International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Pyogenic Granuloma/Peripheral Giant-Cell Granuloma Associated with Implants Tue, 01 Dec 2015 11:35:49 +0000 Introduction. Pyogenic granuloma (PG) and peripheral giant-cell granuloma (PGCG) are two of the most common inflammatory lesions associated with implants; however, there is no established pathway for treatment of these conditions. This paper aims to illustrate the successful treatment of PG and PGCG and also report a systematic review of the literature regarding the various treatments proposed. Methods. To collect relevant information about previous treatments for PG and PGCG involving implants we carried out electronic searches of publications with the key words “granuloma”, “oral”, and “implants” from the last 15 years on the databases Pubmed, National Library of Medicine’s Medline, Scielo, Scopus, and Cochrane Library. Results. From the electronic search 16 case reports were found showing excision and curettage as the main successful treatment. As no clinical trials or observational studies were identified the authors agreed to present results from a review perspective. Conclusion. This is the largest analysis of PG and PGCG associated with implants published to date. Our review would suggest that PGCG associated with implants appears to have a more aggressive nature; however the level of evidence is very limited. Further cohort studies with representative sample sizes and standard outcome measures are necessary for better understanding of these conditions. Enric Jané-Salas, Rui Albuquerque, Aura Font-Muñoz, Beatríz González-Navarro, Albert Estrugo Devesa, and Jose López-López Copyright © 2015 Enric Jané-Salas et al. All rights reserved. Comparing the Air Abrasion Cutting Efficacy of Dentine Using a Fluoride-Containing Bioactive Glass versus an Alumina Abrasive: An In Vitro Study Mon, 30 Nov 2015 15:52:45 +0000 Air abrasion as a caries removal technique is less aggressive than conventional techniques and is compatible for use with adhesive restorative materials. Alumina, while being currently the most common abrasive used for cutting, has controversial health and safety issues and no remineralisation properties. The alternative, a bioactive glass, 45S5, has the advantage of promoting hard tissue remineralisation. However, 45S5 is slow as a cutting abrasive and lacks fluoride in its formulation. The aim of this study was to compare the cutting efficacy of dentine using a customised fluoride-containing bioactive glass Na0SR (38–80 μm) versus the conventional alumina abrasive (29 μm) in an air abrasion set-up. Fluoride was incorporated into Na0SR to enhance its remineralisation properties while strontium was included to increase its radiopacity. Powder outflow rate was recorded prior to the cutting tests. Principal air abrasion cutting tests were carried out on pristine ivory dentine. The abrasion depths were quantified and compared using X-ray microtomography. Na0SR was found to create deeper cavities than alumina () despite its lower powder outflow rate and predictably reduced hardness. The sharper edges of the Na0SR glass particles might improve the cutting efficiency. In conclusion, Na0SR was more efficacious than alumina for air abrasion cutting of dentine. Melissa H. X. Tan, Robert G. Hill, and Paul Anderson Copyright © 2015 Melissa H. X. Tan et al. All rights reserved. Mechanical Properties of Elastomeric Impression Materials: An In Vitro Comparison Thu, 26 Nov 2015 06:25:23 +0000 Purpose. Although new elastomeric impression materials have been introduced into the market, there are still insufficient data about their mechanical features. The tensile properties of 17 hydrophilic impression materials with different consistencies were compared. Materials and Methods. 12 vinylpolysiloxane, 2 polyether, and 3 hybrid vinylpolyether silicone-based impression materials were tested. For each material, 10 dumbbell-shaped specimens were fabricated (), according to the ISO 37:2005 specifications, and loaded in tension until failure. Mean values for tensile strength, yield strength, strain at break, and strain at yield point were calculated. Data were statistically analyzed using one-way ANOVA and Tukey’s tests (). Results. Vinylpolysiloxanes consistently showed higher tensile strength values than polyethers. Heavy-body materials showed higher tensile strength than the light bodies from the same manufacturer. Among the light bodies, the highest yield strength was achieved by the hybrid vinylpolyether silicone (2.70 MPa). Polyethers showed the lowest tensile (1.44 MPa) and yield (0.94 MPa) strengths, regardless of the viscosity. Conclusion. The choice of an impression material should be based on the specific physical behavior of the elastomer. The light-body vinylpolyether silicone showed high tensile strength, yield strength, and adequate strain at yield/brake; those features might help to reduce tearing phenomena in the thin interproximal and crevicular areas. Dino Re, Francesco De Angelis, Gabriele Augusti, Davide Augusti, Sergio Caputi, Maurizio D’Amario, and Camillo D’Arcangelo Copyright © 2015 Dino Re et al. All rights reserved. Protocol for Bone Augmentation with Simultaneous Early Implant Placement: A Retrospective Multicenter Clinical Study Tue, 24 Nov 2015 13:01:17 +0000 Purpose. To present a novel protocol for alveolar bone regeneration in parallel to early implant placement. Methods. 497 patients in need of extraction and early implant placement with simultaneous bone augmentation were treated in a period of 10 years. In all patients the same specific method was followed and grafting was performed utilizing in situ hardening fully resorbable alloplastic grafting materials consisting of β-tricalcium phosphate and calcium sulfate. The protocol involved atraumatic extraction, implant placement after 4 weeks with simultaneous bone augmentation, and loading of the implant 12 weeks after placement and grafting. Follow-up periods ranged from 6 months to 10 years (mean of 4 years). Results. A total of 601 postextraction sites were rehabilitated in 497 patients utilizing the novel protocol. Three implants failed before loading and three implants failed one year after loading, leaving an overall survival rate of . Conclusions. This standardized protocol allows successful long-term functional results regarding alveolar bone regeneration and implant rehabilitation. The concept of placing the implant 4 weeks after extraction, augmenting the bone around the implant utilizing fully resorbable, biomechanically stable, alloplastic materials, and loading the implant at 12 weeks seems to offer advantages when compared with traditional treatment modalities. Peter Fairbairn and Minas Leventis Copyright © 2015 Peter Fairbairn and Minas Leventis. All rights reserved. Cone-Beam Computed Tomographic Assessment of Mandibular Condylar Position in Patients with Temporomandibular Joint Dysfunction and in Healthy Subjects Mon, 23 Nov 2015 14:17:03 +0000 Statement of the Problem. The clinical significance of condyle-fossa relationships in the temporomandibular joint is a matter of controversy. Different studies have evaluated whether the position of the condyle is a predictor of the presence of temporomandibular disorder. Purpose. The purpose of the present study was to investigate the condylar position according to gender in patients with temporomandibular disorder (TMD) and healthy controls using cone-beam computed tomography. Materials and Methods. CBCT of sixty temporomandibular joints in thirty patients with TMD and sixty joints of thirty subjects without TMJ disorder was evaluated in this study. The condylar position was assessed on the CBCT images. The data were analyzed using Pearson chi-square test. Results. No statistically significant differences were found regarding the condylar position between symptomatic and asymptomatic groups. Posterior condylar position was more frequently observed in women and anterior condylar position was more prevalent in men in the symptomatic group. However, no significant differences in condylar position were found in asymptomatic subjects according to gender. Conclusion. This study showed no apparent association between condylar positioning and clinical findings in TMD patients. Maryam Paknahad, Shoaleh Shahidi, Shiva Iranpour, Sabah Mirhadi, and Majid Paknahad Copyright © 2015 Maryam Paknahad et al. All rights reserved. Assessment Using AutoCAD Software of the Preparation of Dentin Walls in Root Canals Produced by 4 Different Endodontic Instrument Systems Wed, 18 Nov 2015 11:20:12 +0000 Objectives. To compare the effectiveness of four instrument systems for preparing oval root canals: manual instrumentation (Step-Back technique), ProTaper Universal, ProTaper Next, and Wave One. Material and Methods. For the purpose of this assessment, 60 teeth extracted for orthodontic or periodontal reasons, specifically canines and premolars with full coronal and root anatomy, were used and 15 samples were assigned to each group. The section of the canals was compared before and after instrumenting and the section of untouched canal wall was measured using AutoCAD software. The data was analysed by means of Shapiro-Wilk, ANOVA, and Kruskal-Wallis tests. Results. In the apical third, 100% of the canals were prepared with all the systems. In the middle third, a value of 0.5989 in the Kruskal-Wallis test was obtained, which indicates no significant difference between the groups. At the coronal third level, the results obtained revealed that Wave One had a significantly lower mean average than the rest (). Conclusions. There are no differences between the various root canal instrument systems in the apical and middle thirds. At the coronal third level, Wave One system showed performance significantly worse than the rest, among which there were no differences. Cristina Cabanillas, Manuel Monterde, Antonio Pallarés, Susana Aranda, and Raquel Montes Copyright © 2015 Cristina Cabanillas et al. All rights reserved. Titanium Oxide: A Bioactive Factor in Osteoblast Differentiation Wed, 18 Nov 2015 11:04:51 +0000 Titanium and titanium alloys are currently accepted as the gold standard in dental applications. Their excellent biocompatibility has been attributed to the inert titanium surface through the formation of a thin native oxide which has been correlated to the excellent corrosion resistance of this material in body fluids. Whether this titanium oxide layer is essential to the outstanding biocompatibility of titanium surfaces in orthopedic biomaterial applications is still a moot point. To study this critical aspect further, human fetal osteoblasts were cultured on thermally oxidized and microarc oxidized (MAO) surfaces and cell differentiation, a key indicator in bone tissue growth, was quantified by measuring the expression of alkaline phosphatase (ALP) using a commercial assay kit. Cell attachment was similar on all the oxidized surfaces although ALP expression was highest on the oxidized titanium alloy surfaces. Untreated titanium alloy surfaces showed a distinctly lower degree of ALP activity. This indicates that titanium oxide clearly upregulates ALP expression in human fetal osteoblasts and may be a key bioactive factor that causes the excellent biocompatibility of titanium alloys. This result may make it imperative to incorporate titanium oxide in all hard tissue applications involving titanium and other alloys. P. Santiago-Medina, P. A. Sundaram, and N. Diffoot-Carlo Copyright © 2015 P. Santiago-Medina et al. All rights reserved. Oral Health Status of the Elderly at Tonga, West Region, Cameroon Sun, 08 Nov 2015 14:31:08 +0000 Objectives. The aim of this study was to determine the oral health status of elderly persons in Tonga, West Region of Cameroon. Methodology. This is a cross-sectional study of persons of at least 65 years, living in Tonga village, West Region of Cameroon. Results. A total of 183 persons aged between 65 and 94 years, mean age of 73 years ±7 s.d., 83 (45,4%) males, and 100 (54,6%) females participated in the study. The most represented age range was 65–74 years (60.1%); 86 (47.3%) and elders above 65 constituted 1.8% of the total population. More than a third 117 (41.4%) had visible dental plaque, 117 (48,6%) had periodontal pockets >4 mm, 153 (54,1%) had teeth with total crown destruction, 70 (38.3%) had not lost a tooth, 23 (12.6%) had lost 1 tooth, 19 (10.4%) have lost at least 2 teeth, 100 (55.7%) were partially edentulous at the maxilla and 98 (53.6%) at the mandible, 2 (1.1%) were completely edentulous at the maxilla and 3 (1.6%) at the mandible, and 3.8% had removable dentures. The mean DMF index was 6.11 and 69.4% had dental caries. Risk factors to dental caries were toothbrushing and tobacco consumption while dental plaque was associated to pocket depth of 4–6 mm. Barriers to oral health care included ignorance 47 (25.7%), financial difficulties 124 (67.8%), and distance to the nearest clinic 12 (6.5%). Conclusion. The oral status of the elderly was generally poor. Yotat Michele Lolita, Agbor Ashu Michael, Ntumba Hubert, Djachechi Florence, and Bolenge Jacques Copyright © 2015 Yotat Michele Lolita et al. All rights reserved. Evaluation of Osteogenic and Cementogenic Potential of Periodontal Ligament Fibroblast Spheroids Using a Three-Dimensional In Vitro Model of Periodontium Sun, 08 Nov 2015 08:09:38 +0000 The aim of this study was to develop a three-dimensional in vitro model of periodontium to investigate the osteogenic and cementogenic differentiation potential of the periodontal ligament fibroblast (PDLF) spheroids within a dentin-membrane complex. PDLFs were cultured in both spheroid forms and monolayers and were seeded onto two biological collagen-based and synthetic membranes. Cell-membrane composites were then transferred onto dentin slices with fibroblasts facing the dentin surface and further cultured for 20 days. The composites were then processed for histology and immunohistochemical analyses for osteocalcin, Runx2, periostin, and cementum attachment protein (CAP). Both membranes seeded with PDLF-derived cells adhered to dentin and fibroblasts were present at the dentin interface and spread within both membranes. All membrane-cell-dentine composites showed positive staining for osteocalcin, Runx2, and periostin. However, CAP was not expressed by any of the tissue composites. It can be concluded that PDLFs exhibited some osteogenic potential when cultured in a 3D matrix in the presence of dentin as shown by the expression of osteocalcin. However the interaction of cells and dentin in this study was unable to stimulate cementum formation. The type of membrane did not have a significant effect upon differentiation, but fibroblast seeded-PGA membrane demonstrated better attachment to dentin than the collagen membrane. Zurairah Berahim, Keyvan Moharamzadeh, Adrian K. Jowett, and Andrew Rawlinson Copyright © 2015 Zurairah Berahim et al. All rights reserved. Effect of EDTA Conditioning and Carbodiimide Pretreatment on the Bonding Performance of All-in-One Self-Etch Adhesives Mon, 19 Oct 2015 08:45:06 +0000 Objective. This study evaluated the effect of ethylenediaminetetraacetic acid (EDTA) conditioning and carbodiimide (EDC) pretreatment on the shear bond strength of two all-in-one self-etch adhesives to dentin. Methods. Flat coronal dentin surfaces were prepared on one hundred and sixty extracted human molars. Teeth were randomly divided into eight groups according to two different self-etch adhesives used [G-Bond and OptiBond-All-In-One] and four different surface pretreatments: (a) adhesive applied following manufacturer’s instructions; (b) dentin conditioning with 24% EDTA gel prior to application of adhesive; (c) EDC pretreatment followed by application of adhesive; (d) application of EDC on EDTA conditioned dentin surface followed by application of adhesive. Composite restorations were placed in all the samples. Ten samples from each group were subjected to immediate and delayed (6-month storage in artificial saliva) shear bond strength evaluation. Data collected was subjected to statistical analysis using three-way ANOVA and post hoc Tukey’s test at a significance level of .  Results and Conclusion. EDTA preconditioning as well as EDC pretreatment alone had no significant effect on the immediate and delayed bond strengths of either of the adhesives. However, EDC pretreatment on EDTA conditioned dentin surface resulted in preservation of resin-dentin bond strength of both adhesives with no significant fall over six months. Shipra Singh, Rajni Nagpal, Shashi Prabha Tyagi, and Naveen Manuja Copyright © 2015 Shipra Singh et al. All rights reserved. Impact of Digital Panoramic Radiograph Magnification on Vertical Measurement Accuracy Mon, 19 Oct 2015 07:17:50 +0000 Objectives. The purpose of this panoramic radiography study was to assess the impact of image magnification on the accuracy of vertical measurements in the posterior mandible. Methods. Six dental implants, inserted in the posterior segments of a resin model, were used as reference objects. Two observers performed implant length measurements using a proprietary viewer with two preset image magnifications: the low (1.9 : 1) and the medium (3.4 : 1) image magnifications. They also measured the implant lengths in two Digital Imaging Communications in Medicine viewers set at low (1.9 : 1), medium (3.4 : 1), and high (10 : 1) image magnifications. Results. The error between the measured length and the real implant length was close to zero for all three viewers and image magnifications. The percentage of measurements equal to the real implant length was the highest (83.3%) for the high image magnification and below 30% for all viewers with the low image magnification. Conclusions. The high and medium image magnifications used in this study allowed accurate vertical measurements, with all three imaging programs, in the posterior segments of a mandibular model. This study suggests that a low image magnification should not be used for vertical measurements on digital panoramic radiographs when planning an implant in the posterior mandible. Marc El Hage, Jean-Pierre Bernard, Christophe Combescure, and Lydia Vazquez Copyright © 2015 Marc El Hage et al. All rights reserved. Effect of Nd:YAG Low Level Laser Therapy on Human Gingival Fibroblasts Sun, 04 Oct 2015 13:01:56 +0000 Aim. To evaluate the effect of Low Level Laser Therapy (LLLT) on human gingival fibroblasts in terms of proliferation and growth factors’ secretion (EGF, bFGF, and VEGF). Materials and Methods. Primary cultures of keratinized mucosa fibroblasts were irradiated by a Nd:YAG laser 1064 nm with the following energy densities: 2.6 J/cm2, 5.3 J/cm2, 7.9 J/cm2, and 15.8 J/cm2. Controls were not irradiated. Cultures were examined for cell proliferation and growth factors’ secretion after 24, 48, and 72 hours. All experimental procedures were performed in duplicate. Data were analyzed by Student’s -test (). Results. All laser-irradiation doses applied promoted a higher cell proliferation at 48 hours in a dose-response relationship compared to controls. This difference reached statistical significance for the cultures receiving 15.8 J/cm2 (). Regarding EGF, all laser irradiation doses applied promoted a higher secretion at 48 hours in a reverse dose-response pattern compared to controls. This difference reached statistical significance for the cultures receiving 2.6 J/cm2 (). EGF levels at the other time points, bFGF, and VEGF showed a random variation between the groups. Conclusion. Within the limits of this study, LLLT (Nd:YAG) may induce gingival fibroblasts’ proliferation and upregulate the secretion of EGF. Further studies are needed to confirm these results. Andreas S. Gkogkos, Ioannis K. Karoussis, Ioannis D. Prevezanos, Kleopatra E. Marcopoulou, Kyriaki Kyriakidou, and Ioannis A. Vrotsos Copyright © 2015 Andreas S. Gkogkos et al. All rights reserved. Nanomodified Peek Dental Implants: Bioactive Composites and Surface Modification—A Review Thu, 01 Oct 2015 11:31:43 +0000 Purpose. The aim of this review is to summarize and evaluate the relevant literature regarding the different ways how polyetheretherketone (PEEK) can be modified to overcome its limited bioactivity, and thereby making it suitable as a dental implant material. Study Selection. An electronic literature search was conducted via the PubMed and Google Scholar databases using the keywords “PEEK dental implants,” “nano,” “osseointegration,” “surface treatment,” and “modification.” A total of 16 in vivo and in vitro studies were found suitable to be included in this review. Results. There are many viable methods to increase the bioactivity of PEEK. Most methods focus on increasing the surface roughness, increasing the hydrophilicity and coating osseoconductive materials. Conclusion. There are many ways in which PEEK can be modified at a nanometer level to overcome its limited bioactivity. Melt-blending with bioactive nanoparticles can be used to produce bioactive nanocomposites, while spin-coating, gas plasma etching, electron beam, and plasma-ion immersion implantation can be used to modify the surface of PEEK implants in order to make them more bioactive. However, more animal studies are needed before these implants can be deemed suitable to be used as dental implants. Shariq Najeeb, Zohaib Khurshid, Jukka Pekka Matinlinna, Fahad Siddiqui, Mohammad Zakaria Nassani, and Kusai Baroudi Copyright © 2015 Shariq Najeeb et al. All rights reserved. Association of Awake Bruxism with Khat, Coffee, Tobacco, and Stress among Jazan University Students Wed, 30 Sep 2015 10:30:26 +0000 Objective. The objective is to assess the prevalence of bruxism among the university students and to check its association with their khat chewing habit. Materials and Methods. A cross-sectional descriptive study is designed using cluster random sampling. Pretested questionnaire was administered by a trained interviewer to assess awake bruxism and the use of variables like khat, coffee, tobacco, and stress. Chi-square test at 5% significance was used for assessing the association. Logistic regression was also performed after adjusting for covariates. Results. A high response rate (95%) was obtained as the distribution and collection of questionnaire was within an hour interval. 85% (63%, males; 22%, females) experienced an episode of bruxism at least one time in the past six months. Regression analysis revealed an association of stress (; OR = 5.902, 95% CI 2.614–13.325) and khat use (; OR = 1.629, 95% CI 0.360–7.368) with bruxism. Interestingly, it is observed that the one who chew khat experienced 3.56 times (95% CI; 2.62–11.22) less pain when compared to the nonusers. Conclusion. This study is the first of its kind to assess the association of bruxism with khat chewing. High amount of stress and khat use can be considered as important risk indicators for awake bruxism. Mir Faeq Ali Quadri, Ali Mahnashi, Ayman Al Almutahhir, Hamzah Tubayqi, Abdullah Hakami, Mohamed Arishi, and Abdulwahab Alamir Copyright © 2015 Mir Faeq Ali Quadri et al. All rights reserved. Oral Lesions Induced by Chronic Khat Use Consist Essentially of Thickened Hyperkeratinized Epithelium Sun, 27 Sep 2015 13:51:18 +0000 Objectives. The habit of khat chewing is prevalent in many Middle Eastern and African cultures and has been associated with various adverse conditions in humans. This study aimed to describe histological changes induced by chronic khat chewing on the buccal mucosa. Methods. Biopsies of the buccal mucosa from 14 chronic khat chewers, 20 chronic khat chewers who also smoked tobacco, and 8 nonchewers were compared for epithelial thickness, degree and type of keratinization, and connective tissue changes. Results. Tissues from khat chewers depicted abnormal keratinization of the superficial cell layer and showed increased epithelial thickness affecting all layers. Epithelial thickness in control samples was 205 ± 26 μm whereas thickness in khat chewers and khat chewers who smoked tobacco was significantly higher measuring 330 ± 35 μm and 335 ± 19 μm, respectively. Tissues from khat chewers also showed increased intracellular edema, increased melanin pigment deposits, and increased number of rete pegs most of which were thin and deep. Conclusions. These results show that oral lesions induced by chronic chewing of khat in the buccal mucosa present with white and brown discoloration due to increased epithelial thickness, increased keratinization, and melanin deposition. Ochiba Mohammed Lukandu, Lionel Sang Koech, and Paul Ngugi Kiarie Copyright © 2015 Ochiba Mohammed Lukandu et al. All rights reserved. Evaluation of Static Friction of Polycrystalline Ceramic Brackets after Conditioning with Different Powers of Er:YAG Laser Sun, 27 Sep 2015 09:48:15 +0000 This research aimed to reduce the friction between the wire and brackets by Er:YAG laser. To measure the friction between the wires and brackets in 0° and 10° of wire angulations, 40 polycrystalline ceramic brackets (Hubit, South Korea) were divided into 8 study groups and irradiated by 100, 200, and 300 mj/s of Er:YAG laser power. Two groups of brackets were not irradiated. The friction between the wires and brackets was measured with universal testing machine (SANTAM) with a segment of .019 × .025 SS wire pulled out of the slot of bracket. ANOVA and -test were used for analyzing the results. To evaluate the effect of the laser on surface morphology of the bracket, SEM evaluations were carried out. The mean frictional resistances between the brackets and wires with 0° of angulation by increasing the laser power decreased compared with control group, but, in 10° of angulation, the friction increased regardless of the laser power and was comparable to the friction of nonirradiated brackets. Furthermore, with each laser power, frictional resistance of brackets in 10° of angulation was significantly higher than 0° of angulation. These results were explained by SEM images too. Valiollah Arash, Saeed Javanmard, Zeinab Eftekhari, Manouchehr Rahmati-Kamel, and Mohammad Bahadoram Copyright © 2015 Valiollah Arash et al. All rights reserved. Transcrestal Sinus Lift Procedure Approaching Atrophic Maxillary Ridge: A 60-Month Clinical and Radiological Follow-Up Evaluation Wed, 16 Sep 2015 09:33:11 +0000 Aim. The aim of this study was to assess the success and the survival rate of dental implants placed in augmented bone after sinus lifting procedures. Material and Methods. 31 patients were mainly enrolled for a residual upper jaw crest thickness of 3 mm. CBCT scans were performed before and after the augmentation technique and at the follow-up appointments, at 3, 6, 12, 24, and up to 60 months. The follow-up examination included cumulative survival rate of implants, peri-implant marginal bone loss, and the height of sinus floor augmentation. Results. This retrospective study on 31 patients and 45 implants later inserted in a less than 3 mm crest showed excellent survival rates (99.5%), one implant was lost before loading due to an acute infection after 24 days, and two implants did not osteointegrate and were removed after 3 months. The radiological evaluation showed an average bone loss of 0.25 mm (±0.78 mm) at the first follow-up appointment (3 months) up to 0.30 mm (±1.28 mm) after 60-month follow-up. Conclusion. In this study it was reported how even in less than 3 mm thick crest a transcrestal technique can predictably be used with a long-term clinical and radiological outcome, giving patients excellent stability of the grafted material and healthy clinical results. G. Lo Giudice, G. Iannello, A. Terranova, R. Lo Giudice, G. Pantaleo, and M. Cicciù Copyright © 2015 G. Lo Giudice et al. All rights reserved. In Vitro Effect of Zingiber officinale Extract on Growth of Streptococcus mutans and Streptococcus sanguinis Wed, 12 Aug 2015 10:58:39 +0000 Background and Objectives. Tooth decay is an infectious disease of microbial origin. Considering the increasing prevalence of antibiotic resistance due to their overuse and also their side effects, medicinal plants are now considered for use against bacterial infections. This study aimed to assess the effects of different concentrations of Zingiber officinale extract on proliferation of Streptococcus mutans and Streptococcus sanguinis in vitro. Materials and Methods. In this experimental study, serial dilutions of the extract were prepared in two sets of 10 test tubes for each bacterium (total of 20). Standard amounts of bacterial suspension were added; 100ƛ of each tube was cultured on prepared solid agar plates and incubated at 37°C for 24 hours. Serial dilutions of the extract were prepared in another 20 tubes and 100ƛ of each tube was added to blood agar culture medium while being prepared. The mixture was transferred to the plates. The bacteria were inoculated on plates and incubated as described. Results. The minimum inhibitory concentration (MIC) was 0.02 mg/mL for S. mutans and 0.3 mg/mL for S. sanguinis. The minimum bactericidal concentration (MBC) was 0.04 mg for S. mutans and 0.6 mg for S. sanguinis. Conclusion. Zingiber officinale extract has significant antibacterial activity against S. mutans and S. sanguinis cariogenic microorganisms. Arash Azizi, Shabnam Aghayan, Saeed Zaker, Mahdieh Shakeri, Navid Entezari, and Shirin Lawaf Copyright © 2015 Arash Azizi et al. All rights reserved. Endodontic Procedural Errors: Frequency, Type of Error, and the Most Frequently Treated Tooth Mon, 10 Aug 2015 12:31:40 +0000 Introduction. The aim of this study is to determine the most common endodontically treated tooth and the most common error produced during treatment and to note the association of particular errors with particular teeth. Material and Methods. Periapical radiographs were taken of all the included teeth and were stored and assessed using DIGORA Optime. Teeth in each group were evaluated for presence or absence of procedural errors (i.e., overfill, underfill, ledge formation, perforations, apical transportation, and/or instrument separation) and the most frequent tooth to undergo endodontic treatment was also noted. Results. A total of 1748 root canal treated teeth were assessed, out of which 574 (32.8%) contained a procedural error. Out of these 397 (22.7%) were overfilled, 155 (8.9%) were underfilled, 16 (0.9%) had instrument separation, and 7 (0.4%) had apical transportation. The most frequently treated tooth was right permanent mandibular first molar (11.3%). The least commonly treated teeth were the permanent mandibular third molars (0.1%). Conclusion. Practitioners should show greater care to maintain accuracy of the working length throughout the procedure, as errors in length accounted for the vast majority of errors and special care should be taken when working on molars. Waqas Yousuf, Moiz Khan, and Hasan Mehdi Copyright © 2015 Waqas Yousuf et al. All rights reserved. Amoxicillin/Clavulanic Acid for the Treatment of Odontogenic Infections: A Randomised Study Comparing Efficacy and Tolerability versus Clindamycin Sun, 02 Aug 2015 06:55:12 +0000 Background. Treatment of odontogenic infections includes surgical drainage and adjunctive antibiotics. This study was designed to generate efficacy and safety data to support twice daily dosing of amoxicillin/clavulanic acid compared to clindamycin in odontogenic infections. Methods. This was a phase IV, randomised, observer blind study; 472 subjects were randomised to receive amoxicillin/clavulanic acid (875 mg/125 mg BID, ) or clindamycin (150 mg QID, ) for 5 or 7 days based on clinical response. The primary endpoint was percentage of subjects achieving clinical success (composite measure of pain, swelling, fever, and additional antimicrobial therapy required) at the end of treatment. Results. The upper limit of two-sided 95% confidence interval for the treatment difference between the study arms (7.7%) was within protocol specified noninferiority margin of 10%, thus demonstrating noninferiority of amoxicillin/clavulanic acid to clindamycin. Secondary efficacy results showed a higher clinical success rate at Day 5 in the amoxicillin/clavulanic acid arm. Most adverse events (raised liver enzymes, diarrhoea, and headache) were similar across both arms and were of mild to moderate intensity. Conclusion. Amoxicillin/clavulanic acid was comparable to clindamycin in achieving clinical success (88.2% versus 89.7%) in acute odontogenic infections and the safety profile was consistent with the known side effects of both drugs. Trial Registration. This trial is registered with identifier: NCT02141217. Archiel Launch Tancawan, Maria Noemi Pato, Khamiza Zainol Abidin, A. S. Mohd Asari, Tran Xuan Thong, Puja Kochhar, Chandra Muganurmath, Monique Twynholm, and Keith Barker Copyright © 2015 Archiel Launch Tancawan et al. All rights reserved. Correlations between Perceived Oral Malodor Levels and Self-Reported Oral Complaints Mon, 27 Jul 2015 15:40:14 +0000 Objectives. Even though objective data indicating the absence of oral malodor are presented to patients, they may be skeptical about the results, possibly due to the presence of some discomfort in the oral cavity. The objective of this study was to investigate whether there is an association among self-perceptions of oral malodor, oral complaints, and the actual oral malodor test result. Materials and Methods. Questions concerning self-perceptions of oral malodor and subjective intraoral symptoms were extracted from a questionnaire on oral malodor completed by 363 subjects who visited the clinic for oral malodor of Tokyo Dental College Chiba Hospital and gave consent to this study. In addition, the association of self-perception of oral malodor with values obtained after organoleptic and OralChroma measurement was analyzed. Results. No correlation between 195 subjects (54%) who were judged “with oral malodor” (organoleptic score of ≥1) and 294 subjects (81.6%) who had a self-perceptions of oral malodor was observed. Self-perception of oral malodor was significantly correlated with tongue coating and a strange intraoral taste . Conclusions. Subjects with a self-perception of oral malodor were not necessarily consistent with those actually having an oral malodor. In addition, it was suggested that patients became aware of oral malodor when they felt oral complaints. Atsushi Kameyama, Kurumi Ishii, Sachiyo Tomita, Chihiro Tatsuta, Toshiko Sugiyama, Yoichi Ishizuka, Toshiyuki Takahashi, and Masatake Tsunoda Copyright © 2015 Atsushi Kameyama et al. All rights reserved. The Impact of Subject Age, Gender, and Arch Length on Attitudes of Syrian Dentists towards Shortened Dental Arches Tue, 21 Jul 2015 09:37:56 +0000 Objective. This study aimed to investigate the impact of subject age, gender, and arch length on dentists’ attitudes towards unrestored shortened dental arches. Materials and Methods. 93 Syrian dentists were interviewed and presented with 24 scenarios for male and female subjects of different ages and shortened dental arches of varying length. Participants were asked to indicate on a standardized visual analogue scale how they would value the health of the mouth if the posterior space was left unrestored. Results. A value of 0.0 represented the worst possible health state for a mouth and 1.0 represented the best. The highest mean value (0.73) was assigned to a shortened dental arch with missing second molar teeth in the mouth of a 70-year-old subject. A 35-year-old female subject with an extremely shortened dental arch (all molar and premolar teeth are missing) attracted the lowest mean value (0.26). The statistical analysis indicated a significant decrease in the value placed on unrestored shortened dental arches as the number of remaining teeth decreased (). While subject gender had almost no impact on dentists’ attitudes towards shortened dental arches, the scenarios for the older shortened dental arch subjects attracted significantly higher values compared to the scenarios for the younger subjects (). Conclusion. Subject age and arch length affect dentists’ attitudes towards shortened dental arches, but subject gender does not. Mohammad Zakaria Nassani, Tammam Ibrahim Al-Nahhal, Omar Kujan, Bassel Tarakji, and Elizabeth Jane Kay Copyright © 2015 Mohammad Zakaria Nassani et al. All rights reserved. Longer-Term Postcure Measurement of Cuspal Deformation Induced by Dimensional Changes in Dental Materials Thu, 16 Jul 2015 11:03:09 +0000 Aim. This paper presents a simple, versatile in vitro methodology that enables indirect quantification of shrinkage and expansion stresses under clinically relevant conditions without the need for a dedicated instrument. Methods. For shrinkage effects, resulting cusp deformation of aluminum blocks with MOD type cavity, filled with novel filling compositions and commercial cements, has been measured using a bench-top micrometer and a Linear Variable Differential Transformer (LVDT, a displacement transducer) based instrument. Results. The results demonstrated the validity of the proposed simple methodology. The technique was successfully used in longer-term measurements of shrinkage and expansion stress for several dental compositions. Conclusions. In contrast to in situ techniques where a measuring instrument is dedicated to the sample and its data collection, the proposed simple methodology allows for transfer of the samples to the environment of choice for storage and conditioning. The presented technique can be reliably used to quantify stress development of curing materials under clinically relevant (oral) conditions. This enables direct examination and comparison of structural properties corresponding to the final stage of formed networks. The proposed methodology is directly applicable to the study of self-curing systems as they require mouth-type conditions (temperature and humidity) to achieve their designed kinetics and reactions. A. Falsafi, J. D. Oxman, P.-H. Tse, and T. T. Ton Copyright © 2015 A. Falsafi et al. All rights reserved. Evaluation of Extraradicular Diffusion of Hydrogen Peroxide during Intracoronal Bleaching Using Different Bleaching Agents Tue, 14 Jul 2015 06:26:24 +0000 Objectives. Extra radicular diffusion of hydrogen peroxide associated with intracoronal teeth bleaching was evaluated. Methods. 108 intact single rooted extracted mandibular first premolars teeth were selected. The teeth were instrumented with WaveOne system and obturated with gutta percha and divided into four groups () according to the bleaching materials used. Each main group was divided into three subgroups () according to the time of extra radicular hydrogen peroxide diffusion measurements at 1, 7, and 14 days: group 1 (35% hydrogen peroxide), group 2 (35% carbamide peroxide), group 3 (sodium perborate-30% hydrogen peroxide mixture), and group 4 (sodium perborate-water mixture). Four cemental dentinal defects were prepared just below the CEJ on each root surface. The amount of hydrogen peroxide that leached out was evaluated after 1, 7, and 14 days by spectrophotometer analysis. The results were analyzed using the ANOVA and Tukey’s test. Results. Group 1 showed highest extra radicular diffusion, followed by group 3 and group 2, while group 4 showed the lowest mean extra radicular diffusion. Conclusion. Carbamide peroxide and sodium perborate-water mixture are the most suitable bleaching materials used for internal bleaching due to their low extra radicular diffusion of hydrogen peroxide. Mohammad E. Rokaya, Khaled Beshr, Abeer Hashem Mahram, Samah Samir Pedir, and Kusai Baroudi Copyright © 2015 Mohammad E. Rokaya et al. All rights reserved. Implants in the Anterior Maxilla: Aesthetic Challenges Thu, 11 Jun 2015 09:09:46 +0000 Sang-Choon Cho, Stuart J. Froum, Angela R. Kamer, Peter M. Loomer, Georgios Romanos, and Burak Demiralp Copyright © 2015 Sang-Choon Cho et al. All rights reserved. Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women Wed, 03 Jun 2015 08:01:36 +0000 Introduction. The aim of this study is to compare the quality of life (QoL) in partially edentulous osteoporotic women who have missing teeth restored with dental implant retained restorations with those who do not and, secondarily, to report the rate of osteonecrosis in this sample. Methods. 237 participants completed the Utian QoL survey, a 23-question document measuring across psychosocial domains of well-being including occupational, health, emotional, and sexual domains which together contribute to an overall score. The subset of participants having dental implant supported prosthesis (64) was compared to the subset having nonimplant supported fixed restorations (47), the subset having nonimplant supported removable restorations (60), and the subset having no restoration of missing teeth (66). Results. ANOVA showed significant difference in all QoL domains between the four subsets . Although 134 reported oral bisphosphonate and 51 reported IV bisphosphonate use, no signs of ONJ were identified in any participants. Conclusion. These findings show implant retained oral rehabilitation has a statistically significant impact over nonimplant and traditional fixed restorations, removable restorations, and no restoration of missing teeth in far reaching areas including occupational, health, emotional, sexual, and overall QoL. These findings also support future examination of psychosocial outcomes associated with oral rehabilitation and the incorporation of oral health into women’s health promotion. Christine DeBaz, Jenna Hahn, Lisa Lang, and Leena Palomo Copyright © 2015 Christine DeBaz et al. All rights reserved. Interdental Papilla Length and the Perception of Aesthetics in Asymmetric Situations Wed, 03 Jun 2015 07:26:41 +0000 The purpose of the study was to determine if there was a difference in the perception of aesthetics, by dental specialty, using computer assisted asymmetric alteration of the papilla length in the aesthetic zone with an apical alteration of the contact point of the clinical crowns. Standardized photographs were presented to sixty-five randomly selected dentists from New York University College of Dentistry on a computer screen for evaluation. Then, the dental professionals were asked to rate the smile in each picture. Control and experiment photographs were used. Data was analyzed using the statistical package SPSS version 21 and one-way ANOVA. The perception of esthetics depends on the dental professional specialty; results provide evidence that asymmetric deficiency in papilla length of 2 mm or more is perceived as “unattractive” by the dental specialists. Yung Cheng Paul Yu, Ahmed Alamri, Helena Francisco, Sang-Choon Cho, and Stuart Hirsch Copyright © 2015 Yung Cheng Paul Yu et al. All rights reserved. In Vitro Ability of a Novel Nanohydroxyapatite Oral Rinse to Occlude Dentine Tubules Wed, 03 Jun 2015 06:36:57 +0000 Objectives. The aim of the study was to investigate the ability of a novel nanohydroxyapatite (nHA) desensitizing oral rinse to occlude dentine tubules compared to selected commercially available desensitizing oral rinses. Methods. 25 caries-free extracted molars were sectioned into 1 mm thick dentine discs. The dentine discs () were etched with 6% citric acid for 2 minutes and rinsed with distilled water, prior to a 30-second application of test and control oral rinses. Evaluation was by (1) Scanning Electron Microscopy (SEM) of the dentine surface and (2) fluid flow measurements through a dentine disc. Results. Most of the oral rinses failed to adequately cover the dentine surface apart from the nHa oral rinse. However the hydroxyapatite, 1.4% potassium oxalate, and arginine/PVM/MA copolymer oral rinses, appeared to be relatively more effective than the nHA test and negative control rinses (potassium nitrate) in relation to a reduction in fluid flow measurements. Conclusions. Although the novel nHA oral rinse demonstrated the ability to occlude the dentine tubules and reduce the fluid flow measurements, some of the other oral rinses appeared to demonstrate a statistically significant reduction in fluid flow through the dentine disc, in particular the arginine/PVM/MA copolymer oral rinse. Robert G. Hill, Xiaohui Chen, and David G. Gillam Copyright © 2015 Robert G. Hill et al. All rights reserved. Quality of Root Canals Performed by the Inaugural Class of Dental Students at Libyan International Medical University Mon, 01 Jun 2015 12:49:52 +0000 Objective. The purpose of this study was to radiographically evaluate technical quality of root canal fillings performed by dental undergraduates at Libyan International Medical University in Libya. Methods. Root canal cases were treated at university dental clinic from the fall of 2012 to the fall of 2013 by the fourth and fifth year dental students. Students used step-back preparation and cold lateral compaction in the treatment. Radiographs were reviewed over a two-year period from initial procedure to final restoration. Radiographs were evaluated for adequacy or inadequacy by length, density, and taper. Length inadequacy was classified as short or overextended. Overall quality was considered “adequate” based on all three variables. Chi-square tested differences between teeth groupings and adequacy classification. Significant value results were adjusted by Bonferroni correction. Results. Adequate length of root canal fillings were observed in roughly half of all samples (48.6%). Density was adequate in 75.8% of the samples. Taper was observed as adequate in 68.8%. Higher quality was evident in anterior teeth (plus premolars) versus molars (65.6% versus 43.3%, resp.; ). Conclusion. Overall quality of endodontic treatment performed by undergraduate dental students was adequate in 53.9% of the cases. Significant opportunity exists to improve the quality of root canals provided by dental students. Ranya F. Elemam, Ziad Salim Abdul Majid, Matt Groesbeck, and Álvaro F. Azevedo Copyright © 2015 Ranya F. Elemam et al. All rights reserved. Various Techniques to Increase Keratinized Tissue for Implant Supported Overdentures: Retrospective Case Series Mon, 01 Jun 2015 11:44:43 +0000 Purpose. The purpose of this retrospective case series is to describe and compare different surgical techniques that can be utilized to augment the keratinized soft tissue around implant-supported overdentures. Materials and Methods. The data set was extracted as deidentified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at New York University College of Dentistry. Eight edentulous patients were selected to be included in this study. Patients were treated for lack of keratinized tissue prior to implant placement, during the second stage surgery, and after delivery of the final prosthesis. Results. All 8 patients in this study were wearing a complete maxillary and/or mandibular denture for at least a year before the time of the surgery. One of the following surgical techniques was utilized to increase the amount of keratinized tissue: apically positioned flap (APF), pedicle graft (PG), connective tissue graft (CTG), or free gingival graft (FGG). Conclusions. The amount of keratinized tissue should be taken into consideration when planning for implant-supported overdentures. The apical repositioning flap is an effective approach to increase the width of keratinized tissue prior to the implant placement. Ahmed Elkhaweldi, Carmen Rincon Soler, Rodrigo Cayarga, Takanori Suzuki, and Zev Kaufman Copyright © 2015 Ahmed Elkhaweldi et al. All rights reserved.