International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Surface Roughness, Microhardness, and Microleakage of a Silorane-Based Composite Resin after Immediate or Delayed Finishing/Polishing Tue, 09 Feb 2016 12:29:39 +0000 Objective. This study evaluated the effect of immediate or delayed finishing/polishing using different systems on the surface roughness, hardness, and microleakage of a silorane-based composite. Material and Methods. Specimens were made with silorane-based composite (Filtek P90, 3M ESPE) and assigned to the treatments: control (light-cured); aluminum oxide discs (Sof-Lex, 3M ESPE); diamond-impregnated silicone tips (Astropol, Ivoclar Vivadent); aluminum oxide-impregnated silicone tips (Enhance, Dentsply). Half of the specimens were finished/polished immediately and the rest after 7 days. Surface roughness (Ra, μm; ) and Vickers microhardness (50 g; 45 s; ) were measured. Cavities were prepared in bovine incisors and filled with Filtek P90. The fillings received immediate or delayed finishing/polishing () and were subjected to dye penetration test (0.5% basic fuchsin, 24 h). Data were analyzed by ANOVA and Scheffe, Kruskal-Wallis, and Mann-Whitney tests (). Results. The finishing/polishing system significantly influenced roughness and microhardness (). For enamel, microleakage was not affected by the finishing/polishing system (). For dentin, Sof-Lex discs and Astropol points promoted greater microleakage than Enhance points (). Conclusion. Considering roughness, microhardness, and microleakage together, immediate finishing/polishing of a silorane-based composite using aluminum oxide discs may be recommended. Fernanda Carvalho Rezende Lins, Raquel Conceição Ferreira, Rodrigo Richard Silveira, Carolina Nemésio Barros Pereira, Allyson Nogueira Moreira, and Claudia Silami Magalhães Copyright © 2016 Fernanda Carvalho Rezende Lins et al. All rights reserved. Materials and Bioactive Factors in Dental Restoration and Periodontal Therapy Tue, 09 Feb 2016 07:42:27 +0000 Vesna Miletic, Tihana Divnic-Resnik, Natasa Nikolic Jakoba, Andrija Petar Bosnjak, and Paulo Henrique Perlatti D’Alpino Copyright © 2016 Vesna Miletic et al. All rights reserved. Impact of Orthodontic Treatment on Periodontal Tissues: A Narrative Review of Multidisciplinary Literature Tue, 19 Jan 2016 13:49:29 +0000 The aim of this review is to describe the most commonly observed changes in periodontium caused by orthodontic treatment in order to facilitate specialists’ collaboration and communication. An electronic database search was carried out using PubMed abstract and citation database and bibliographic material was then used in order to find other appropriate sources. Soft and hard periodontal tissues changes during orthodontic treatment and maintenance of the patients are discussed in order to provide an exhaustive picture of the possible interactions between these two interwoven disciplines. Angelina Gorbunkova, Giorgio Pagni, Anna Brizhak, Giampietro Farronato, and Giulio Rasperini Copyright © 2016 Angelina Gorbunkova et al. All rights reserved. A Three-Dimensional Finite Element Study on the Biomechanical Simulation of Various Structured Dental Implants and Their Surrounding Bone Tissues Tue, 19 Jan 2016 08:50:49 +0000 Background/Purpose. This three-dimensional finite element study observed the stress distribution characteristics of 12 types of dental implants and their surrounding bone tissues with various structured abutments, implant threads, and healing methods under different amounts of concentrated loading. Materials and Methods. A three-dimensional geometrical model of a dental implant and its surrounding bone tissue was created; the model simulated a screw applied with a preload of 200 N or a torque of 0.2 N·m and a prosthetic crown applied with a vertical or an inclined force of 100 N. The Von Mises stress was evaluated on the 12 types of dental implants and their surrounding bone tissues. Results. Under the same loading force, the stress influence on the implant threads was not significant; however, the stress influence on the cancellous bone was obvious. The stress applied to the abutment, cortical bone, and cancellous bone by the inclined force applied to the crown was larger than the stress applied by the vertical force to the crown, and the abutment stress of the nonsubmerged healing implant system was higher than that of the submerged healing implant system. Conclusion. A dental implant system characterised by a straight abutment, rectangle tooth, and nonsubmerged healing may provide minimum value for the implant-bone interface. Gong Zhang, Hai Yuan, Xianshuai Chen, Weijun Wang, Jianyu Chen, Jimin Liang, and Peng Zhang Copyright © 2016 Gong Zhang et al. All rights reserved. Comparison of the Mechanical Properties of Early Leukocyte- and Platelet-Rich Fibrin versus PRGF/Endoret Membranes Wed, 06 Jan 2016 11:35:39 +0000 Objectives. The mechanical properties of membranes are important factors in the success of treatment and clinical handling. The goal of this study was to compare the mechanical properties of early leukocyte- and platelet-rich fibrin (L-PRF) versus PRGF/Endoret membrane. Materials and Methods. In this experimental study, membranes were obtained from 10 healthy male volunteers. After obtaining 20 cc venous blood from each volunteer, 10 cc was used to prepare early L-PRF (group 1) and the rest was used to get a membrane by PRGF-Endoret system (group 2). Tensile loads were applied to specimens using universal testing machine. Tensile strength, stiffness, and toughness of the two groups of membranes were calculated and compared by paired -test. Results. The mean tensile strength and toughness were higher in group 1 with a significant difference (). The mean stiffness in group 1 was also higher but not statistically significant (). Conclusions. The results showed that early L-PRF membranes had stronger mechanical properties than membranes produced by PRGF-Endoret system. Early L-PRF membranes might have easier clinical handling and could be a more proper scaffold in periodontal regenerative procedures. The real results of the current L-PRF should be in fact much higher than what is reported here. Hooman Khorshidi, Saeed Raoofi, Rafat Bagheri, and Hodasadat Banihashemi Copyright © 2016 Hooman Khorshidi et al. All rights reserved. Knowledge of Future Dental Practitioners towards Oral Cancer: Exploratory Findings from a Public University in Malaysia Tue, 29 Dec 2015 12:33:46 +0000 Objective. To assess knowledge and awareness of oral cancer in the early identification of risk factors among undergraduate dental students. Methods. A total of 162 undergraduate (third, fourth, and fifth year) dental students at International Islamic University, Malaysia, were approached to participate in the study, and those who agreed were administered. A 9-item pretested questionnaire contains questions on oral examination, oral cancer risk factors, and requests for further information. Descriptive statistics were conducted using chi-square testing. Results. The response rate of the study was 70.3% (114/162), with 26 (22.8%) males and 88 (77.2%) females. All undergraduate dental students were familiar with examining the oral mucosa of their patients and most were likely to advise patients about the risk factors for developing oral cancer (98.2%). Nearly one-third (32.4%) of students reported examining patients with oral lesions as early signs for oral cancer () and nearly 70% agreed that they did not have sufficient knowledge regarding the prevention and detection of oral cancer (). In addition, more than 95.6% agreed that there is a need for additional information/teaching regarding oral cancer. Further, 61.3% and 14.1% identified tobacco smoking and drinking alcohol as major risk factors for developing oral cancer. Conclusion. This study demonstrated lack of awareness about risk factors among undergraduate dental students regarding oral cancer. Reinforcing awareness and enhancing the benefits of early detection on prevention of oral cancer should be done through training and/or educational intervention. Akshaya Srikanth Bhagavathula, Nazrin Bin Zakaria, and Shazia Qasim Jamshed Copyright © 2015 Akshaya Srikanth Bhagavathula et al. All rights reserved. Association between IFN-γ +874A/T and IFN-γR1 (-611A/G, +189T/G, and +95C/T) Gene Polymorphisms and Chronic Periodontitis in a Sample of Iranian Population Mon, 28 Dec 2015 12:49:29 +0000 Background. Interferon gamma (IFN-γ) is an immune regulatory cytokine that acts through its receptor and plays important role in progression of inflammatory disease such as chronic periodontitis (CP). The purpose of this study was to determine the differences in the distribution of IFN-γ (+874A/T) and IFN-γR1 (-611A/G, +189T/G, and +95C/T) gene polymorphisms among CP and healthy individuals and to investigate relationships between these polymorphisms and susceptibility to CP. Materials and Methods. 310 individuals were enrolled in the study including 210 CP patients and 100 healthy controls. Single nucleotide polymorphisms at IFN-γ (+874A/T) and IFN-γR1 (-611A/G, +189T/G, and +95C/T) were analyzed by ARMS-PCR and PCR-RFLP methods. Results. The significant difference was found in genotype and allele frequency of IFN-γ (+874A/T) gene polymorphism in chronic periodontitis patients and healthy controls. The distribution of genotypes and allele frequencies for IFN-γR1 (-611A/G, +189T/G, and +95C/T) were similar among the groups and no differences in the frequencies of alleles or genotypes of IFN-γR1 genetic polymorphisms variants between case and control groups were detected. Conclusion. The finding of this study showed that IFN-γ +874A/T gene polymorphism may affect susceptibility to CP, whereas IFN-γR1 genetic polymorphisms at -611A/G, +189T/G, and +95C/T were not associated with this disease. Zahra Heidari, Hamidreza Mahmoudzadeh-Sagheb, Mohammad Hashemi, Somayeh Ansarimoghaddam, Bita Moudi, and Nadia Sheibak Copyright © 2015 Zahra Heidari et al. All rights reserved. Photodynamic Antimicrobial Chemotherapy for Root Canal System Asepsis: A Narrative Literature Review Thu, 10 Dec 2015 12:08:23 +0000 Aim. The aim of this comprehensive literature review was to address the question: Does photodynamic therapy (PDT) improve root canal disinfection through significant bacterial reduction in the root canal system? Methodology. A comprehensive narrative literature review was performed to compare PDT effect with sodium hypochlorite as the comparative classical irrigant. Two reviewers independently conducted literature searches using a combination of medical subject heading terms and key words to identify relevant studies comparing information found in 7 electronic databases from January 2000 to May 2015. A manual search was performed on bibliography of articles collected on electronic databases. Authors were contacted to ask for references of more research not detected on the prior electronic and manual searches. Results. The literature search provided 62 titles and abstracts, from which 29 studies were related directly to the search theme. Considering all publications, 14 (48%) showed PDT to be more efficient in antimicrobial outcome than NaOCl (0.5–6% concentration) used alone and 2 (7%) revealed similar effects between them. Toluidine blue and methylene blue are the most used photosensitizers and most commonly laser has 660 nm of wavelength with a 400 nm diameter of intracanal fiber. Conclusions. PDT has been used without a well-defined protocol and still remains at an experimental stage waiting for further optimization. The level of evidence available in clinical studies to answer this question is low and at high risk of bias. P. Diogo, T. Gonçalves, P. Palma, and J. M. Santos Copyright © 2015 P. Diogo et al. 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.