results There were significant differences in H1-H0 (final hardness—baseline hardness) among the groups. Baseline and final hardness of each group was also significantly different (SDF>SDF+GSE>GSE>GSE+SDF). Elastic modulus of SDF and SDF+GSE increased compared to the control group. Conclusions SDF and SDF+GSE treatment can be recommended to increase hardness and elastic modulus of caries-affected dentin.

Pedagogical Evaluation of Digital Technology to Enhance Dental Student Learning.

Abstract: Objective A large number of digital tools supporting students have emerged over recent years which are encouraged in tutoring. A study conducted at the University of Montpellier (France) among 3rd, 4th, and 5th year dentistry students aimed primarily to identify the type of pedagogical support the students preferred according to their discipline. The secondary aim was to evaluate the student satisfaction after establishing a new pedagogical support. Materials and Methods A total of 165 questionnaires were completed. The main questions concerned pedagogical use of information technology and multimedia tools, choice of dentistry disciplines most justifying their use, and pedagogical gaps in these disciplines. Next, a program of pedagogical videos was developed for the most corresponding discipline. A satisfaction survey was finally conducted. Results Nearly 95.7% of students found online classes and E-learning via the virtual learning environment useful, with the most requested type being video. Demand was stronger in conservative dentistry and endodontics (27%), prosthetics (19%), and periodontology (18%). The most apprehended disciplines were endodontics in the 3rd year, endodontics and prosthetics in the 4th year, and prosthetics in the 5th year. Regarding satisfaction, 100% of students appreciated these videos and 99.4% considered they fulfilled expectations. Conclusion All students requested videos, especially for clinical subjects such as endodontics. With digital technology, our world is experiencing a technological revolution resulting in many daily life changes. With students evolving in a digitally saturated society, our ways of learning and teaching need rethinking. Digital technology can help improve learning effectiveness and develop pedagogical practices more adapted to today's students.

Antibacterial and Remineralization Efficacy of Casein Phosphopeptide, Glycomacropeptide Nanocomplex, and Probiotics in Experimental Toothpastes: An In Vitro Comparative Study.

Abstract: Objective This article evaluates the antibacterial and remineralization potential of experimentally prepared toothpastes containing different mixtures of nano casein phosphopeptides (nCPP), nano amorphous calcium phosphate (nACP), probiotic ­ Lactobacillus rhamnosus B-445 (L. rhamnosus), and nano glycomacropeptide (nGMP). Materials and Methods Five experimental toothpaste samples were prepared and grouped, such that group (A0) was the experimental toothpaste base formula. Groups (A1), (A2), (A3), and (A4) were the experimental toothpastes containing: nCPP; nCPP and nACP; nCPP, nACP, and L. rhamnosus, and nCPP, nACP, and nGMP, ­respectively. Group (A5) was the commercial group (GC MI Paste Plus). The five groups were screened against Streptococcus mutans (ATCC 25175) growth, and investigated for their remineralizing potentials on demineralized bovine enamel using Vickers ­microhardness test (Vickers hardness number [VHN]). Scanning electron microscope (SEM) images were obtained for the demineralized and remineralized enamel of the two most effective toothpastes against in vitro bacterial induced enamel demineralization. Statistical analysis was performed using one-way analysis of variance (ANOVA) as well as repeated measures ANOVA followed by Tukey’s post hoc test. Results Both (A3) and (A4) were significantly higher in mean inhibition zone ­diameters than group (A1) and (A2). Group (A4) showed the highest statistical ­significance in the mean difference between VHN values of demineralization and 15 days remineralization period. SEM images showed the deposition of nano-sized particles fill the ­microrough surface pattern of the etched enamel. Conclusion All these findings suggest the use of probiotic, nCPP–nACP, and nGMP as a dental anticariogenic and remineralizing active agents.

Hydroxyapatite in Oral Biofilm Management.

Abstract: Particulate hydroxyapatite, Ca5 (PO4)3 (OH), shows a good biocompatibility and is used as a biomimetic ingredient in dental care formulations due to its similarity to human enamel. Numerous studies show its efficiency, for example, in reducing dentin hypersensitivity, and in the remineralization of enamel and dentin. In addition, oral care products with hydroxyapatite improve periodontal health under in vivo conditions. This review article summarizes data on the effects of hydroxyapatite particles in oral biofilm management. Two databases (PubMed and SciFinder) were searched for studies using specific search terms. In contrast to frequently used antibacterial agents for biofilm control, such as chlorhexidine, stannous salts, and quaternary ammonium salts, hydroxyapatite particles in oral care products lead to a reduction in bacterial attachment to enamel surfaces in situ without having pronounced antibacterial effects or showing unwanted side effects such as tooth discoloration. Furthermore, antibacterial agents might lead to dysbiosis of the oral ecology, which was recently discussed regarding pros and cons. Remarkably, the antiadherent properties of hydroxyapatite particles are comparable to those of the gold standard in the field of oral care biofilm management, chlorhexidine in situ. Although biomimetic strategies have been less well analyzed compared with commonly used antibacterial agents in oral biofilm control, hydroxyapatite particles are a promising biomimetic alternative or supplement for oral biofilm management.

Evidence-Based Studies and Perspectives of the Use of Brazilian Green and Red Propolis in Dentistry.

Abstract: This review analyzes the evidence and perspectives of dental use of the green and red propolis produced in Brazil by Apis mellifera L. Multiple applications of propolis were found considering its antibacterial, antifungal, anti-inflammatory, immunomodulatory, antiviral, and healing properties. Its therapeutic effects are mainly due to the presence of alcohols, aldehydes, aliphatic acids, aliphatic esters, amino acids, aromatic acids, aromatic esters, flavonoids, hydrocarbyl esters, ethers, fatty acids, ketones, terpenes, steroids, and sugars. Propolis has been mainly used in dentistry in the composition of dentifrices and mouthwashes. Studies have also demonstrated promising use against dentin hypersensitivity, root canal treatment, Candida albicans, and other microorganisms. Overall review of the literature presented here demonstrated that both Brazilian green and red propolis are effective for the problems of multiple etiologies that affect the oral cavity in different dental specialties.

Cytotoxicity Evaluation of Minimum Antibacterial Values of Different Medicaments Used in Endodontic Regenerative Procedures

Abstract: Objectives This study aimed to evaluate the cytotoxicity of minimum antibacterial values of medicaments used in endodontic regeneration on stem cells. Materials and Methods “Minimum inhibitory concentration,” “minimum bactericidal concentration,” and “minimum biofilm inhibitory concentration” of triple and double antibiotic paste, a modified triple antibiotic paste (minocycline replaced by clindamycin), Augmentin, and calcium hydroxide were determined using Enterococcus faecalis (ATCC 29212) by microtiter plate method. Direct cytotoxic effects of drugs were evaluated by lactate dehydrogenase and water-soluble tetrazolium salt-1 assays using stem cells of apical papilla obtained from immature third molars via enzymatic digestion. Statistical Analysis Data were analyzed using IBM SPSS Statistics 24, one-way analysis of variance and post hoc comparisons. The statistical power was set at p Results All medicaments caused similar cytotoxicity and cell proliferation at “minimum inhibitory concentration” (p > 0.05) except Augmentin which was significantly more toxic than others (p 0.05). Triple and double antibiotic paste revealed similar favorable effects in terms of toxicity and proliferation rate at most of the tested concentrations (p > 0.05). At “minimum biofilm inhibitory concentration” both the modified paste and Augmentin caused less proliferation rate than triple and double antibiotic paste (p Conclusions Considering the antimicrobial potency, triple antibiotic paste seems to be the safest drug for the stem cells of apical papilla, while Augmentin may have some adverse effects.

Knowledge of Pregnant Women about Pregnancy Gingivitis and Children Oral Health

Abstract: Objective A cross-sectional questionnaire-based study was carried out among 251 pregnant women to assess their level of knowledge and perception regarding pregnancy gingivitis and the oral health of new born children. Materials and Methods A self-administered validated questionnaire was distributed among pregnant women visiting the Child and Maternity Hospital, Ministry of Health, Aseer, Saudi Arabia. The questionnaire included the questions related to their knowledge/awareness about cause, treatment, preventive measures, and the adverse effects of gingivitis on oral health of a woman. Statistical Analysis The data was entered into Microsoft excel sheet and put to statistical analysis using SPSS (version 17). Descriptive analysis and also chi-squared test was used for comparison. Results Majority of pregnant women were found unaware about developing of pregnancy gingivitis as well as the cause, effects, treatment, and preventive measures for the same. Most of the subjects agreed that it was essentially required to have oral health education before their pregnancy term would start. Conclusion Most of the pregnant women said that they were unaware about pregnancy gingivitis, though few reported of being aware about it. It is inferred that the collaborative efforts between general dentists, pediatric dentists, public health dentists, and medical professionals are needed to raise awareness among pregnant women regarding timely dental care to avoid the adverse pregnancy related outcomes due to gingivitis and periodontitis.

In Vivo Evaluation of Operative Torque Generated by Two Nickel-Titanium Rotary Instruments during Root Canal Preparation.

Abstract: Objectives This in vivo study evaluated the operative torque and preparation time of ProTaper NEXT (Dentsply Maillefer; Ballaigues, Switzerland) and EdgeFile X7 (EdgeEndo; Albuquerque, New Mexico, United States) rotary systems during root canal preparation of maxillary premolars. Materials and Methods Ten double-rooted maxillary premolars with independent canals were selected. Each canal in each tooth was prepared with one of the rotary systems (n = 10), ProTaper NEXT or EdgeFile X7. The instruments were rotated at 300 rpm with maximum torque set at 2 N.cm using an electric motor (KaVo; Biberach, Germany) that automatically recorded torque values at every 1/10th of a second (ds). Statistical Analysis Operative torque (N.cm) and preparation time (s) of the first shaping instrument (size 17/.04) of both rotary systems were recorded and statistically compared using the Mann–Whiney U test with a significance level set at 5%. Results No instrument exhibited flute deformation or underwent intracanal failure. No differences were found between the instruments regarding the maximum (peak) torque values (p > 0.05). EdgeFile X7 17/.04 required significantly less preparation time (3.75 seconds interquartile range [IQR]: 3.2–9.0) than ProTaper NEXT X1 (15.45 seconds IQR: 8.35–21.1) (p Conclusions Although no difference was found between the median peak torque values of ProTaper NEXT X1 and EdgeFile X7 17/.04 instruments, the operative torque and instrumentation time results were impacted by their different designs and alloys during clinical preparation of root canals.

Osteogenic Differentiation and Biocompatibility of Bovine Teeth Scaffold with Rat Adipose-derived Mesenchymal Stem Cells.

Abstract: Objective Adipose-derived mesenchymal stem cells (ADMSCs) have great potential for regenerative medicine. These have been combined with biomaterials such as Bovine teeth that are preferred as a periodontal regeneration material. The main purpose of this study is to evaluate and analyze a biocompatibility test and osteogenic differentiation of bovine teeth scaffold seeded with ADMSCs in vitro. Materials and Methods A true experimental study with post-test only group design was conducted. Random sampling and Lameshow's formula were used to determine the sample. The scaffold, obtained from bovine teeth as the bone graft material, was analyzed using 3- (4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, and its attachment was evaluated by scanning electron microcopy (SEM) and micro-computed tomography with ADMSCs. ADMDSCs attachment present in the bovine teeth scaffold was assessed using SEM at 1-hour, 12-hour, and 24-hour intervals. Statistical Analysis Analysis of variance was used to analyze the MTT assay results (p 0.05). Results The highest viability of cells (97.08%) was found at a concentration of 10% by means of an MTT test (p Conclusion The scaffold from bovine teeth is biocompatible and accelerates osteogenic differentiation of ADMSC.

Nonprescription Bleaching versus Home Bleaching with Professional Prescriptions: Which One is Safer? A Comprehensive Review of Color Changes and Their Side Effects on Human Enamel.

Abstract: Objectives This study evaluates the efficacy and safety of the professionally prescribed and nonprescription over-the-counter (OTC) bleaching agents. Materials and Methods Extracted human upper central incisors were prepared and stained with red wine for 14 days before being subjected to four different bleaching agents: professionally prescribed opalescence PF 15%, VOCO Perfect Bleach 10%, nonprescription OTC Crest 3D Whitestrips, and Whitelight Teeth Whitening System. Colorimetric measurement was performed with Vita Easyshade Handheld Spectrophotometer, enamel surface microhardness measured using Vickers Hardness machine, and surface roughness was evaluated with profilometer, before and after bleaching. Scanning electron microscope (SEM) evaluation and atomic force microscopy were conducted postbleaching. Statistical Analysis The data were analyzed with t-test, two-way ANOVA, one-way ANOVA, and Turkey’s test at a significance level of 5%. Results All bleaching products have the same efficacy to whiten stained enamel. Opalescence PF 15% showed significant increase in the microhardness (92.69 ± 68.316). All groups demonstrated significant increase in surface roughness (p Conclusion Professionally prescribed bleaching agent of Opalescence PF 15% is effective tin whitening the teeth, while the other bleaching products may be effective but also have deleterious effects on the enamel.

Relationship of Mandibular Ramus Dimensions to Lower Third Molar Impaction.

Abstract: Objectives The aim of this study was to investigate the mandibular ramus features that could contribute to the etiology of mandibular third molar impaction. Materials and Methods Two hundred and forty subjects were divided into two groups: impacted group: 115 subjects presented with an impacted mandibular third molar, and control group: 125 subjects with the normal mandibular third molar eruption. Digital panoramic radiographs were used, and four angular and twelve linear measurements were done. Comparisons between groups were done using Student's t-test. Pearson correlation and linear regression tests were used to assess the degree of relationship between retromolar space and mandibular measurements. Results Control group showed significant greater measurements in most of the variables, whereas the impacted group showed significant larger gonial angle and larger inclination of lower posterior teeth than the control group. Significant correlations were found between retromolar space and coronoid height, ramal heights, ramus notch depths, the inclination of lower posterior teeth, and retromolar space/3M width ratio in both groups. Conclusion The present study found that the configuration of the mandibular ramus appears to be discrete in many aspects in the erupted other than impacted lower third molars subjects, which might be a possible cause for the impaction.

Efficacy of a Copper–Calcium–Hydroxide Solution in Reducing Microbial Plaque on Orthodontic Clear Aligners: A Case Report

Abstract: The aim of this study was to investigate the ability of a copper–calcium–hydroxide-based compound to remove microbial plaque naturally produced onto orthodontic clear aligners. A commercially available dental paste, named Cupral, based on copper–calcium–hydroxide, was used. A healthy volunteer (female, 32 years old), undergoing orthodontic treatment with thermoplastic clear aligners was enrolled. By conventional/confocal microscopy and colony-forming unit (CFU) assay, 2-week used aligners were examined for microbial plaque, prior and following exposure to Cupral. Confocal microscopy revealed abundant plaque irregularly distributed onto the aligner surface. Following Cupral treatment, a drastic decrease occurred in plaque thickness and matrix presence. As assessed by the CFU assay, total microbial load approached 109 CFUs/aligner, with slight differences in aerobiosis and anaerobiosis culture conditions; six macroscopically different types of colonies were detected and identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Following Cupral treatment, microbial load dropped to undetectable levels, irrespectively of the conditions considered. Exposure of clear aligners to Cupral results in the elimination of contaminating microorganisms; the antimicrobial activity is retained up to 1.25% concentration. Overall, our data describe a novel use of Cupral, a copper–calcium–hydroxide-based compound, in daily hygiene practices with promising results.

Morphological Assessment of Maxillary Sinus Septa Variations with Cone-Beam Computed Tomography in a Turkish Population

Abstract: Objective The purpose of this study was to measure and classify sinus septa variables (prevalence, numbers, heights, locations, orientations, and morphology) and to determine the effects of age, gender, and dental status on the presence of septa and also to evaluate the effects of septa on pathological mucosal thickening. Materials and Methods A total of 2,000 patients were analyzed through conebeam computed tomography (CBCT). The total of 500 maxillary sinuses were included in this study. The number of maxillary sinus septa was determined on axial sections of CBCT images. Their locations, orientations, and morphologies were determined on both the axial and sagittal sections, and their heights were determined only on the sagittal sections. The influence of age, gender, dental status, and pathological mucosal thickening on the presence of septa was statistically analyzed. Mann–Whitney U-test and descriptive statistics were used for statistical analysis. Results The average height of the determined 287 septa was measured as 7.36 mm. The highest rates of septa location, morphology, and orientation were found, respectively, in the middle region septa (57.49%), completed septa (75.95%), and transverse septa (93.37%). The effect of dental status, age, and gender on the presence of septa was not statistically significant (p > 0.05). Conclusion These high rates of findings support the importance of CBCT in the diagnosis of the variations of the maxillary sinus septa. Therefore, it is important to evaluate CBCT images of the relevant region to increase the success of surgical interventions in the maxillary posterior region and to eliminate possible complications.

Clinical and Esthetical Evaluation of 79 Lithium Disilicate Multilayered Anterior Veneers with a Medium Follow-Up of 3 Years.

Abstract: Objectives Primary aim of this study was to evaluate survival rate of lithium disilicate veneers in upper and lower anterior teeth. Secondary aims were to evaluate changing in proportions of teeth before and after restorations and to assess mean thickness of the veneers. Materials and Methods Seventy-nine upper and lower lithium disilicate veneers were made in 13 patients with worn teeth. Mean follow-up was 3 years. To perform anterior definitive rehabilitations, malocclusions and loss of vertical dimension were treated by full mouth rehabilitations to obtain proper occlusal conditions. Veneers were made of lithium disilicate core and fluorapatite-based ceramic stratification. Survival rate was calculated by Kaplan–Meier analysis. Changing in teeth proportion before and after restorations was analyzed by a paired t-test. Descriptive statistics of thickness values were also performed. Results One case of detachment was observed with a 98.7% survival rate. Teeth’s proportions were preserved although the first upper right incisor and canine changed in dimension. Conclusions Lithium disilicate veneers in esthetical rehabilitations of worn teeth proved to be an effective way of treatment in a medium follow-up of 3 years. Proportions seemed to be maintained with a minimum dental removal.

Synthesis and Characterizations of a Collagen-Rich Biomembrane with Potential for Tissue-Guided Regeneration.

Abstract: Objectives In this study, a collagen-rich biomembrane obtained from porcine ­intestinal submucosa for application in guided bone regeneration was developed and characterized. Then, its biological and mechanical properties were compared with that of commercial products (GenDerm [Baumer], Lumina-Coat [Criteria], Surgitime PTFE [Bionnovation], and Surgidry Dental F [Technodry]). Materials and Methods The biomembrane was extracted from porcine intestinal submucosa. Scanning electron microscopy, spectroscopic dispersive energy, glycosaminoglycan quantification, and confocal microscopy by intrinsic fluorescence were used to evaluate the collagen structural patterns of the biomembrane. Mechanical tensile and deformation tests were also performed. Statistical Analysis The results of the methods used for experimental membrane characterizations were compared with that obtained by the commercial membranes and statistically analyzed (significance of 5%). Results The collagen-rich biomembrane developed also exhibited a more organized, less porous collagen fibril network, with the presence of glycosaminoglycans. The experimental biomembrane exhibited mechanical properties, tensile strength, and deformation behavior with improved average stress/strain when compared with other commercial membranes tested. Benefits also include a structured, flexible, and ­bioresorbable characteristics scaffold. Conclusions The experimental collagen-rich membrane developed presents physical–chemical, molecular, and mechanical characteristics similar to or better than that of the commercial products tested, possibly allowing it to actively participating in the process of bone neoformation.

Effect of Vitamin C as an Adjunct in Nonsurgical Periodontal Therapy in Uncontrolled Type 2 Diabetes Mellitus Patients.

Abstract: Objective The main purpose of this article is to evaluate periodontal parameters of chronic periodontitis patients with uncontrolled type 2 diabetes mellitus after initial periodontal therapy plus vitamin C. Materials and Methods A double-blind, placebo-controlled, clinical trial was conducted. Subjects received initial periodontal therapy plus 500 mg/day vitamin C for 2 months (n = 15) or placebo (n = 16). Fasting blood sugar (FBS), hemoglobin A1c (HbA1C), and plasma vitamin C level were assessed at baseline and 2 months post-treatment. Plaque Index, Sulcus Bleeding Index, Gingival Index, pocket depth, and clinical attachment level were measured at baseline, 1 month, and 2 months post-treatment. Results Almost all subjects had low level of plasma vitamin C at baseline. In the test group, plasma vitamin C was significantly increased to an adequate level at the end of 2 months. After periodontal treatment, FBS and HbA1c were not significantly different compared with baseline in the test group. In the control group, FBS was significantly decreased from baseline. However, no significant difference between groups was found either in FBS or HbA1c. All periodontal parameters were significantly improved from baseline in both groups. However, no significant difference was found between groups. Conclusion Supplementation of 500 mg/day vitamin C did not give an additional benefit in promoting periodontal status in periodontitis patients with uncontrolled type 2 diabetes mellitus.

Fluorescence and Opalescence of Two Dental Composite Resins.

Abstract: Objective Lifelike esthetic appearance of dental restorations is among the main goals in restorative dentistry. This study aimed to assess and compare the opalescence and fluorescence of two dental composite resins. Materials and Methods This in vitro experimental study evaluated the A2 shade of Filtek Z350 XT Enamel, Filtek Z350 XT Dentin, Aelite Aesthetic Enamel, and Aelite All Purpose Body composite resins. Composite discs were fabricated with 10 mm diameter and 0.5 and 1 mm thicknesses (n = 2) using a plexiglass mold and subjected to colorimetry. The color parameters were determined according to the International Commission on Illumination (CIE) L*a*b* system using a spectrophotometer. The fluorescence and opalescence were also measured and reported separately for 0.5 and 1 mm thicknesses of Z350, Aelite Body, and Enamel composite resins. To determine the opalescence, the color of samples in the reflectance mode was measured using a calibration cylinder and in the transmittance mode in presence of 100% ultraviolet (UV) light. To determine the fluorescence, the color of samples against a white background in the reflectance mode in presence or absence of 100% UV light was measured. Statistical Analysis Data were analyzed using SPSS via three-way analysis of variance and independent t-test. Results The fluorescence of 0.5 mm thickness of all composites was higher than that of 1 mm thickness (p Conclusion Thickness, type, and brand of composite resins affected their fluorescence and opalescence.

Correlation of Bite Force Interpretation in Maximal Intercuspal Position among Patient, Clinician, and T-Scan III System.

Abstract: Objective The main purpose of this article was to determine the correlation of bite force in maximal intercuspal position (MIP) among patient’s perceptions, clinician subjective interpretation, and T-Scan III system. Materials and Methods Forty-three dental students at Naresuan University (Phitsanulok, Thailand) participated in the study. Subjects were positioned by Frankfurt horizontal plane paralleled to the horizontal plane and asked to bilaterally clenched in MIP. Patient’s perception was evaluated by asking which side of the jaw had heavier bite force (right, left, or equally on both sides). Then, the clinician subjective interpretation was assessed using traditional occlusal indicators. Furthermore, patient’s bite force was analyzed using T-Scan III. Statistical Analysis Cohen’s weighted kappa test was used to evaluate the correlation of bite force. Results The best correlation between patient’s perception and T-Scan III was at the ± 7.5% cutoff range with 15 subject agreements. While the best correlation between clinician subjective interpretation and T-Scan III was at ± 5.0% cutoff range with 23 subject agreements. Cohen’s weighted kappa indicated slight agreement between T-Scan III and patient’s perception and fair agreement between T-Scan III and clinician. Conclusions Clinician subjective interpretation is more clinically reliable than patient’s perception when T-Scan III is used as a gold standard.

Antimicrobial Effect of Newly Formulated Toothpastes and a Mouthrinse on Specific Microorganisms: An In Vitro Study.

Abstract: Objective The aim of this in vitro study was to assess the antimicrobial properties of newly formulated toothpastes (four toothpastes for adults and two toothpastes for kids/babies) and a mouthrinse. Materials and Methods Newly formulated six different toothpastes and one mouthrinse of a single brand and commercially available five toothpastes and three mouthrinse were investigated for their antimicrobial activity against two oral pathogens, Streptococcus mutans and Candida albicans, by agar well diffusion assay. After incubation, the inhibition zone diameters were measured in millimeters and statistical analyses were performed. Results All experimental adult toothpastes exhibited good antimicrobial activity against S. mutans and C. albicans except the experimental toothpaste D. Experimental toothpaste B exhibited the highest antibacterial activity against C. albicans and S. mutans. Experimental toothpaste for kids showed the best antimicrobial activity against S. mutans when kids’ toothpastes were compared. None of the tested toothpastes for kids/babies showed antibacterial effects for C. albicans. Among the mouthrinse tested, Sensodyne mouthrinse showed the best results. Experimental mouthrinse showed significantly lower antibacterial activity against S. mutans then Sensodyne, Eludril, and chlorhexidine mouthrinse. Conclusion Although experimental toothpaste and mouthrinse formulations revealed good results in terms of antimicrobial activity to some specific microorganisms, further studies involving more bacterial species or analyzing the quality and efficacy of these products by other in vitro or in vivo tests are needed.

Influence of Thymoquinone Exposure on the Micro-Hardness of Dental Enamel: An In Vitro Study.

Abstract: Objective The aim of this study was to assess changes in micro-hardness level of enamel after it was exposed to thymoquinone (TQ). Materials and Methods Sixteen enamel blocks were prepared and divided into two groups (each group received eight blocks, n = 8); Gp 1 (control): enamel blocks kept in 100 mL artificial saliva (AS) for 24 hours and Gp 2: enamel blocks kept in a mixture of TQ powder (1 g) and AS (100 mL) for 24 hours. Post-immersion they were subjected to simulated brushing with each sample receiving 8,000 linear strokes. For brushing, 3 mL of AS and TQ oil was used for groups 1 and 2, respectively. Enamel surfaces were analyzed for changes in values of surface micro-hardness (pre-immersion, post-immersion, and post-brushing) by obtaining Vickers hardness number (VHN). Results The present study indicated improvement in micro-hardness levels for both groups although experimental group showed more enhancement. The mean baseline VHN for control group was 498.6, 500.4 for post-immersion, and 503.5 for post-brushing. The mean baseline VHN for experimental group was 448.7, 531 for post-immersion, and 610.3 for post-brushing. Statistically significant differences (p Statistical Analysis Wilcoxon signed-rank test was applied for the evaluation of pre- and post-exposure hardness values. Level of significance was ≤0.05. Conclusion The exposure of enamel to TQ led to an improvement in its micro-hardness levels. Further studies are required to understand the mechanism of action of TQ on human tissues.

Fabrication and Characterization of Chitosan-Collagen Membrane from Barramundi (Lates Calcarifer) Scales for Guided Tissue Regeneration.

Abstract: Objectives The aim of this study was to evaluate the synthesis, mechanical strength, and morphology of chitosan–collagen membranes from barramundi scales for guided tissue regeneration technique. Materials and Methods Collagen was extracted from barramundi scales by immersion in acetic acid. The resulting wet collagen was later dried. The membrane was fabricated by mixing chitosan with collagen from barramundi scales. Membrane characterization parameters were measured using Fourier transform infrared (FTIR), scanning electron microscopy (SEM) and mechanical property. Results The FTIR spectrum showed the typical peak of the mixture of chitosan and collagen. The tensile strength and elongation at break of the membrane in dry condition were 0.28 MPa and 8.53%, respectively, while in the wet condition these were 0.12 MPa and 25.6%. The membrane porosity test result was 38.85%; SEM result showed a porous membrane surface with size varying around 16 to 100 µm. Conclusion The chitosan-collagen membrane from the barramundi scale showed the fibrous membrane surface that has ideal porous size as guided tissue regeneration membrane and the lower mechanical strength.

Apical Transportation and Centering Ability After Root Canal Filling Removal Using Reciprocating and Continuous Rotary Systems: A CBCT Study.

Abstract: Objective To evaluate the apical transportation and centering ability promoted by reciprocating and continuous rotary systems after root canal filling removal. Materials and Methods After obturation, 40 mesial root canals of mandibular molars were distributed into four groups (n = 20) for filling material removal: PTU group–F2 instrument (25.08) of ProTaper Universal system; R25 group–R25 instrument (25.08) of Reciproc system; X2 group–X2 instrument (25.06) of ProTaper Next system and X3 group–X2 instrument (25.06) of ProTaper Next system, followed by X3 instrument (30.07). Cone-beam computed tomographic analysis was performed before and after filling material removal for acquisition of apical images. Apical transportation (AT) and its direction, and centering ability (CA), were assessed using the equations AT = (X1–X2)–(Y1–Y2) and CA = (X1–X2/Y1–Y2 or Y1–Y2/X1–X2), respectively. Data were submitted to the nonparametric Kruskal–Wallis and Dunn multiple comparison tests (p Results There was no statistically significant difference among groups for AT (p > 0.05), with a tendency toward transportation in the distal direction. Also, there was no statistically significant difference among groups regarding CA (p > 0.05). Conclusions The different systems, including ProTaper Next, caused AT within the acceptable clinical limit after filling removal. In addition, none of the tested systems presented adequate CA.