International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Importance of Diversity in the Oral Microbiota including Candida Species Revealed by High-Throughput Technologies Tue, 22 Apr 2014 07:23:23 +0000 Taking advantage of high-throughput technologies, deep sequencing of the human microbiome has revealed commensal bacteria independent of the ability to culture them. The composition of the commensal microbiome is dependent on bacterial diversity and the state of the host regulated by the immune system. Candida species are well known as components of the commensal oral microbiota. Candida species frequently colonize and develop biofilms on medical devices like dentures and catheters. Therefore, Candida biofilm on dentures leads to a decrease in the bacterial diversity and then to a change in the composition of the oral microbiota. A disturbance in the balance between commensal bacteria and the host immune system results in a switch from a healthy state to a diseased state even in the limited oral niche. Tamaki Cho, Jun-ichi Nagao, Rieko Imayoshi, and Yoshihiko Tanaka Copyright © 2014 Tamaki Cho et al. All rights reserved. A New Classification of Endodontic-Periodontal Lesions Mon, 14 Apr 2014 10:05:13 +0000 The interrelationship between periodontal and endodontic disease has always aroused confusion, queries, and controversy. Differentiating between a periodontal and an endodontic problem can be difficult. A symptomatic tooth may have pain of periodontal and/or pulpal origin. The nature of that pain is often the first clue in determining the etiology of such a problem. Radiographic and clinical evaluation can help clarify the nature of the problem. In some cases, the influence of pulpal pathology may cause the periodontal involvement and vice versa. The simultaneous existence of pulpal problems and inflammatory periodontal disease can complicate diagnosis and treatment planning. An endo-perio lesion can have a varied pathogenesis which ranges from simple to relatively complex one. The differential diagnosis of endodontic and periodontal diseases can sometimes be difficult, but it is of vital importance to make a correct diagnosis for providing the appropriate treatment. This paper aims to discuss a modified clinical classification to be considered for accurately diagnosing and treating endo-perio lesion. Khalid S. Al-Fouzan Copyright © 2014 Khalid S. Al-Fouzan. All rights reserved. Oral Health Promotion in Infants and Children: Models and Long-Term Effectiveness Sun, 13 Apr 2014 11:26:54 +0000 Gajanan Kulkarni Copyright © 2014 Gajanan Kulkarni. All rights reserved. Trends in Computer-Aided Manufacturing in Prosthodontics: A Review of the Available Streams Tue, 08 Apr 2014 08:43:03 +0000 In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses. Jaafar Abduo, Karl Lyons, and Mohammed Bennamoun Copyright © 2014 Jaafar Abduo et al. All rights reserved. Diagnostic Applications of Cone-Beam CT for Periodontal Diseases Thu, 03 Apr 2014 09:28:01 +0000 Objectives. This paper aims to review the diagnostic application of cone beam computed tomography (CBCT) in the field of periodontology. Data. Original articles that reported on the use of CBCT for periodontal disease diagnosis were included. Sources. MEDLINE (1990 to January 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: “CBCT,” “volumetric CT,” “periodontal disease ,” and “periodontitis.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Conclusions. Bony defects, caters, and furcation involvements seem to be better depicted on CBCT, whereas bone quality and periodontal ligament space scored better on conventional intraoral radiography. CBCT does not offer a significant advantage over conventional radiography for assessing the periodontal bone levels. Yousef A. AlJehani Copyright © 2014 Yousef A. AlJehani. All rights reserved. A Proposed New Index for Clinical Evaluation of Interproximal Soft Tissues: The Interdental Pressure Index Tue, 01 Apr 2014 13:42:01 +0000 The interdental pressure index (IPI) is introduced to specifically evaluate clinical interproximal-tissue conditions and assess the effect of interproximal hygiene stimulation. This index scores clinical responses of periodontal tissues to the apical pressure of a horizontally placed periodontal probe. It is negative when gingival tissues are firm, bleeding-free, and slightly ischemic by the stimulation; otherwise it is positive. The clinical validation showed high intraoperator agreement (0.92; 95% CI: 0.82–0.96; ) and excellent interoperator agreement (0.76; 95% CI: 0.14–1.38; ). High internal consistency with bleeding on probing () and gingival index (Cronbach’s ) was obtained. Histological validation obtained high sensitivity (100%) and specificity (80%) for IPI+ toward inflammatory active form. The same results were recorded for IPI− toward chronic inactive form. IPI results as a simple and noninvasive method with low error probability and good reflection of histological condition that can be applied for oral hygiene motivation. Patient compliance to oral hygiene instructions is essential in periodontal therapy and IPI index can be a practical and intuitive tool to check and reinforce this important aspect. Checchi Luigi, Montevecchi Marco, Marucci Gianluca, and Checchi Vittorio Copyright © 2014 Checchi Luigi et al. All rights reserved. Psychosocial and Quality of Life Outcomes of Prosthetic Auricular Rehabilitation with CAD/CAM Technology Mon, 31 Mar 2014 00:00:00 +0000 Introduction. The psychosocial and quality of life (QoL) of patients with deformed or missing ears are frequently compromised. The aim of this study is to develop innovative techniques using CAD/CAM technology in prosthetic auricular rehabilitation and provide improvement in the treatment outcomes, including their psychology and QoL. Methods. This is a preliminary clinical cohort study. Six patients requesting for auricular reconstruction were recruited and rehabilitated with implant-supported prosthesis using CAD/CAM technology. Different treatment outcomes including QoL and psychological changes were assessed at different time points. Results. A significant reduction in severity of depressive symptoms and an improving trend of satisfaction with life were found at 1 year postoperatively when compared with the preoperative findings. The domain scores in ‘‘Body image’’, ‘‘Family/friends/strangers’’, and ‘‘Mood’’ were also significantly higher at 1 year postoperatively than 1 week postoperatively. However, only 50% of the patients wear their auricular prosthesis regularly. Conclusion. This preliminary study has confirmed that implant-supported auricular prosthesis could induce improvement in the psychology and QoL with statistically significant differences in the domains of the body image, social interaction, and mood. Our present findings can inform research design and hypotheses generation of future studies. Chi Keung Tam, Colman Patrick McGrath, Samuel Mun Yin Ho, Edmond Ho Nang Pow, Henry Wai Kuen Luk, and Lim Kwong Cheung Copyright © 2014 Chi Keung Tam et al. All rights reserved. Outcome of Endodontic Treatments Made by Postgraduate Students in the Dental Clinic of Bretonneau Hospital Thu, 20 Mar 2014 09:22:50 +0000 Objective. The objective of this retrospective study is double: (1) to assess the 1–4 years of outcome of endodontic treatment performed by postgraduate students in endodontics in the Dental Clinic of Bretonneau Hospital and (2) to examine outcome predictors. Method. 363 teeth in 296 patients were treated between 2007 and 2011. 183 patients (224 teeth) were lost during the followup. 113 patients were included in the study (recall: 38%), corresponding to 139 teeth of which 8 were extracted. 131 remaining teeth (36%) were examined clinically and radiographically. Apical periodontitis (AP) was absent (PAI = 1) or present (PAI ≥ 2). Outcome was classified as “healed,” “healing,” or “diseased”. Results. The success rate was 92%. No failure was observed among the 23 initial endodontic treatments. Among the 108 retreated teeth, 80% were “healed” and 11% were “healing.” An association was found between success rate and preoperative signs or symptoms (absent 95% versus present 83%), preoperative root filling density (inadequate 93% versus adequate 57%), but not between preoperative AP status and success. Conclusion. Outcomes in this retrospective study were similar to those previously reported. However, a larger sample size is needed to assess outcome predictors more precisely. Virginie Touboul, Alice Germa, Jean-Jacques Lasfargues, and Eric Bonte Copyright © 2014 Virginie Touboul et al. All rights reserved. Nano in Implant Dentistry Thu, 06 Mar 2014 13:21:56 +0000 Ryo Jimbo, Martin Andersson, and Stefan Vandeweghe Copyright © 2014 Ryo Jimbo et al. All rights reserved. Marginal and Internal Fit of Cobalt-Chromium Fixed Dental Prostheses Generated from Digital and Conventional Impressions Mon, 03 Mar 2014 10:38:05 +0000 Objectives. Digital impressions are increasingly used and have the potential to avoid the problem of inaccurate impressions. Only a few studies to verify the accuracy of digital impressions have been performed. The purpose of this study was to compare the marginal and internal fit of 3-unit tooth supported fixed dental prostheses (FDPs) fabricated from digital and conventional impressions. Methods. Ten FDPs were produced from digital impressions using the iTero system and 10 FDPs were produced using vinyl polysiloxane (VPS) impression material. A triple-scan protocol and CAD software were used for measuring and calculating discrepancies of the FDPs at 3 standard areas: mean internal discrepancy, absolute marginal gap, and cervical area discrepancy. The Mann-Whitney U test was used for analyzing the results. Results. For conventional and digital impressions, respectively, FDPs had an absolute marginal gap of 147?µm and 142?µm, cervical area discrepancy of 69?µm and 44?µm, and mean internal discrepancy of 117?µm and 93?µm. The differences were statistically significant in the cervical and internal areas (). Significance. The results indicated that the digital impression technique is more exact and can generate 3-unit FDPs with a significantly closer fit compared to the VPS technique. Per Svanborg, Henrik Skjerven, Pablo Carlsson, Alf Eliasson, Stig Karlsson, and Anders Örtorp Copyright © 2014 Per Svanborg et al. All rights reserved. Disease Management of Early Childhood Caries: ECC Collaborative Project Mon, 03 Mar 2014 09:10:21 +0000 Until recently, the standard of care for early childhood caries (ECC) has been primarily surgical and restorative treatment with little emphasis on preventing and managing the disease itself. It is now recognized that surgical treatment alone does not address the underlying etiology of the disease. Despite costly surgeries and reparative treatment, the onset and progression of caries are likely to continue. A successful rebalance of risk and protective factors may prevent, slow down, or even arrest dental caries and its progression. An 18-month risk-based chronic disease management (DM) approach to address ECC in preschool children was implemented as a quality improvement (QI) collaborative by seven teams of oral health care providers across the United States. In the aggregate, fewer DM children experienced new cavitation, pain, and referrals to the operating room (OR) for restorative treatment compared to baseline historical controls. The teams found that QI methods facilitated adoption of the DM approach and resulted in improved care to patients and better outcomes overall. Despite these successes, the wide scale adoption and spread of the DM approach may be limited unless health policy and payment reforms are enacted to compensate providers for implementing DM protocols in their practice. Man Wai Ng, Francisco Ramos-Gomez, Martin Lieberman, Jessica Y. Lee, Richard Scoville, Cindy Hannon, and Peter Maramaldi Copyright © 2014 Man Wai Ng et al. All rights reserved. Evaluation of Bone Healing on Sandblasted and Acid Etched Implants Coated with Nanocrystalline Hydroxyapatite: An In Vivo Study in Rabbit Femur Sun, 02 Mar 2014 16:13:35 +0000 This study aimed at investigating if a coating of hydroxyapatite nanocrystals would enhance bone healing over time in trabecular bone. Sandblasted and acid etched titanium implants with and without a submicron thick coat of hydroxyapatite nanocrystals (nano-HA) were implanted in rabbit femur with healing times of 2, 4, and 9 weeks. Removal torque analyses and histological evaluations were performed. The torque analysis did not show any significant differences between the implants at any healing time. The control implant showed a tendency of more newly formed bone after 4 weeks of healing and significantly higher bone area values after 9 weeks of healing. According to the results from this present study, both control and nano-HA surfaces were biocompatible and osteoconductive. A submicron thick coating of hydroxyapatite nanocrystals deposited onto blasted and acid etched screw shaped titanium implants did not enhance bone healing, as compared to blasted and etched control implants when placed in trabecular bone. Lory Melin Svanborg, Luiz Meirelles, Victoria Franke Stenport, Per Kjellin, Fredrik Currie, Martin Andersson, and Ann Wennerberg Copyright © 2014 Lory Melin Svanborg et al. All rights reserved. Investigation of Coronal Leakage of Root Fillings after Smear Layer Removal with EDTA or Er,Cr:YSGG Laser through Capillary Flow Porometry Wed, 19 Feb 2014 14:14:19 +0000 No studies have been performed evaluating the marginal seal of root fillings after direct exposure of root canal (RC) walls to Er,Cr:YSGG laser irradiation. Therefore, 75 root filled teeth (5 × 15–cold lateral condensation) were analyzed for through-and-through leakage (TTL) using capillary flow porometry (CFP). The cleaning protocol determined the experimental groups: (1) irrigation with NaOCl 2.5% and EDTA 17% or standard protocol (SP), (2) SP + Er,Cr:YSGG lasing (dried RC), (3) NaOCl 2.5% + Er,Cr:YSGG lasing (dried RC), (4) SP + Er,Cr:YSGG lasing (wet RC), and (5) NaOCl 2.5% + Er,Cr:YSGG lasing (wet RC). Groups 6 to 10 consisted of the same filled teeth with resected apices. Resection was performed after the first CFP measurement. CFP was used to assess minimum, mean flow, and maximum pore diameters after 48 h. Statistics were performed using nonparametric tests (). Additional three roots per group were submitted to SEM of the RC walls. TTL was observed in all groups without statistically significant differences between the different groups for minimum, mean, and maximum pore diameter (). In this study, the use of EDTA and/or Er,Cr:YSGG laser did not reduce through-and-through leakage in nonresected and resected roots. Tom Edgard Maria Vergauwen, Rafaël Michiels, Dries Torbeyns, Maarten Meire, Mieke De Bruyne, and Roeland Jozef Gentil De Moor Copyright © 2014 Tom Edgard Maria Vergauwen et al. All rights reserved. Bisphosphonate Related Osteonecrosis of the Jaw: A Study of 18 Cases Associated with Fungal Infection Tue, 18 Feb 2014 08:13:46 +0000 Osteonecrosis of the jaw (ONJ) is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult. Microbiological investigations have detected a variety of oral pathogens such as Actinomyces, Enterococcus, Candida albicans, Aspergillus, Haemophilus influenzae, alpha-hemolytic streptococci, Lactobacillus, Enterobacter, and Klebsiella pneumoniae. To better treat it, it is important to understand its causes and complications. Materials and Methods. Our present study addresses a microscopic observation of curetted jaw necrotic lesions related to bisphosphonates. Results. A mycotic infestation has been found in all of the 18 cases studied. Discussion. An identification of the fungal agent and its incrimination in the pathogenesis of bisphosphonates related osteonecrosis of the jaw could change radically the management of this condition. V. Aftimos, T. Zeinoun, R. Bou Tayeh, and G. Aftimos Copyright © 2014 V. Aftimos et al. All rights reserved. Anthocyanin Incorporated Dental Copolymer: Bacterial Growth Inhibition, Mechanical Properties, and Compound Release Rates and Stability by 1H NMR Tue, 18 Feb 2014 00:00:00 +0000 Objective. To evaluate bacterial growth inhibition, mechanical properties, and compound release rate and stability of copolymers incorporated with anthocyanin (ACY; Vaccinium macrocarpon). Methods. Resin samples were prepared (Bis-GMA/TEGDMA at 70/30 mol%) and incorporated with 2 w/w% of either ACY or chlorhexidine (CHX), except for the control group. Samples were individually immersed in a bacterial culture (Streptococcus mutans) for 24 h. Cell viability () was assessed by counting the number of colony forming units on replica agar plates. Flexural strength (FS) and elastic modulus (E) were tested on a universal testing machine (). Compound release and chemical stability were evaluated by UV spectrophotometry and 1H NMR (). Data were analyzed by one-way ANOVA and Tukey’s test (α = 0.05). Results. Both compounds inhibited S. mutans growth, with CHX being most effective (). Control resin had the lowest FS and E values, followed by ACY and CHX, with statistical difference between control and CHX groups for both mechanical properties (). The 24 h compound release rates were ACY: 1.33 g/mL and CHX: 1.92 g/mL. 1H NMR spectra suggests that both compounds remained stable after being released in water. Conclusion. The present findings indicate that anthocyanins might be used as a natural antibacterial agent in resin based materials. Halyna Hrynash, Vinay Kumar Pilly, Alexandra Mankovskaia, Yaoyang Xiong, Getulio Nogueira Filho, Eduardo Bresciani, Céline Marie Lévesque, and Anuradha Prakki Copyright © 2014 Halyna Hrynash et al. All rights reserved. Mandibular Canine Dimorphism in Establishing Sex Identity in the Lebanese Population Mon, 10 Feb 2014 10:56:23 +0000 Background and Objective. In forensic investigations, mandibular canines provide excellent materials to identify gender since they are more likely to survive disasters. The objective of this study was to investigate gender dimorphism by comparing the mesiodistal width of mandibular permanent canines and intercanine distance in a group of Lebanese population. Methods. Participants consisted of undergraduate students from the School of Dentistry, Lebanese University, for two academic years who fulfilled the inclusion criteria. Canine widths and intercanine distance were measured by one operator directly on dental casts using a digital caliper. Results. One hundred thirty-three Lebanese dental students (54 males and 69 females) aged 18–25 were included in the study. The intercanine distance was significantly greater in males ( value < 0.0001). The right and the left canine widths were significantly greater in males than in females ( value < 0.0001). However, no significant difference was found between left and right canines for males ( value > 0.05) and females ( value > 0.05). The mean width of canine was greater than 7.188 mm for males. Conclusion. The parameters measured in the present study are of great help in sex identification in forensic investigations in the Lebanese adult population. Fouad Ayoub, Loubna Shamseddine, Mohamad Rifai, Antoine Cassia, Randa Diab, Ibrahim Zaarour, Maria Saadeh, and Georges Rouhana Copyright © 2014 Fouad Ayoub et al. All rights reserved. Conservative Surgical Management of Stage I Bisphosphonate-Related Osteonecrosis of the Jaw Thu, 06 Feb 2014 15:37:25 +0000 Purpose. To report the efficacy of conservative surgical treatment for stage I bisphosphonate-related osteonecrosis of the jaw (BRONJ). Materials and Methods. This study reports the clinical outcomes of 63 patients treated for BRONJ stage I (according to Ruggiero's staging system) at the Oral Pathology and Laser-Assisted Surgery Unit of the University of Parma between January 2004 and January 2011. Surgical interventions were performed, under local analgesia, in patients unresponsive for a period of six months to noninvasive treatments such as cycles of local or systemic antibacterial therapy combined or not to low level laser therapy, ozone therapy, or Hyperbaric Oxygen Therapy. All interventions were performed after the consultation of oncologist or physician. Results. In our experience, conservative surgical treatment is associated with the highest number of BRONJ healed sites in stage I disease. Complete healing was observed in 92.6% of sites surgically treated. Conclusions. This study confirms that treatment of patients affected by minimal bone exposition, (stage I of BRONJ), through conservative surgical strategies, possibly with laser, may result in a high control of the disease in the long term. Paolo Vescovi, Elisabetta Merigo, Marco Meleti, Maddalena Manfredi, Carlo Fornaini, Samir Nammour, Giovanni Mergoni, Amin Sarraj, and Jose V. Bagan Copyright © 2014 Paolo Vescovi et al. All rights reserved. Impact of an Anticaries Mouthrinse on In Vitro Remineralization and Microbial Control Thu, 06 Feb 2014 09:53:04 +0000 Objective. The objective of this research was to evaluate the caries control potential of a new fluoride mouthrinse that also contained antimicrobial agents and a biofilm disrupting agent using different in vitro models. Methods. Four in vitro studies were conducted to assess the performance of this three pronged approach to caries control: (1) traditional enamel fluoride uptake, (2) surface microhardness study using pH cycling model and subsequent fluoride uptake, (3) a salivary biofilm flow-through study to determine the anti-microbial activity, and (4) a single species biofilm model measuring effect on biofilm matrix disruption. Results. The data showed that a LISTERINE rinse with fluoride, essential oils and xylitol was superior in promoting enamel fluoride uptake and in enhancing antimicrobial activity over traditional commercially available fluoridated products. An increase of the surface microhardness was observed when the LISTERINE rinse was used in combination with fluoridated toothpaste versus the fluoridated toothpaste alone. Finally, it was demonstrated that xylitol solutions disrupted and reduced the biovolume of biofilm matrix of mature Streptococcus mutans. Conclusion. These in vitro studies demonstrated that a fluoride mouthrinse with antimicrobial agent and biofilm matrix disrupting agent provided multifaceted and enhanced anti-caries efficacy by promoting remineralization, reducing acidogenic bacteria and disrupting biofilm matrix. Frank C. Sun, E. Eric Engelman, James A. McGuire, Gabrielle Kosmoski, Lauren Carratello, Danette Ricci-Nittel, Jane Z. Zhang, Bruce R. Schemehorn, and Robert J. Gambogi Copyright © 2014 Frank C. Sun et al. All rights reserved. Diversity Considerations for Promoting Early Childhood Oral Health: A Pilot Study Thu, 30 Jan 2014 13:10:06 +0000 Objectives. Several groups in Manitoba, Canada, experience early childhood caries (ECC), including Aboriginal, immigrant, and refugee children and those from select rural regions. The purpose of this pilot study was to explore the views of parents and caregivers from four cultural groups on early childhood oral health and ECC. Methods. A qualitative descriptive study design using focus groups recruited parents and caregivers from four cultural groups. Discussions were documented, audio-recorded, transcribed, and then analyzed for content based on themes. Results. Parents and caregivers identified several potential barriers to good oral health practice, including child’s temperament, finances, and inability to control sugar intake. Both religion and genetics were found to influence perceptions of oral health. Misconceptions regarding breastfeeding and bottle use were present. One-on-one discussions, parental networks, and using laypeople from similar backgrounds were suggested methods to promote oral health. The immigrant and refugee participants placed emphasis on the use of visuals for those with language barriers while Hutterite participants suggested a health-education approach. Conclusions. These pilot study findings provide initial insight into the oral health-related knowledge and beliefs of these groups. This will help to inform planning of ECC prevention and research strategies, which can be tailored to specific populations. Sarah Prowse, Robert J. Schroth, Alexandria Wilson, Jeanette M. Edwards, Janet Sarson, Jeremy A. Levi, and Michael E. Moffatt Copyright © 2014 Sarah Prowse et al. All rights reserved. Preferences of UK-Based Dentists When Undertaking Root Coverage and Regenerative Procedures: A Pilot Questionnaire Study Tue, 28 Jan 2014 09:48:32 +0000 Objectives. The purpose of the present study was to evaluate the awareness and preferences of registered United Kingdom (UK) dentists specialising or with an interest in periodontics in root coverage and regenerative procedures. Methods. A cross-sectional postal survey of 366 dentists was conducted. The questionnaire was divided in two sections and most of the questions were giving the option of multiple answers. Frequencies and associations between the demographic profiles of the participants with their answers were evaluated. Results. 63% of dentists with an interest in periodontics and 32% of specialists returned the questionnaire. Guided tissue regeneration procedures and the use of enamel matrix derivatives were recommended for the reconstruction of bony defects and both subepithelial connective tissue graft and coronally advanced flap with or without enamel matrix derivatives were the most popular choices for root coverage. Smoking was considered a contraindication by most of the participants and conflicting responses were given regarding the use of antibiotics as part of the care following regenerative procedures. Conclusions. The participants incorporated both traditional and “novel” techniques and products in reconstructive procedures and appeared to be up to date with the evidence from the dental literature. However, it was evident that there was confusion regarding the role of antibiotics in regenerative procedures. M. Siaili, D. Chatzopoulou, and D. G. Gillam Copyright © 2014 M. Siaili et al. All rights reserved. A Model for Community-Based Pediatric Oral Heath: Implementation of an Infant Oral Care Program Thu, 23 Jan 2014 06:47:11 +0000 The Affordable Care Act (ACA) mandates risk assessments, preventive care, and evaluations based on outcomes. ACA compliance will require easily accessible, cost-effective care models that are flexible and simple to establish. UCLA has developed an Infant Oral Care Program (IOCP) in partnership with community-based organizations that is an intervention model providing culturally competent perinatal and infant oral care for underserved, low-income, and/or minority children aged 0–5 and their caregivers. In collaboration with the Venice Family Clinic's Simms/Mann Health and Wellness Center, UCLA Pediatrics, Women, Infants, and Children (WIC), and Early Head Start and Head Start programs, the IOCP increases family-centered care access and promotes early utilization of dental services in nontraditional, primary care settings. Emphasizing disease prevention, management, and care that is sensitive to cultural, language, and oral health literacy challenges, IOCP patients achieve better oral health maintenance “in health” not in “disease modality”. IOCP uses interprofessional education to promote pediatric oral health across multiple disciplines and highlights the necessity for the “age-one visit”. This innovative clinical model facilitates early intervention and disease management. It sets a new standard of minimally invasive dental care that is widely available and prevention focused, with high retention rates due to strong collaborations with the community-based organizations serving these vulnerable, high-risk children. Francisco J. Ramos-Gomez Copyright © 2014 Francisco J. Ramos-Gomez. All rights reserved. Effects of Ion-Releasing Tooth-Coating Material on Demineralization of Bovine Tooth Enamel Tue, 21 Jan 2014 10:35:26 +0000 We compared the effect of a novel ion-releasing tooth-coating material that contained S-PRG (surface-reaction type prereacted glass-ionomer) filler to that of non-S-PRG filler and nail varnish on the demineralization of bovine enamel subsurface lesions. The demineralization process of bovine enamel was examined using quantitative light-induced fluorescence (QLF) and electron probe microanalyzer (EPMA) measurement. Ion concentrations in demineralizing solution were measured using inductively coupled plasma atomic (ICP) emission spectrometry and an ion electrode. The nail varnish group and the non-S-PRG filler group showed linear demineralization. Although the nail varnish group and the non-S-PRG filler group showed linear demineralization, the S-PRG filler group did not. Further, plane-scanning by EPMA analysis in the S-PRG filler group showed no changes in Ca ion distribution, and F ions showed peak levels on the surface of enamel specimens. Most ions in the demineralizing solution were present at higher concentrations in the S-PRG filler group than in the other two groups. In conclusion, only the S-PRG filler-containing tooth-coating material released ions and inhibited demineralization around the coating. Koji Kawasaki and Masaki Kambara Copyright © 2014 Koji Kawasaki and Masaki Kambara. All rights reserved. The Effect of Hydroxyapatite Nanocrystals on Osseointegration of Titanium Implants: An In Vivo Rabbit Study Sun, 19 Jan 2014 12:19:05 +0000 Osseointegration is dependent on implant surface characteristics, including surface chemistry and topography. The presence of nanosized calcium phosphates on the implant surface is interesting to investigate since they affect both the nanotopography and surface chemistry, forming a bone mineral resembling surface. In this work, the osseointegration of titanium implants with and without the presence of hydroxyapatite (HA) nanocrystals has been evaluated in vivo. The integration was examined using removal torque measurements and real-time polymerase chain reaction (RT-PCR) analysis. The study was performed using two healing time points, 3 and 12 weeks. The results showed that the torque needed to remove the implants was insignificant between the non- and HA-coated implants, both at weeks 3 and 12. The RT-PCR, however, showed significant differences for osteoblast, osteoclast, and proinflammation markers when HA nanocrystals were present. Karin Breding, Ryo Jimbo, Mariko Hayashi, Ying Xue, Kamal Mustafa, and Martin Andersson Copyright © 2014 Karin Breding et al. All rights reserved. Impact of Periodontal Diseases on Health-Related Quality of Life of Users of the Brazilian Unified Health System Wed, 18 Dec 2013 09:12:40 +0000 Objective. This study assessed the impact of periodontal diseases on health-related quality of life of adult users of the Brazilian Unified Health System. Study Design. A cross-sectional study was conducted on an outpatient basis. The sample included 151 adults treated in the Periodontics section at Dental Specialty Centres of Juiz de Fora (Minas Gerais, Brazil). The Oral Health Impact Profile (OHIP-14) measured the impact of periodontal disease on quality of life. Participants were interviewed to obtain self-perception of general and oral health and socioeconomic data, and dental records were consulted to obtain periodontal status data. The values of central tendency of the OHIP-14 were compared with socioeconomic, demographic, and self-reported health predictors using nonparametric tests. The final analysis was performed using multiple linear regressions. Results. The results showed that psychological discomfort and physical disability exhibited a negative impact. The following variables can explain approximately 27% of the impact of oral health conditions on health-related quality of life in this group: periodontal disease, self-perceived oral health, and the need to use or replace dental prosthesis. Conclusion. The need for prosthetic rehabilitation and worse periodontal status are associated with health-related quality of life, which can be predicted by the self-perception of health. Pamella Valente Palma, Paula Liparini Caetano, and Isabel Cristina Gonçalves Leite Copyright © 2013 Pamella Valente Palma et al. All rights reserved. Pain during Removal of Carious Lesions in Children: A Randomized Controlled Clinical Trial Mon, 02 Dec 2013 14:00:23 +0000 The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the traditional method (low-speed bur) in pediatric patients. A randomized, controlled, clinical trial with a “split-mouth” design was carried out involving 20 children (10 girls and 10 boys) aged four to seven years. Forty primary teeth (two per child) were randomly allocated to either Group 1 (G1: chemomechanical caries removal with Papacarie gel) or Group 2 (G2: removal of carious dentin with low-speed bur). A face scale was used to classify the sensation of pain during the procedure (1: absence of pain; 2: mild pain; 3: moderate pain; 4: moderately intense pain; 5: intense pain; and 6: extremely intense pain). Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney () test. Pain scores were higher in G2, with statistically significant differences in comparison to G1 (; ; ). Chemomechanical caries removal with Papacarie provides a lesser degree of pain in comparison to conventional caries removal and does not require the use of local anesthesia. The clinical trial registration number is NCT01811420. Lara Jansiski Motta, Sandra Kalil Bussadori, Ana Paula Campanelli, André Luis da Silva, Thays Almeida Alfaya, Camila Haddad Leal de Godoy, and Maria Fidela de Lima Navarro Copyright © 2013 Lara Jansiski Motta et al. All rights reserved. Chemokines and Cytokines as Salivary Biomarkers for the Early Diagnosis of Oral Cancer Tue, 26 Nov 2013 13:54:47 +0000 Chemokines have been shown to be important in both inflammation and carcinogenesis and are able to be measured in saliva with relatively robust methods including enzyme-linked immunosorbent assays (ELISA). Thus it has been hypothesized that patients with oral cancer and oral potentially malignant lesions will have elevated levels of specific chemokines in oral fluids and that this may be used as a marker of both the early detection of malignant disease and progression to malignancy. The concept that salivary biomarkers can be easily measured and indicate disease states has profound consequences for clinical practice and may open up new strategies for the diagnosis, prognosis, and potential therapy of oral squamous cell carcinoma (OSCC). This review focuses on our understanding of cytokines and chemokines and the potential role that they may have in clinical practice. Gareema Prasad and Michael McCullough Copyright © 2013 Gareema Prasad and Michael McCullough. All rights reserved. Management of Internal Root Resorption on Permanent Teeth Thu, 21 Nov 2013 14:14:13 +0000 Internal root resorption (IRR) is a particular category of pulp disease characterized by the loss of dentine as a result of the action of clastic cells stimulated by pulpal inflammation. This review article explains the etiology, the prevalence of IRR, and, in addition to the clinical data, the contribution of the three-dimensional imaging (CBCT) to the diagnosis, the clinical decision, and the therapeutic management of IRR. The authors discussed the various therapeutic options including the orthograde or retrograde fillings of the root canal resorption area. Root canal treatment remains the treatment of choice of internal root resorption as it removes the granulation tissue and blood supply of the clastic cells. The authors describe with different clinical cases the modern endodontic techniques including optical aids, ultrasonic improvement of chemical debridement, and the use of alternative materials such as calcium silicate combined with thermoplastic filling (warm gutta-percha). In these conditions, the prognosis of the conservative treatment of internal resorptions, even if root walls are perforated, is good. Elisabeth Nilsson, Eric Bonte, François Bayet, and Jean-Jacques Lasfargues Copyright © 2013 Elisabeth Nilsson et al. All rights reserved. Comparing Health Promotion Programs in Public Dental Service of Vantaa, Finland: A Clinical Trial in 6–36-Month-Old Children Mon, 18 Nov 2013 14:37:49 +0000 Objective. The study assessed whether the new family-based programs in health promotion or the training of dental professionals had an impact on the colonization of mutans streptococci (MS) in young children. Material and Methods. The participants were children born in 2008 and inhabitants of Vantaa aged 24–36 months. The families with first-born children were invited to a questionnaire study. Vantaa was categorized into three matching areas, which were randomly assigned to different programs. New counseling methods were trained. The routine program used earlier served as the control group. The children born in 2006 served as a historic control. The outcome measure was the presence of MS. Statistical method was logistic regression. Results. Colonization of MS was found only in few children born in 2006 or 2008; 15% and 11%, respectively. Within the 2008 birth cohort, the addition of parental counseling did not improve the routine program. Instead, the father’s advanced level of education () and the child’s reported the use of xylitol at least three times a day () associated with negative MS scores. Conclusions. The routine program and training of the professionals seem to reduce the proportion of children with MS more than adding parental self-care to oral health programs. Irma Arpalahti, Mimmi Tolvanen, and Kaisu Pienihakkinen Copyright © 2013 Irma Arpalahti et al. All rights reserved. Arthrocentesis and Temporomandibular Joint Disorders: Clinical and Radiological Results of a Prospective Study Mon, 11 Nov 2013 12:13:33 +0000 Purpose. We evaluated the efficacy of arthrocentesis in the treatment of temporomandibular joint (TMJ) disorders. Material and Methods. In this prospective clinical case series, 30 consecutive patients with TMJ disorders underwent arthrocentesis using saline and sodium hyaluronate injections. Outcome measures were TMJ pain, maximum mouth opening (MMO), joint noises, and anatomical changes in the TMJ architecture. Patients were evaluated using cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) at the beginning of treatment and 60 days after the last arthrocentesis. Pretreatment and posttreatment clinical parameters were compared using paired and unpaired t-tests, and McNemar’s test was used to evaluate CBCT and MRI changes (). Results. At 1-year follow-up examinations, visual analogue scale scores indicated that pain was reduced significantly and mean postoperative MMO was increased significantly. CBCT findings showed no significant change, and MRI showed only slight reductions in inflammatory signs. Conclusions. Within the limitations of this study, we can conclude that arthrocentesis is a simple, minimally invasive procedure with a relatively low risk of complications and significant clinical benefits in patients with TMJ disorders. This trial is registered with NCT01903512. Giacomo De Riu, Mirella Stimolo, Silvio Mario Meloni, Damiano Soma, Milena Pisano, Salvatore Sembronio, and Antonio Tullio Copyright © 2013 Giacomo De Riu et al. All rights reserved. Long-Term Effectiveness of Parent Education Using the “Baby Oral Health” Model on the Improvement of Oral Health of Young Children Sun, 10 Nov 2013 13:41:41 +0000 Purpose. To determine the long-term effectiveness of comprehensive education given to parents and caregivers with respect to the incidence of preventable oral diseases, utilization of dental services, and retention of knowledge related to oral health. Methods. Group presentations on oral health were conducted for caregivers of infants () using an interactive audio-visual aid. Followup occurred at 18 months. A comparison group () was enrolled from the same community groups. Chi-square and Fisher’s exact tests were used to analyze findings. Results. There was a difference in caries incidence, knowledge levels of caregivers, and utilization of dental services () when comparing the SGB to the SGFU. Conclusions. One-time exposure to parent education using a comprehensive interactive audio-visual aid has an effect on reducing caries incidence and increasing dental utilization. While most knowledge is retained by parents, there is some attrition in the information retained over an 18-month time period. This emphasizes the importance of repeated reinforcement of the same concepts over a shorter time span. Gajanan V. Kulkarni Copyright © 2013 Gajanan V. Kulkarni. All rights reserved.