International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Esthetic Concerns and Acceptability of Treatment Modalities in Primary Teeth: A Comparison between Children and Their Parents Wed, 29 Jun 2016 10:44:44 +0000 Background and Aim. Esthetic concerns in primary teeth have been studied mainly from the point of view of parents. The aim of this study was to study compare the opinions of children aged 5–8 years to have an opinion regarding the changes in appearance of their teeth due to dental caries and the materials used to restore those teeth. Methodology. A total of 107 children and both of their parents (), who were seeking dental treatment, were included in this study. A tool comprising a questionnaire and pictures of carious lesions and their treatment arranged in the form of a presentation was validated and tested on 20 children and their parents. The validated tool was then tested on all participants. Results. Children had acceptable validity statistics for the tool suggesting that they were able to make informed decisions regarding esthetic restorations. There was no difference between the responses of the children and their parents on most points. Zirconia crowns appeared to be the most acceptable full coverage restoration for primary anterior teeth among both children and their parents. Conclusion. Within the limitations of the study it can be concluded that children in their sixth year of life are capable of appreciating the esthetics of the restorations for their anterior teeth. Sharat Chandra Pani, Abdulrahman Al Saffan, Sultan AlHobail, Fares Bin Salem, AlBara AlFuraih, and Mohammad AlTamimi Copyright © 2016 Sharat Chandra Pani et al. All rights reserved. Radiological Evaluation of Penetration of the Irrigant according to Three Endodontic Irrigation Techniques Tue, 28 Jun 2016 15:05:41 +0000 Introduction. This experimental study is to compare radiographs based on the penetration depth of the irrigant following three final irrigation techniques. Material and Method. A sample of sixty teeth with single roots were prepared with stainless steel K files followed by mechanized Ni-Ti files iRace® under irrigation with 2.5% sodium hypochlorite. Radiopaque solution was utilized to measure the penetration depth of the irrigant. Three irrigation techniques were performed during this study: (i) passive irrigation, (ii) manually activated irrigation, and (iii) passive irrigation with an endodontic needle CANAL CLEAN®. Radiographs were performed to measure the length of irrigant penetration in each technique. Results. In comparison, passive irrigation with a conventional syringe showed infiltration of the irrigant by an average of , whereas the manually activated irrigation technique indicated an average of infiltration. Irrigation with an endodontic syringe showed an average infiltration of . The results revealed highly significant difference between the three irrigation techniques (%). Conclusion. Adding manual activation to the irrigant improved the result by 20%. This study indicates that passive irrigation with an endodontic needle has proved to be the most effective irrigation technique of the canal system. Said Dhaimy, Sara Imdary, Sara Dhoum, Imane Benkiran, and Amal El Ouazzani Copyright © 2016 Said Dhaimy et al. All rights reserved. The Antimicrobial Photodynamic Therapy in the Treatment of Peri-Implantitis Sun, 26 Jun 2016 12:01:40 +0000 Introduction. The aim of this study is to demonstrate the effectiveness of addition of the antimicrobial photodynamic therapy to the conventional approach in the treatment of peri-implantitis. Materials and Methods. Forty patients were randomly assigned to test or control groups. Patients were assessed at baseline and at six (T1), twelve (T2), and twenty-four (T3) weeks recording plaque index (PlI), probing pocket depth (PPD), and bleeding on probing (BOP); control group received conventional periodontal therapy, while test group received photodynamic therapy in addition to it. Result. Test group showed a 70% reduction in the plaque index values and a 60% reduction in PD values compared to the baseline. BOP and suppuration were not detectable. Control group showed a significative reduction in plaque index and PD. Discussion. Laser therapy has some advantages in comparison to traditional therapy, with faster and greater healing of the wound. Conclusion. Test group showed after 24 weeks a better value in terms of PPD, BOP, and PlI, with an average pocket depth value of 2 mm, if compared with control group (3 mm). Our results suggest that antimicrobial photodynamic therapy with diode laser and phenothiazine chloride represents a reliable adjunctive treatment to conventional therapy. Photodynamic therapy should, however, be considered a coadjuvant in the treatment of peri-implantitis associated with mechanical (scaling) and surgical (grafts) treatments. Umberto Romeo, Gianna Maria Nardi, Fabrizio Libotte, Silvia Sabatini, Gaspare Palaia, and Felice Roberto Grassi Copyright © 2016 Umberto Romeo et al. All rights reserved. Color Stability of the Bulk-Fill Composite Resins with Different Thickness in Response to Coffee/Water Immersion Tue, 14 Jun 2016 09:10:22 +0000 We aimed to evaluate the color stability of bulk-fill and conventional composite resin with respect to thickness and storage media. Twenty specimens of a conventional composite resin (6 mm diameter and 2 mm thick) and 40 specimens of the bulk-fill Tetric EvoCeram composite resin at two different thicknesses (6 mm diameter and 2 mm thick or 4 mm thick, ) were prepared. The specimens were stored in distilled water during the study period (28 d). Half of the specimens were remained in distilled water and the other half were immersed in coffee solution 20 min/d and kept in distilled water between the cycles. Color changes () were measured using the CIE color space and a digital imaging system at 1, 7, 14, and 28 days of storage. Data were analyzed using Two-way ANOVA and Tukey’s HSD post hoc test (). Composite resins showed significant increase in color changes by time (bulk-fill > conventional; ). Coffee exhibited significantly more staining susceptibility than that of distilled water (). There was greater color changes with increasing the increment thickness, which was significant at 14 () and 28 d (). Color change of bulk-fill composite resin was greater than that of the conventional one after coffee staining and is also a function of increment thicknesses. Sayna Shamszadeh, Seyedeh Mahsa Sheikh-Al-Eslamian, Elham Hasani, Ahmad Najafi Abrandabadi, and Narges Panahandeh Copyright © 2016 Sayna Shamszadeh et al. All rights reserved. 3D-Printed Scaffolds and Biomaterials: Review of Alveolar Bone Augmentation and Periodontal Regeneration Applications Sun, 05 Jun 2016 13:30:02 +0000 To ensure a successful dental implant therapy, the presence of adequate vertical and horizontal alveolar bone is fundamental. However, an insufficient amount of alveolar ridge in both dimensions is often encountered in dental practice due to the consequences of oral diseases and tooth loss. Although postextraction socket preservation has been adopted to lessen the need for such invasive approaches, it utilizes bone grafting materials, which have limitations that could negatively affect the quality of bone formation. To overcome the drawbacks of routinely employed grafting materials, bone graft substitutes such as 3D scaffolds have been recently investigated in the dental field. In this review, we highlight different biomaterials suitable for 3D scaffold fabrication, with a focus on “3D-printed” ones as bone graft substitutes that might be convenient for various applications related to implant therapy. We also briefly discuss their possible adoption for periodontal regeneration. Farah Asa’ad, Giorgio Pagni, Sophia P. Pilipchuk, Aldo Bruno Giannì, William V. Giannobile, and Giulio Rasperini Copyright © 2016 Farah Asa’ad et al. All rights reserved. The Reinforcement Effect of Nano-Zirconia on the Transverse Strength of Repaired Acrylic Denture Base Thu, 02 Jun 2016 06:14:00 +0000 Objective. The aim of this study was to evaluate the effect of incorporation of glass fiber, zirconia, and nano-zirconia on the transverse strength of repaired denture base. Materials and Methods. Eighty specimens of heat polymerized acrylic resin were prepared and randomly divided into eight groups (): one intact group (control) and seven repaired groups. One group was repaired with autopolymerized resin while the other six groups were repaired using autopolymerized resin reinforced with 2 wt% or 5 wt% glass fiber, zirconia, or nano-zirconia particles. A three-point bending test was used to measure the transverse strength. The results were analyzed using SPSS and repeated measure ANOVA and post hoc least significance (LSD) test (). Results. Among repaired groups it was found that autopolymerized resin reinforced with 2 or 5 wt% nano-zirconia showed the highest transverse strength (). Repairs with autopolymerized acrylic resin reinforced with 5 wt% zirconia showed the lowest transverse strength value. There was no significant difference between the groups repaired with repair resin without reinforcement, 2 wt% zirconia, and glass fiber reinforced resin. Conclusion. Reinforcing of repair material with nano-zirconia may significantly improve the transverse strength of some fractured denture base polymers. Mohammed Gad, Aws S. ArRejaie, Mohamed Saber Abdel-Halim, and Ahmed Rahoma Copyright © 2016 Mohammed Gad et al. All rights reserved. 3D Printing/Additive Manufacturing Single Titanium Dental Implants: A Prospective Multicenter Study with 3 Years of Follow-Up Sun, 29 May 2016 14:08:30 +0000 This prospective 3-year follow-up clinical study evaluated the survival and success rates of 3DP/AM titanium dental implants to support single implant-supported restorations. After 3 years of loading, clinical, radiographic, and prosthetic parameters were assessed; the implant survival and the implant-crown success were evaluated. Eighty-two patients (44 males, 38 females; age range 26–67 years) were enrolled in the present study. A total of 110 3DP/AM titanium dental implants (65 maxilla, 45 mandible) were installed: 75 in healed alveolar ridges and 35 in postextraction sockets. The prosthetic restorations included 110 single crowns (SCs). After 3 years of loading, six implants failed, for an overall implant survival rate of 94.5%; among the 104 surviving implant-supported restorations, 6 showed complications and were therefore considered unsuccessful, for an implant-crown success of 94.3%. The mean distance between the implant shoulder and the first visible bone-implant contact was 0.75 mm (±0.32) and 0.89 (±0.45) after 1 and 3 years of loading, respectively. 3DP/AM titanium dental implants seem to represent a successful clinical option for the rehabilitation of single-tooth gaps in both jaws, at least until 3-year period. Further, long-term clinical studies are needed to confirm the present results. Samy Tunchel, Alberto Blay, Roni Kolerman, Eitan Mijiritsky, and Jamil Awad Shibli Copyright © 2016 Samy Tunchel et al. All rights reserved. Correlation Assessment between Three-Dimensional Facial Soft Tissue Scan and Lateral Cephalometric Radiography in Orthodontic Diagnosis Sun, 29 May 2016 11:53:06 +0000 Purpose. The aim of the present prospective study was to investigate correlations between 3D facial soft tissue scan and lateral cephalometric radiography measurements. Materials and Methods. The study sample comprised 312 subjects of Caucasian ethnic origin. Exclusion criteria were all the craniofacial anomalies, noticeable asymmetries, and previous or current orthodontic treatment. A cephalometric analysis was developed employing 11 soft tissue landmarks and 14 sagittal and 14 vertical angular measurements corresponding to skeletal cephalometric variables. Cephalometric analyses on lateral cephalometric radiographies were performed for all subjects. The measurements were analysed in terms of their reliability and gender-age specific differences. Then, the soft tissue values were analysed for any correlations with lateral cephalometric radiography variables using Pearson correlation coefficient analysis. Results. Low, medium, and high correlations were found for sagittal and vertical measurements. Sagittal measurements seemed to be more reliable in providing a soft tissue diagnosis than vertical measurements. Conclusions. Sagittal parameters seemed to be more reliable in providing a soft tissue diagnosis similar to lateral cephalometric radiography. Vertical soft tissue measurements meanwhile showed a little less correlation with the corresponding cephalometric values perhaps due to the low reproducibility of cranial base and mandibular landmarks. Piero Antonio Zecca, Rosamaria Fastuca, Matteo Beretta, Alberto Caprioglio, and Aldo Macchi Copyright © 2016 Piero Antonio Zecca et al. All rights reserved. Soft Tissue Stability around Single Implants Inserted to Replace Maxillary Lateral Incisors: A 3D Evaluation Thu, 19 May 2016 14:14:33 +0000 Purpose. To evaluate the soft tissue stability around single implants inserted to replace maxillary lateral incisors, using an innovative 3D method. Methods. We have used reverse-engineering software for the superimposition of 3D surface models of the dentogingival structures, obtained from intraoral scans of the same patients taken at the delivery of the final crown (S1) and 2 years later (S2). The assessment of soft tissues changes was performed via calculation of the Euclidean surface distances between the 3D models, after the superimposition of S2 on S1; colour maps were used for quantification of changes. Results. Twenty patients (8 males, 12 females) were selected, 10 with a failing/nonrestorable lateral incisor (test group: immediate placement in postextraction socket) and 10 with a missing lateral incisor (control group: conventional placement in healed ridge). Each patient received one immediately loaded implant (Anyridge®, Megagen, Gyeongbuk, South Korea). The superimposition of the 3D surface models taken at different times (S2 over S1) revealed a mean (±SD) reduction of 0.057 mm (±0.025) and 0.037 mm (±0.020) for test and control patients, respectively. This difference was not statistically significant (p = 0.069). Conclusions. The superimposition of the 3D surface models revealed an excellent peri-implant soft tissue stability in both groups of patients, with minimal changes registered along time. F. G. Mangano, F. Luongo, G. Picciocchi, C. Mortellaro, K. B. Park, and C. Mangano Copyright © 2016 F. G. Mangano et al. All rights reserved. The Use of Narrow Diameter Implants in the Molar Area Wed, 11 May 2016 12:53:19 +0000 Implant rehabilitations in the posterior jaw are influenced by many factors such as the condition of the remaining teeth, the force factors related to the patient, the quality of the bone, the maintenance of the hygiene, the limited bone height, the type and extent of edentulism, and the nature of the opposing arch. The gold standard is to place a regular diameter implant (>3.7 mm) or a wide one to replace every missing molar. Unfortunately, due to horizontal bone resorption, this option is not possible without lateral bone augmentation. In this situation, narrow diameter implant (NDI < 3.5 mm) could be the alternative to lateral bone augmentation procedures. This paper presents a clinical study where NDIs were used for the replacement of missing molars. They were followed up to 11 years. Special considerations were observed and many parameters were evaluated. NDI could be used to replace missing molar in case of moderate horizontal bone resorption if strict guidelines are respected. Yet, future controlled prospective clinical trials are required to admit their use as scientific evidence. M. Saad, A. Assaf, and E. Gerges Copyright © 2016 M. Saad et al. All rights reserved. ATP Bioluminometers Analysis on the Surfaces of Removable Orthodontic Aligners after the Use of Different Cleaning Methods Sun, 08 May 2016 08:46:59 +0000 Purpose. The aim was to quantify the bacteria concentration on the surface of orthodontic clear aligners using three different cleaning methods. Furthermore the objective was to validate the efficacy of the bioluminometer in assessing the bacteria concentration. Materials and Methods. Twenty subjects (six males and fourteen females) undergoing orthodontic therapy with clear aligners (Invisalign® Align Technology, Santa Clara, California) were enrolled in this study. The observation time was of six weeks. The patients were instructed to use different cleaning methods (water, brushing with toothpaste, and brushing with toothpaste and use of sodium carbonate and sulphate tablet). At the end of each phase a microbiological analysis was performed using the bioluminometer. Results. The highest bacteria concentration was found on aligners cleaned using only water (583 relative light units); a value of 189 relative light units was found on aligners cleaned with brushing and toothpaste. The lowest bacteria concentration was recorded on aligners cleaned with brushing and toothpaste and the use of sodium carbonate and sulfate tablet. Conclusions. The mechanical removal of the bacterial biofilm proved to be effective with brushing and toothpaste. The best results in terms of bacteria concentration were achieved adding the use of sodium carbonate and sulfate tablet. Luca Levrini, Alessandro Mangano, Silvia Margherini, Camilla Tenconi, Davide Vigetti, Raffaele Muollo, and Gian Marco Abbate Copyright © 2016 Luca Levrini et al. All rights reserved. A Patient Specific Biomechanical Analysis of Custom Root Analogue Implant Designs on Alveolar Bone Stress: A Finite Element Study Wed, 04 May 2016 11:22:10 +0000 Objectives. The aim of this study was to analyse by means of FEA the influence of 5 custom RAI designs on stress distribution of peri-implant bone and to evaluate the impact on microdisplacement for a specific patient case. Materials and Methods. A 3D surface model of a RAI for the upper right canine was constructed from the cone beam computed tomography data of one patient. Subsequently, five (targeted) press-fit design modification FE models with five congruent bone models were designed: “Standard,” “Prism,” “Fins,” “Plug,” and “Bulbs,” respectively. Preprocessor software was applied to mesh the models. Two loads were applied: an oblique force (300 N) and a vertical force (150 N). Analysis was performed to evaluate stress distributions and deformed contact separation at the peri-implant region. Results. The lowest von Mises stress levels were numerically observed for the Plug design. The lowest levels of contact separation were measured in the Fins model followed by the Bulbs design. Conclusions. Within the limitations of the applied methodology, adding targeted press-fit geometry to the RAI standard design will have a positive effect on stress distribution, lower concentration of bone stress, and will provide a better primary stability for this patient specific case. David Anssari Moin, Bassam Hassan, and Daniel Wismeijer Copyright © 2016 David Anssari Moin et al. All rights reserved. Applicative Characteristics of a New Zirconia Bracket with Multiple Slots Sun, 24 Apr 2016 15:32:48 +0000 We have developed a new orthodontic bracket with three slots with lubricative properties on the working surfaces and proposed a new orthodontic treatment system employing 0.012−0.014-inch Ni-Ti arch wires. We recruited 54 patients, of which 27 received treatment with the new zirconia bracket with multiple slots system (M group), and the others received treatment with standard edge-wise appliances (control group [C group]). We compared the (1) tooth movement rate at the early stage of leveling; (2) changes in the dental arch morphology before and after leveling; and (3) pain caused by orthodontic treatment. Student’s -test was used in all assessments. The tooth movement rate in the maxillomandibular dentition was higher in the M group. The basal arch width, anterior length, and the intercanine width in the maxillary dentition were not significantly different in the two groups; however, the intercanine width in the mandibular dentition was higher in the C group. In assessments of treatment-related pain, the visual analogue pain score was 56.0 mm and 22.6 mm in the C and M groups, respectively. A new zirconia bracket with multiple slots system provided better outcomes with respect to tooth movement rate, treatment period, and postoperative pain, thus indicating its effectiveness over conventional orthodontic systems. Koutaro Maki, Katsuyoshi Futaki, Satoru Tanabe, Mariko Takahashi, Yuta Ichikawa, and Tetsutaro Yamaguchi Copyright © 2016 Koutaro Maki et al. All rights reserved. Detection of Carious Lesions and Restorations Using Particle Swarm Optimization Algorithm Wed, 20 Apr 2016 06:59:25 +0000 Background/Purpose. In terms of the detection of tooth diagnosis, no intelligent detection has been done up till now. Dentists just look at images and then they can detect the diagnosis position in tooth based on their experiences. Using new technologies, scientists will implement detection and repair of tooth diagnosis intelligently. In this paper, we have introduced one intelligent method for detection using particle swarm optimization (PSO) and our mathematical formulation. This method was applied to 2D special images. Using developing of our method, we can detect tooth diagnosis for all of 2D and 3D images. Materials and Methods. In recent years, it is possible to implement intelligent processing of images by high efficiency optimization algorithms in many applications especially for detection of dental caries and restoration without human intervention. In the present work, we explain PSO algorithm with our detection formula for detection of dental caries and restoration. Also image processing helped us to implement our method. And to do so, pictures taken by digital radiography systems of tooth are used. Results and Conclusion. We implement some mathematics formula for fitness of PSO. Our results show that this method can detect dental caries and restoration in digital radiography pictures with the good convergence. In fact, the error rate of this method was 8%, so that it can be implemented for detection of dental caries and restoration. Using some parameters, it is possible that the error rate can be even reduced below 0.5%. Mohammad Naebi, Eshaghali Saberi, Sirous Risbaf Fakour, Ahmad Naebi, Somayeh Hosseini Tabatabaei, Somayeh Ansari Moghadam, Elham Bozorgmehr, Nasim Davtalab Behnam, and Hamidreza Azimi Copyright © 2016 Mohammad Naebi et al. All rights reserved. Consecutive Case Series of Healed Single-Molar Sites Immediately Restored with Wide-Diameter Implants: A 1-Year Evaluation Mon, 18 Apr 2016 11:00:23 +0000 Introduction. To evaluate outcomes of wide-diameter (6 mm) implants immediately provisionalized with cement-retained single crowns in posterior molar sites. Materials and Methods. Forty-eight consecutive patients received a total of 53 moderately rough-surface, 6 mm diameter implants in healed sites. All implants were immediately provisionalized with a cement-retained provisional crown. Final prosthesis with cement-retained porcelain fused to metal crowns was delivered 3–6 months later. Patients were followed up for 1 year. Outcome measures were implant failures and success rate, complications, marginal bone levels, bone level changes, papilla index, bleeding on probing, and inflammation. Results. One patient was lost to follow-up. At one year, the implant survival and success rate were 98.1%. The mean marginal bone loss after 1 year was − mm. Ideal papilla score was recorded at 83.8% of the sites. More than 95.6% of the sites showed no bleeding or inflammation. No procedure-related or device-related adverse events were reported. Conclusion. Wide-diameter (6 mm) implants can safely and successfully replace single posterior molars. Longer follow-up studies are necessary to evaluate the long-term success of these implants. Hadi Antoun, Pierre Cherfane, and Bouchra Sojod Copyright © 2016 Hadi Antoun et al. All rights reserved. Minimally Invasive Alveolar Ridge Preservation Utilizing an In Situ Hardening β-Tricalcium Phosphate Bone Substitute: A Multicenter Case Series Thu, 14 Apr 2016 11:34:40 +0000 Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (β-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that β-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques. Minas D. Leventis, Peter Fairbairn, Ashish Kakar, Angelos D. Leventis, Vasileios Margaritis, Walter Lückerath, Robert A. Horowitz, Bappanadu H. Rao, Annette Lindner, and Heiner Nagursky Copyright © 2016 Minas D. Leventis et al. All rights reserved. Influence of the Cement Film Thickness on the Push-Out Bond Strength of Glass Fiber Posts Cemented in Human Root Canals Sun, 10 Apr 2016 15:57:15 +0000 The present study evaluated the influence of the cement film thickness on the push-out bond strength of glass fiber posts in the cervical, medium, and apical thirds of root canal spaces. Thirty roots were randomly divided into three groups, according to the fiber post system’s drills: (G1) #2; (G2) #3; (G3) #4. The posts were cemented using a self-adhesive cement, and a small amount of powdered Rhodamine B was used as a stain. Images of both sides of each slice were obtained before and after the push-out test. To determine the cement thickness, a macro routine was developed using the software KS 400. The data were analyzed statistically using Kruskal-Wallis and Dunn’s test. G2 ( MPa) showed statistically higher bond strength values than G1 ( MPa) and G3 ( MPa). All groups presented higher bond strength values in the apical third. The bur diameter significantly influenced the results of the shear bond strength for the push-out test. The slight increase in the cement thickness allowed an increase in the values of shear bond strength when compared to very thin or very thick cement films. Natália Araújo Silva Prado, Reinaldo de Souza Ferreira, Marcos Henrique de Pinho Maurício, Sidnei Paciornik, and Mauro Sayão de Miranda Copyright © 2016 Natália Araújo Silva Prado et al. All rights reserved. Effect of Different Denture Base Materials and Changed Mouth Temperature on Dimensional Stability of Complete Dentures Thu, 07 Apr 2016 13:36:29 +0000 Background. Type of materials used in fabrication of denture base has an effect on dimension during denture base material processing and other factors related to clinical use. Objective. The study aims were to assess the dimensional stability including thermal changes of three different denture base materials. Methods. Ninety patients were selected to construct complete dentures with different denture base materials. They were randomly divided into three groups: group 1, patients with cobalt chrome metallic base; group 2, patients with heat curing acrylic resin fabricated by injection moulding technique; and group 3, patients with denture bases fabricated by conventional heat curing acrylic resin. The dimensional changes were assessed using digital caliper. Results. After the twelfth month, injection moulding acrylic resin had significantly the highest dimensional change followed by the conventional heat curing acrylic resin. There were no significant differences in the dimensions between the three types of denture base materials at normal mouth temperature, while, after hot tea drinking at 45°C, the dimensional change was significantly the highest in cobalt chrome metallic denture base group. Conclusion. Cobalt chrome metallic denture base has stable dimension compared to denture bases fabricated of acrylic resin but it was more affected by altered mouth temperature. The study was registered in the International Standard Randomized Controlled Trials Number (ISRCTN) registry with study ID (ISRCTN94238244). Khalid A. O. Arafa Copyright © 2016 Khalid A. O. Arafa. All rights reserved. Computer-Assisted Technique for Surgical Tooth Extraction Mon, 28 Mar 2016 11:29:58 +0000 Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut). Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome). In addition, the conventional surgical cutting tools (surgical burs) are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures. Hosamuddin Hamza Copyright © 2016 Hosamuddin Hamza. All rights reserved. Effect of Subject Rotation on Assessment of Esthetic Dental Ratios: A Simulation Study Tue, 22 Mar 2016 08:23:56 +0000 Objective. This study aimed to find out the change in esthetic ratios during rotation of patient’s head using a simulation. Materials and Methods. A plaster study model was photographed placing its midline along the long axis of the camera. Then a series of photographs were taken by rotating the model each degree till 10° on both right and left sides. These photographs were digitally measured and the ratio of the maxillary anterior teeth at zero-degree rotation was compared with that at various degrees of rotation. Results. As the model was rotated to the right side till 10°, the ratio of the right lateral to central incisor gradually decreased while the ratio of the left lateral to central incisor gradually increased. However, the ratio of the canine to lateral incisor on both sides gradually increased. Similar results were obtained when the model was rotated to the left side. The ratio of the lateral to central incisor deviated from the acceptable range (±10%) when there was rotation of more than 7°, whereas the ratio of the canine to lateral incisor was within the acceptable range till 10° rotation on either side. Conclusions. Rotation of the model by more than 7° leads to a substantial change in the esthetic ratio. Rajesh Gyawali, Prabhat Ranjan Pokharel, and Jamal Giri Copyright © 2016 Rajesh Gyawali et al. All rights reserved. Epstein-Barr Virus and Its Association with Oral Hairy Leukoplakia: A Short Review Mon, 07 Mar 2016 14:04:29 +0000 In immunocompromised subjects, Epstein-Barr virus (EBV) infection of terminally differentiated oral keratinocytes may result in subclinical productive infection of the virus in the stratum spinosum and in the stratum granulosum with shedding of infectious virions into the oral fluid in the desquamating cells. In a minority of cases this productive infection with dysregulation of the cell cycle of terminally differentiated epithelial cells may manifest as oral hairy leukoplakia. This is a white, hyperkeratotic, benign lesion of low morbidity, affecting primarily the lateral border of the tongue. Factors that determine whether productive EBV replication within the oral epithelium will cause oral hairy leukoplakia include the fitness of local immune responses, the profile of EBV gene expression, and local environmental factors. Razia Abdool Gafaar Khammissa, Jeanine Fourie, Rakesh Chandran, Johan Lemmer, and Liviu Feller Copyright © 2016 Razia Abdool Gafaar Khammissa et al. All rights reserved. National Economic Burden Associated with Management of Periodontitis in Malaysia Mon, 07 Mar 2016 06:47:55 +0000 Objectives. The aim of this study is to estimate the economic burden associated with the management of periodontitis in Malaysia from the societal perspective. Methods. We estimated the economic burden of periodontitis by combining the disease prevalence with its treatment costs. We estimated treatment costs (with 2012 value of Malaysian Ringgit) using the cost-of-illness approach and included both direct and indirect costs. We used the National Oral Health Survey for Adults (2010) data to estimate the prevalence of periodontitis and 2010 national census data to estimate the adult population at risk for periodontitis. Results. The economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately MYR 32.5 billion, accounting for 3.83% of the 2012 Gross Domestic Product of the country. It would cost the nation MYR 18.3 billion to treat patients with moderate periodontitis and MYR 13.7 billion to treat patients with severe periodontitis. Conclusion. The economic burden of periodontitis in Malaysia is substantial and comparable with that of other chronic diseases in the country. This is attributable to its high prevalence and high cost of treatment. Judicious application of promotive, preventive, and curative approaches to periodontitis management is decidedly warranted. Tuti Ningseh Mohd Dom, Rasidah Ayob, Khairiyah Abd Muttalib, and Syed Mohamed Aljunid Copyright © 2016 Tuti Ningseh Mohd Dom et al. All rights reserved. A Randomized Case-Series Study Comparing the Stability of Implant with Two Different Surfaces Placed in Fresh Extraction Sockets and Immediately Loaded Thu, 03 Mar 2016 15:13:08 +0000 Background. Hydrophilic and moderately rough implant surfaces have been proposed to enhance the osseointegration response. Aim. The aim of this study was to compare early changes of stability for two implants with identical macrodesign but with different surface topographies. Materials and Methods. In 11 patients, a total of 22 implants (11 bimodal (minimally rough, control) and 11 proactive (moderately rough and hydrophilic, test), Neoss Ltd., Harrogate, UK) were immediately placed into fresh extraction sockets and immediately loaded. The peak insertion torque (IT) was measured in Ncm at placement. Resonance Frequency Analysis (RFA) measurements were made at baseline and 2, 4, 6, and 12 weeks after surgery. Results. The two implant types showed similar IT and RFA values at placement (NS). A dip of RFA values after 2 weeks followed by an increase was observed, where the test implant showed a less pronounced decrease and a more rapid recovery than the control implant. The test implants were significantly more stable than the control ones after 12 weeks. Conclusions. The results from the present study indicated that the hydrophilic and rougher test implant was more resistant to immediate loading and showed a significantly higher stability than the smoother control implant after 12 weeks. Leonardo Vanden Bogaerde and Lars Sennerby Copyright © 2016 Leonardo Vanden Bogaerde and Lars Sennerby. All rights reserved. Experimentally Induced Pulpal Lesion and Substance P Expression: Effect of Ketoprofen—A Preliminary Study Mon, 29 Feb 2016 18:48:01 +0000 Objectives. To evaluate substance P (SP) and the effect of ketoprofen administration, a nonsteroidal anti-inflammatory drug (NSAID), on SP in the pulp of upper third molars with experimentally induced pulpal lesion. Materials and Methods. A sample of 20 young systemically healthy adults of both sexes, nonsmokers, with a healthy upper third molar to extract for orthodontic purposes, was selected. Prior to the procedure, an inflammatory process was generated by mechanical exposure of the pulp. After 15 minutes, the pulp was collected using a sterile barbed broach. SP levels were determined by using a commercially available enzyme immunoassay (ELISA) kit. The subjects were randomly divided into two groups: group 1 received a dose of ketoprofen 30 minutes prior to the experimental procedure. The subjects of group 2 did not receive any kind of drug administration. The patients were asked to complete a diary on the postoperative pain. Results. No statistically significant difference could be detected in SP expression between the two groups. In group 1, pain manifestation was significantly delayed in comparison with group 2. Conclusions. Preventive administration of ketoprofen did not significantly affect the pulpal levels of SP but resulted in a significantly postponed manifestation of pain after extraction. Gian Marco Abbate, Paola Sacerdote, Giada Amodeo, Alessandro Mangano, and Luca Levrini Copyright © 2016 Gian Marco Abbate et al. All rights reserved. Oral Gingival Cell Cigarette Smoke Exposure Induces Muscle Cell Metabolic Disruption Mon, 29 Feb 2016 16:48:59 +0000 Cigarette smoke exposure compromises health through damaging multiple physiological systems, including disrupting metabolic function. The purpose of this study was to determine the role of oral gingiva in mediating the deleterious metabolic effects of cigarette smoke exposure on skeletal muscle metabolic function. Using an in vitro conditioned medium cell model, skeletal muscle cells were incubated with medium from gingival cells treated with normal medium or medium containing suspended cigarette smoke extract (CSE). Following incubation of muscle cells with gingival cell conditioned medium, muscle cell mitochondrial respiration and insulin signaling and action were determined as an indication of overall muscle metabolic health. Skeletal muscle cells incubated with conditioned medium of CSE-treated gingival cells had a profound reduction in mitochondrial respiration and respiratory control. Furthermore, skeletal muscle cells had a greatly reduced response in insulin-stimulated Akt phosphorylation and glycogen synthesis. Altogether, these results provide a novel perspective on the mechanism whereby cigarette smoke affects systemic metabolic function. In conclusion, we found that oral gingival cells treated with CSE create an altered milieu that is sufficient to both disrupted skeletal muscle cell mitochondrial function and insulin sensitivity. Andrea C. Baeder, Kiran Napa, Sarah T. Richardson, Oliver J. Taylor, Samantha G. Andersen, Shalene H. Wilcox, Duane R. Winden, Paul R. Reynolds, and Benjamin T. Bikman Copyright © 2016 Andrea C. Baeder et al. All rights reserved. Association between Self-Reported Bruxism and Sleeping Patterns among Dental Students in Saudi Arabia: A Cross-Sectional Study Mon, 29 Feb 2016 11:09:15 +0000 Objectives. The aim of this cross-sectional study was to identify sleeping patterns among dental students and their association with self-reported bruxism in Riyadh Colleges of Dentistry and Pharmacy (RCsDP). Methods. A cross-sectional study was performed including 549 students (67 men and 482 women). A structured questionnaire was adopted from The PSQI (The Pittsburgh Sleep Questionnaire Index) used for data collection. It included questions which are categorized into sleeping habits, sleep-related symptoms, and additional questions concerning bruxism. This questionnaire was randomly distributed among all college preclinical and postclinical students. Sleep bruxism diagnosis was based on self-reported data. The data were analyzed using Chi-square tests through SPSS software for Windows. Results. Statistical analyses revealed significant correlations between self-reported bruxism and sleeping habits including sleep initiation (, ), continuous sleep until morning (, ), nighttime sleep duration (, ), and length of daytime naps (, ). There was an association between self-reported bruxism and sleeping-related symptoms including awakening early in the morning before the usual time without a cause (, ) and increased nightmares (, ). Conclusions. Poor sleeping pattern was an important factor among dental students, who reported sleep bruxism. Shereen M. Shokry, Eman E. El Wakeel, Nassr Al-Maflehi, Zaheera RasRas, Nida Fataftah, and Enam Abdul Kareem Copyright © 2016 Shereen M. Shokry et al. All rights reserved. Nitric Oxide Concentration and Other Salivary Changes after Insertion of New Complete Dentures in Edentulous Subjects Mon, 29 Feb 2016 09:37:21 +0000 Objective. To assess changes in levels of salivary nitric oxide (NO) after insertion of new complete dentures and its association with clinical and salivary parameters. Methods. Nineteen fully edentulous subjects were included, mean age 64.4. Unstimulated whole saliva was collected before and after insertion of the dentures, at follow-up visits, and after 12 months. The concentration of the final stable NO product (nitrite) was measured by a colorimetric assay based on the Griess reaction. Clinical parameters were assessed during all clinical visits. Results. Functional adaptation to the dentures progressively improved, with no complaints at the long-term follow-up. NO concentration was not influenced by the level of functional adaptation, presence of injuries to the mucosa, salivary flow, and saliva viscosity. Pairwise comparison showed a reduction in NO concentration at the first follow-up compared to baseline values but differences were not statistically significant. Significant differences were observed in NO concentrations at the long-term follow-up when compared to the first () and second () visits. Conclusion. NO concentration reduced after denture insertion and returned to baseline levels in the long-term follow-up. This appears to be an autonomic response of the body and provides valuable complementary information for the management of the edentulous patient. Maria de Lourdes Breseghelo, Lídia Andreu Guillo, Túlio Eduardo Nogueira, and Cláudio Rodrigues Leles Copyright © 2016 Maria de Lourdes Breseghelo et al. All rights reserved. Pittsburgh as a High Risk Population: The Potential Savings of a Personalized Dental Care Plan Tue, 23 Feb 2016 12:28:21 +0000 Objectives. Little evidence exists for the current standard of two annual preventative care visits. The purpose of this study was investigate this claim by modeling the potential savings of implementing a personalized care plan for high risk individuals in the Pittsburgh region. Methods. Using radiographs from 39 patients in the University of Pittsburgh Dental Registry and DNA Repository database, two models were created to analyse the direct savings of implementing a more aggressive preventative treatment plan and to view the longitudinal cost of increased annual yearly visits. Results. There is a significant decrease () between original and modeled treatment cost when treatment severity is reduced. In addition, there is a significant decrease in adult lifetime treatment cost () for up to four annual visits. Conclusions. Patients in high risk populations may see significant cost benefits in treatment cost when a personalized care plan, or higher annual preventative care visits, is implemented. Andrew J. Ng and Alexandre R. Vieira Copyright © 2016 Andrew J. Ng and Alexandre R. Vieira. All rights reserved. Influence of Type 2 Diabetes on Prevalence of Key Periodontal Pathogens, Salivary Matrix Metalloproteinases, and Bone Remodeling Markers in Sudanese Adults with and without Chronic Periodontitis Wed, 17 Feb 2016 09:48:06 +0000 This study compared the influence of type 2 diabetes on the occurrence of six periodontal pathogens in plaque samples of patients with and without chronic periodontitis. Levels of salivary MMP-8, MMP-9, RANKL, and OPG were also investigated. The study enrolled 31 patients with type 2 diabetes and chronic periodontitis (DM + CP), 29 with chronic periodontitis (CP), and 20 with type 2 diabetes (DM). Questionnaire-guided interviews were conducted and plaque index, bleeding on probing, and pocket depth were recorded. Polymerase chain reaction (PCR) was utilized to determine the prevalence of the bacteria. The levels of salivary molecules were determined by enzyme immunosorbent assay (ELISA). The CP group had the highest prevalence of P. gingivalis (81.5%), followed by the DM + CP (59.3%) and DM (55.0%) groups (). Similar trends were observed for P. intermedia and T. denticola. The prevalence of T. forsythia was 100% in both periodontitis groups compared to 90% in the DM group. There were no significant differences between the groups regarding the concentrations of MMP-8, MMP-9, or OPG. RANKL concentrations were below the detection limit. Our data show that type 2 diabetes has no significant influence on the prevalence of the investigated periodontal pathogens, or the levels of salivary MMP-8, MMP-9, and OPG. Hasaan Gassim Mohamed, Shaza Bushra Idris, Manal Mustafa, Mutaz Faisal Ahmed, Anne Nordrehaug Åstrøm, Kamal Mustafa, and Salah Osman Ibrahim Copyright © 2016 Hasaan Gassim Mohamed et al. 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.