International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . 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. Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series Mon, 01 Jun 2015 11:43:43 +0000 Purpose. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion. Materials and Methods. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants. Results. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months. Conclusions. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction. Joao Carames, Loana Tovar Suinaga, Yung Cheng Paul Yu, Alejandro Pérez, and Mary Kang Copyright © 2015 Joao Carames et al. All rights reserved. Zirconia Implants in Esthetic Areas: 4-Year Follow-Up Evaluation Study Mon, 01 Jun 2015 11:33:31 +0000 Objectives. The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes of zirconia implants positioned in the esthetic jaw areas. Materials and Method. 13 patients were selected and 20 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge in the esthetic jaw areas. Six months after surgery and then once a year, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. Results. The survival and success rates were 100%. The average marginal bone loss from baseline to 48 months after surgery was +2.1 mm. Four years after surgery, the median and the mode for visible Plaque Index and Bleeding On Probing resulted 1 whereas Probing Pocket Depth amounted to 3 mm (SD = ±0.49 mm). Conclusion. One-piece zirconia dental implants are characterized by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants even in the esthetic areas. Andrea Enrico Borgonovo, Rachele Censi, Virna Vavassori, Oscar Arnaboldi, Carlo Maiorana, and Dino Re Copyright © 2015 Andrea Enrico Borgonovo et al. All rights reserved. Soft Tissue Surgical Procedures for Optimizing Anterior Implant Esthetics Mon, 01 Jun 2015 09:16:58 +0000 Implant dentistry has been established as a predictable treatment with excellent clinical success to replace missing or nonrestorable teeth. A successful esthetic implant reconstruction is predicated on two fundamental components: the reproduction of the natural tooth characteristics on the implant crown and the establishment of soft tissue housing that will simulate a healthy periodontium. In order for an implant to optimally rehabilitate esthetics, the peri-implant soft tissues must be preserved and/or augmented by means of periodontal surgical procedures. Clinicians who practice implant dentistry should strive to achieve an esthetically successful outcome beyond just osseointegration. Knowledge of a variety of available techniques and proper treatment planning enables the clinician to meet the ever-increasing esthetic demands as requested by patients. The purpose of this paper is to enhance the implant surgeon’s rationale and techniques beyond that of simply placing a functional restoration in an edentulous site to a level whereby an implant-supported restoration is placed in reconstructed soft tissue, so the site is indiscernible from a natural tooth. Andreas L. Ioannou, Georgios A. Kotsakis, Michelle G. McHale, Donald E. Lareau, James E. Hinrichs, and Georgios E. Romanos Copyright © 2015 Andreas L. Ioannou et al. All rights reserved. Caries Experience Differs between Females and Males across Age Groups in Northern Appalachia Wed, 27 May 2015 07:26:16 +0000 Sex disparities in dental caries have been observed across many populations, with females typically exhibiting higher prevalence and more affected teeth. In this study we assessed the sex disparities in two Northern Appalachian populations from West Virginia (WV, ) and Pennsylvania (PA, ) by comparing caries indices between males and females across four phases of dental development: primary dentition in children aged 1–5 years, mixed dentition in children aged 6–11 years, permanent dentition in adolescents aged 12–17 years, and permanent dentition in adults aged 18–59 years. No significant sex differences were observed for children aged 1–5 years. Contrary to national and international trends, WV girls aged 6–11 years had 1.5 fewer affected teeth than boys . However, by ages 12–17, caries indices in the WV girls matched those in boys. In both WV and PA adults, women and men had similar total counts of affected teeth (i.e., DMFT), although women had more dental restorations and men had more current decay . These results suggest that in some Appalachian populations, young girls benefit from protection against caries that is lost during adolescence and that adult women utilize dental health care to a greater degree than men. John R. Shaffer, Elizabeth J. Leslie, Eleanor Feingold, Manika Govil, Daniel W. McNeil, Richard J. Crout, Robert J. Weyant, and Mary L. Marazita Copyright © 2015 John R. Shaffer et al. All rights reserved. Challenges Faced in Engaging American Indian Mothers in an Early Childhood Caries Preventive Trial Tue, 19 May 2015 06:24:38 +0000 Objective. This study explores the challenges faced by the research implementation team in engaging new mothers in a community oral health prevention intervention in an American Indian (AI) reservation community. Methods. Qualitative methods in the form of in-depth interviews were used in the study. Qualitative data were collected from research staff workers at a field site, who were involved in the implementation of a culturally tailored, randomized controlled trial of a behavioral intervention utilizing Motivational Interviewing (MI). Results. Several challenges were described by the field staff in engaging new mothers, including low priority placed on oral health, lack of knowledge, and distractions that reduced their ability to engage in learning about oral health of their child. Other difficulties faced in engaging the mothers and the AI community at large were distrust related to racial differences and physical and environmental barriers including poor road conditions, lack of transportation and communication, and remoteness of data collection sites. The field staff developed and applied many strategies, including conducting home visits, applying new communication strategies, and interacting with the community at various venues. Conclusion. Prevention interventions for ECC need to target AI mothers. Strategies developed by the field staff were successful for engaging mothers in the study. Tamanna Tiwari, Judith Albino, and Terrence S. Batliner Copyright © 2015 Tamanna Tiwari et al. All rights reserved. Oral Health in a Sample of Pregnant Women from Northern Appalachia (2011–2015) Mon, 18 May 2015 13:42:26 +0000 Background. Chronic poor oral health has a high prevalence in Appalachia, a large region in the eastern USA. The Center for Oral Health Research in Appalachia (COHRA) has been enrolling pregnant women and their babies since 2011 in the COHRA2 study of genetic, microbial, and environmental factors involved in oral health in Northern Appalachia. Methods. The COHRA2 protocol is presented in detail, including inclusion criteria (healthy, adult, pregnant, US Caucasian, English speaking, and nonimmunocompromised women), recruiting (two sites: Pittsburgh, Pennsylvania, and West Virginia, USA), assessments (demographic, medical, dental, psychosocial/behavioral, and oral microbial samples and DNA), timelines (longitudinal from pregnancy to young childhood), quality control, and retention rates. Results. Preliminary oral health and demographic data are presented in 727 pregnant women, half from the greater Pittsburgh region and half from West Virginia. Despite similar tooth brushing and flossing habits, COHRA2 women in West Virginia have significantly worse oral health than the Pittsburgh sample. Women from Pittsburgh are older and more educated and have less unemployment than the West Virginia sample. Conclusions. We observed different prevalence of oral health and demographic variables between pregnant women from West Virginia (primarily rural) and Pittsburgh (primarily urban). These observations suggest site-specific differences within Northern Appalachia that warrant future studies. Katherine Neiswanger, Daniel W. McNeil, Betsy Foxman, Manika Govil, Margaret E. Cooper, Robert J. Weyant, John R. Shaffer, Richard J. Crout, Hyagriv N. Simhan, Scott R. Beach, Stella Chapman, Jayme G. Zovko, Linda J. Brown, Stephen J. Strotmeyer, Jennifer L. Maurer, and Mary L. Marazita Copyright © 2015 Katherine Neiswanger et al. All rights reserved. Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients Tue, 12 May 2015 07:37:55 +0000 Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible) with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months). Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years. M. Daas, A. Assaf, K. Dada, and J. Makzoumé Copyright © 2015 M. Daas et al. All rights reserved. Index of Orthodontic Treatment Need in Obese Adolescents Sun, 05 Apr 2015 08:10:04 +0000 Aim. This case-control retrospective study is aimed at assessing if obese adolescents need more orthodontic treatment in comparison with normal-weight patients of the same age. Methods. The test group included 100 obese subjects (50 males and 50 females; average age: 13.09 ± 1.19 years old) and the control group included 100 normal-weight patients matched for age and sex (50 males and 50 females; average age: 13.07 ± 1.26 years old). Clinical examinations were conducted on dental casts to assess the need of orthodontic treatment, by using the Index of Orthodontic Treatment Need (IOTN) (DHC, dental health component; AC, aesthetic components). Results. No statistically significant difference () was observed between the two groups with regard to AC. Obese females showed a significant () higher percentage of DHC 3 (32%) in comparison to the normal-weight girls (22%); for the other grades of DHC and for the single kind of malocclusion, no significant difference was found. Conclusions. Obese adolescents showed a similar need for orthodontic treatment compared to normal-weight patients of the same age. However, in obese females, a slightly greater need for orthodontic treatment was observed, compared to normal-weight patients. Maria Rita Giuca, Marco Pasini, Silvia Caruso, Simona Tecco, Stefano Necozione, and Roberto Gatto Copyright © 2015 Maria Rita Giuca et al. All rights reserved. A Comparative Evaluation of Static Frictional Resistance Using Various Methods of Ligation at Different Time Intervals: An In Vitro Study Tue, 31 Mar 2015 11:34:41 +0000 Aim. To compare and evaluate the static frictional resistance offered by the four different types of ligation methods in both dry and wet conditions and at different durations when immersed in artificial saliva. Material and Methods. Alastik Easy to Tie modules, Super Slick Mini Stix elastomeric modules, Power “O” modules, and 0.009″ Stainless Steel ligatures were used to compare the static friction using maxillary canine and premolar Preadjusted Edgewise brackets with 0.022″ × 0.028″ slot and 0.019″ × 0.025″ stainless steel wires. Results. The mean frictional resistance for Alastik modules was the lowest and that of Stainless Steel ligatures was found to be highest among the four groups compared and the difference among the four groups was statistically significant (). The mean static frictional resistance in all groups under dry conditions was lower than that under wet conditions. No statistical significant differences were found when the groups were compared at different time periods of immersion in artificial saliva. Conclusion. This study concludes that the Alastik modules showed the lowest mean static frictional forces compared to any other ligation method, though no significant difference was found for different time periods of immersion in the artificial saliva. Amanpreet Singh Natt, Amandeep Kaur Sekhon, Sudhir Munjal, Rohit Duggal, Anup Holla, Prahlad Gupta, Piyush Gandhi, and Sahil Sarin Copyright © 2015 Amanpreet Singh Natt et al. All rights reserved. Spectrogram Analysis of Complete Dentures with Different Thickness and Palatal Rugae Materials on Speech Production Thu, 26 Mar 2015 13:08:51 +0000 Objective. To investigate the influence of reproduction of different thickness and palatal rugae materials on complete dentures speech using Computerized Speech Lab (CSL) (spectrogram). Materials and Methods. Three completely edentulous male patients (aged 50–60 years) were selected for reading a paragraph. Twelve upper dentures were constructed, four for each patient. The patients’ speech groups were divided into five groups, Group I: patients without dentures; Group II: patients rehabilitated with conventional acrylic dentures; Group III: patients with conventional acrylic dentures with rugae reproduction; Group IV: patients with dentures with metallic framework of minimal thickness and direct ragged metallic palatal surface at rugae area; Group V: patients with dentures with palatal rugae constructed from resilient acrylic resin material with thickness less than conventional denture. Speech samples were recorded after insertion of each denture for groups using Computerized Speech Lab (CSL) (spectrogram). The sounds selected were lingopalatal /s/z/sh/t/d/ and /l/. Results. Group III produced high mean significant difference with /sh/t/ sound. For Group IV, the difference was noticed with /s/z/sh/t/ and /d/ sounds, while for Group V the difference was shown with /z/l/ sound (). Conclusion. It is recommended to reproduce the rugae area in complete denture because the phonetic quality of complete denture with rugae is superior to the conventional denture. Hamada Zaki Mahross and Kusai Baroudi Copyright © 2015 Hamada Zaki Mahross and Kusai Baroudi. All rights reserved. Quantitative Analysis of Salivary TNF-α in Oral Lichen Planus Patients Sun, 15 Mar 2015 11:21:37 +0000 Objective. The aim of this study was to quantitatively evaluate the salivary tumor necrosis factor-alpha (TNF-α) level in oral lichen planus patients and to compare the levels of TNF-α between saliva and serum of OLP and controls. Methods. Serum and whole saliva from 30 patients with active lesions of oral lichen planus (OLP) and 30 healthy persons were investigated for the presence of TNF-α by enzyme immunoassay. Student’s independent t-test and two-sample binomial proportion test were used to calculate significance of the mean values of TNF-alpha in serum and saliva and to determine the proportions of the detected and nondetected samples in both groups. Results. Proportion of detection and the mean of detectability between saliva and serum of Group B show an almost equal value, which suggests that saliva can be a good alternate to serum to analyze TNF-α in oral lichen planus patients. T. Malarkodi and S. Sathasivasubramanian Copyright © 2015 T. Malarkodi and S. Sathasivasubramanian. 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