International Journal of Dentistry The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Digital Dentistry: New Materials and Techniques Thu, 20 Oct 2016 08:58:13 +0000 Francesco Mangano, Jamil A. Shibli, and Thomas Fortin Copyright © 2016 Francesco Mangano et al. All rights reserved. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals Thu, 20 Oct 2016 06:00:49 +0000 Sugar alcohols (polyols) are used in food manufacturing and in medical tests and examinations. d-Glucitol (sorbitol) and d-mannitol were previously the most common alditols used for these purposes. After the 1960s, xylitol became a common ingredient in noncariogenic confectioneries, oral hygiene products, and diabetic food. Erythritol, a polyol of the tetritol type, can be regarded as the sweetener of the “next generation.” The disaccharide polyols maltitol, lactitol, and isomalt have also been used in food manufacturing and in medical tests. Consumption of pentitol- and hexitol-type polyols and disaccharide polyols may cause gastrointestinal disturbances at least in unaccustomed subjects. The occurrence of disturbances depends on consumer properties and on the molecular size and configuration of the polyol molecule. Adaptation may take place as a result of enzyme induction in the intestinal flora. Some of the literature on xylitol has been difficult to access by health-care professionals and will be reviewed here. Research and clinical field experience have found no pathology in polyol-associated osmotic diarrhea—the intestinal mucosa having normal basic structure, except in extreme instances. Xylitol is better tolerated than hexitols or the disaccharide polyols. Erythritol, owing to its smaller molecular weight and configuration that differ from other alditols, normally avoids the gastrointestinal reactions encountered with other polyols. This review will also touch upon the FODMAPs diet concept. Kauko K. Mäkinen Copyright © 2016 Kauko K. Mäkinen. All rights reserved. The Prosthetic Workflow in the Digital Era Tue, 18 Oct 2016 07:37:35 +0000 The purpose of this retrospective study was to clinically evaluate the benefits of adopting a full digital workflow for the implementation of fixed prosthetic restorations on natural teeth. To evaluate the effectiveness of these protocols, treatment plans were drawn up for 15 patients requiring rehabilitation of one or more natural teeth. All the dental impressions were taken using a Planmeca PlanScan® (Planmeca OY, Helsinki, Finland) intraoral scanner, which provided digital casts on which the restorations were digitally designed using Exocad® (Exocad GmbH, Germany, 2010) software and fabricated by CAM processing on 5-axis milling machines. A total of 28 single crowns were made from monolithic zirconia, 12 vestibular veneers from lithium disilicate, and 4 three-quarter vestibular veneers with palatal extension. While the restorations were applied, the authors could clinically appreciate the excellent match between the digitally produced prosthetic design and the cemented prostheses, which never required any occlusal or proximal adjustment. Out of all the restorations applied, only one exhibited premature failure and was replaced with no other complications or need for further scanning. From the clinical experience gained using a full digital workflow, the authors can confirm that these work processes enable the fabrication of clinically reliable restorations, with all the benefits that digital methods bring to the dentist, the dental laboratory, and the patient. Lidia Tordiglione, Michele De Franco, and Giovanni Bosetti Copyright © 2016 Lidia Tordiglione et al. All rights reserved. Nonsurgical Management of Oral Mucocele by Intralesional Corticosteroid Therapy Sun, 16 Oct 2016 07:19:26 +0000 Background. Oral mucocele is a common lesion resulting from an alteration of minor salivary glands due to mucus accumulation. Rapid appearance, specific location, history of trauma, bluish colour, and consistency help in the diagnosis. Conventional surgical removal is the treatment of choice but has several disadvantages like damage to adjacent ducts with further development of satellite lesions. Therefore, the present study was undertaken to evaluate the efficacy of intralesional corticosteroid injection (betamethasone) as a nonsurgical treatment procedure in oral mucoceles. Material and Method. A total of 20 cases (males and females, 10–30 years of age) with clinically diagnosed oral mucoceles were given 1 mL of betamethasone intralesionally. All the patients were examined after a period of 7, 14, and 21 days to evaluate the response of the lesion towards treatment and consequently given the 2nd, 3rd, 4th injections. If the lesion resolved after one or two injections, the treatment was discontinued. Results. Out of the 20 cases, 18 of them showed complete regression of the lesion whereas the remaining 2 cases showed decrease in size. All the patients received maximum of 4 consecutive shots in weekly interval. Conclusion. Intralesional corticosteroid therapy can be considered as the first choice in the treatment of oral mucoceles. Rupam Sinha, Soumyabrata Sarkar, Tanya Khaitan, Arpita Kabiraj, and Anirban Maji Copyright © 2016 Rupam Sinha et al. All rights reserved. Inhibitory Effect of Enterococcus faecium WB2000 on Volatile Sulfur Compound Production by Porphyromonas gingivalis Sun, 09 Oct 2016 08:07:26 +0000 Volatile sulfur compounds (VSCs) produced by oral anaerobes are the major compounds responsible for oral malodor. Enterococcus faecium WB2000 is recognized as an antiplaque probiotic bacterium. In this study, the effect of E. faecium WB2000 on VSC production by Porphyromonas gingivalis was evaluated, and the mechanism of inhibition of oral malodor was investigated. P. gingivalis ATCC 33277 was cultured in the presence of four lactic acid bacteria, including E. faecium WB2000. Subsequently, P. gingivalis ATCC 33277, W50, W83, and two clinical isolates were cultured in the presence or absence of E. faecium WB2000, and the emission of VSCs from spent culture medium was measured by gas chromatography. The number of P. gingivalis ATCC 33277 in mixed culture with E. faecium WB2000 decreased at 6 h, and the rate of decrease was higher than that in mixed cultures with the other lactic acid bacteria. The numbers of five P. gingivalis strains decreased at similar rates in mixed culture with E. faecium WB2000. The concentration of methyl mercaptan was lower in spent culture medium from P. gingivalis and E. faecium WB2000 cultures compared with that from P. gingivalis alone. Therefore, E. faecium WB2000 may reduce oral malodor by inhibiting the growth of P. gingivalis and neutralizing methyl mercaptan. Nao Suzuki, Takuya Higuchi, Masato Nakajima, Akie Fujimoto, Hiromitsu Morita, Masahiro Yoneda, Takashi Hanioka, and Takao Hirofuji Copyright © 2016 Nao Suzuki et al. All rights reserved. Diagnostic Features of Common Oral Ulcerative Lesions: An Updated Decision Tree Mon, 03 Oct 2016 11:47:26 +0000 Diagnosis of oral ulcerative lesions might be quite challenging. This narrative review article aims to introduce an updated decision tree for diagnosing oral ulcerative lesions on the basis of their diagnostic features. Various general search engines and specialized databases including PubMed, PubMed Central, Medline Plus, EBSCO, Science Direct, Scopus, Embase, and authenticated textbooks were used to find relevant topics by means of MeSH keywords such as “oral ulcer,” “stomatitis,” and “mouth diseases.” Thereafter, English-language articles published since 1983 to 2015 in both medical and dental journals including reviews, meta-analyses, original papers, and case reports were appraised. Upon compilation of the relevant data, oral ulcerative lesions were categorized into three major groups: acute, chronic, and recurrent ulcers and into five subgroups: solitary acute, multiple acute, solitary chronic, multiple chronic, and solitary/multiple recurrent, based on the number and duration of lesions. In total, 29 entities were organized in the form of a decision tree in order to help clinicians establish a logical diagnosis by stepwise progression. Hamed Mortazavi, Yaser Safi, Maryam Baharvand, and Somayeh Rahmani Copyright © 2016 Hamed Mortazavi et al. All rights reserved. Perceptions of Altered Smile Esthetics: A Comparative Evaluation in Orthodontists, Dentists, and Laypersons Wed, 28 Sep 2016 13:43:05 +0000 Objective. The current investigation was proposed to determine the impression of trained dental professionals and laypeople towards the modified smile esthetics. Materials and Methods. Twenty-six images were randomized in a survey and graded according to attractiveness by the orthodontists, general dentists, and laypeople. Photographs of gingival display, midline diastema, central incisor crown length, and lateral incisor crown width were manipulated with five minor changes in each. For smile arc and buccal corridor, two major changes were incorporated besides the ideal photograph. One-way ANOVA and Post Hoc analysis of the responses were measured for each group. Results. Most evaluators opined that the ideal smile in each category was the most acceptable. Orthodontists were more perceptive and exacting in accepting variations in the smile arc and buccal corridors. Dental professionals and laypeople indicated that either complete absence or a 0.5 mm of alterations in a gingival display, midline diastema, and crown length makes a smile beautiful and pleasant. Changes in crown width were not perceivable by all the three groups. Conclusion. Eastern Arabic laymen are more conscious about alterations in gingival display, midline diastema, and crown length in their smile. Hence, the orthodontist should pay attention to these factors during any orthodontic treatment. Amjad Al Taki, Mohammed Khalesi, Muftah Shagmani, Islam Yahia, and Fatma Al Kaddah Copyright © 2016 Amjad Al Taki et al. All rights reserved. The Effect of Different Cleaning Protocols on Post Space: A SEM Study Wed, 28 Sep 2016 10:11:37 +0000 Aim. Purpose of the present paper is to analyze the efficiency of different post-space irrigation protocols. Methods. 28 single rooted teeth were endodontically treated. After post-space preparation every sample was assigned to one of three experimental groups and to one control group. In each group different irrigation protocols were performed as follows: EDTA (Group A), 37% orthophosphoric acid (Group B), and EDTA + 37% orthophosphoric acid with ultrasounds activation (Group C). In the control group (Group D) the irrigate association was not activated by ultrasounds. Three zones (coronal, middle, and apical) of each sample were analyzed by using Scan Electron Microscopy (SEM) without any metallization procedures. The presence of smear layer on the canal surface was qualitatively evaluated by applying Serafino’s score with values included between 0 and 2. Results. The results of the research showed how Group C recorded the better results (). Group A and Group B showed lower mean scores ( and ); Group D showed the lowest mean score of . The SEM observation analysis demonstrated how the smear layer presence decreased in the crown-apical direction. Conclusions. The different post-space treatments statistically determine significant differences on the dentinal surfaces cleansing. The absence of ultrasonic activation lowers the cleansing efficacy of endocanalar irrigants, showing sensible differences among each post-space zone. Giuseppe Lo Giudice, Angelo Lizio, Roberto Lo Giudice, Antonio Centofanti, Giuseppina Rizzo, Michele Runci, Angela Alibrandi, and Marco Cicciù Copyright © 2016 Giuseppe Lo Giudice et al. All rights reserved. Biological Effects of Medicinal Plants on Induced Periodontitis: A Systematic Review Wed, 21 Sep 2016 10:06:48 +0000 Objective. The aim of this systematic review was to investigate the advances in the study of medicinal plants and their biologic effects on periodontitis in animal models. Study Design. A systematic search was conducted by three independent researchers, who screened articles published up to March/2016, to identify the studies that contained sufficient and clear information on the association of the medicinal plants and periodontitis in murine models. The searches were performed using PubMed, Cochrane, and Science Direct databases. Results. After a critical analysis of titles and abstracts, 30 studies were finally eligible for analysis. The studies presented a great diversity of the experiment designed regarding the methods of induced periodontitis and the evaluation of the medicinal plants efficacy. None of the studies described the possible toxic effects associated with the administration of the plant material to animals and whether they could prevent damage to organs caused by systemic effect of induced periodontitis. Gel-based formulations containing plant substances are seen as an interesting strategy to treat periodontitis. Conclusions. In this systematic review, the state-of-the-art knowledge on the medicinal plants and the induced periodontitis was critically evaluated and discussed from the experiment designed to the possible clinical application. Jefferson Soares de Oliveira, Moara e Silva Conceição Pinto, Lucas de Araújo de Bastos Santana, Antonione Santos Bezerra Pinto, David di Lenardo, and Daniel Fernando Pereira Vasconcelos Copyright © 2016 Jefferson Soares de Oliveira et al. All rights reserved. Correlation between Microleakage and Absolute Marginal Discrepancy in Zirconia Crowns Cemented with Four Resin Luting Cements: An In Vitro Study Sun, 18 Sep 2016 14:24:50 +0000 Objectives. To evaluate microleakage and absolute marginal discrepancy (AMD) and to assess correlation between AMD and microleakage with four resin luting cements. Material and Methods. 20 extracted human third molars were prepared for full-coverage crowns. 20 zirconia copings were made (LAVA, 3M ESPE) and cemented. Specimens were randomly allocated for each used type of cement into 4 groups, RelyX® (Rx), Multilink® (Mk), PANAVIA 2.1® (P), and Maxcem® (Mx) and immersed in 10% safranin for 72 hours. 20x magnification lenses were used to observe microleakage areas (μm2) and images software was used to measure AMD areas (μm). Discrepancy and microleakage between the cements were compared with one-way ANOVA test with confidence interval of 95%. Results. Rx Group showed microleakage has lowest value and AMD has highest value. P Group showed microleakage has the highest value and Mk Group presented AMD has lowest value. There were no significative differences between the cements. There were no linear correlations between microleakage and AMD; however a complex regression statistical model obtained allowed formulating an association between both variables (microleakage = ). Conclusions. No significative differences were found among 4 types of cements. No linear correlations between AMD and microleakage were found. Clinical Significance. AMD is not easily related to microleakage. Characteristics of cements are fundamental to decreasing of microleakage values. Abad-Coronel Cristian, Li Jeanette, Martínez-Rus Francisco, and Pradíes Guillermo Copyright © 2016 Abad-Coronel Cristian et al. All rights reserved. Corrigendum to “A Study of Success Rate of Miniscrew Implants as Temporary Anchorage Devices in Singapore” Sun, 18 Sep 2016 07:39:24 +0000 Yi Lin Song, Mimi Yow, Ming Tak Chew, Kelvin Weng Chiong Foong, and Hung Chew Wong Copyright © 2016 Yi Lin Song et al. All rights reserved. PCR-Based Identification of Oral Streptococcal Species Wed, 14 Sep 2016 11:57:48 +0000 The microbial etiology of dental caries is still debated. Among the hypothesized contributors are the “low pH streptococci,” a designation given to unusually acid proficient strains among the primary plaque colonizers S. oralis, S. mitis, S. gordonii, and S. anginosus. However, accurate assignment of species is difficult among the oral streptococci. Our objective was to develop a streamlined method for identifying strains of S. oralis and S. mitis from plaque samples so that they could be analyzed in a separate study devoted to low pH streptococci and caries. Two independent PCR amplifications of a locus highly conserved among streptococci were used for presumptive species identification. Multilocus sequence analysis (MLSA) was used to measure accuracy. Sensitivity was 100% for selecting S. oralis and S. mitis among the clones sampled. Specificity was good except for the most closely related species that could not be reliably distinguished even by MLSA. The results with S. oralis and S. mitis were used to identify new primer sets that expanded the utility of the approach to other oral streptococcal species. These novel primer sets offer a convenient means of presumptive identification that will have utility in many studies where large scale, in-depth genomic analyses are not practical. Jeffrey A. Banas, Min Zhu, Deborah V. Dawson, Huojun Cao, and Steven M. Levy Copyright © 2016 Jeffrey A. Banas et al. All rights reserved. Erythritol Is More Effective Than Xylitol and Sorbitol in Managing Oral Health Endpoints Sun, 21 Aug 2016 10:02:11 +0000 Objective. To provide a comprehensive overview of published evidence on the impact of erythritol, a noncaloric polyol bulk sweetener, on oral health. Methods. A literature review was conducted regarding the potential effects of erythritol on dental plaque (biofilm), dental caries, and periodontal therapy. The efficacy of erythritol on oral health was compared with xylitol and sorbitol. Results. Erythritol effectively decreased weight of dental plaque and adherence of common streptococcal oral bacteria to tooth surfaces, inhibited growth and activity of associated bacteria like S. mutans, decreased expression of bacterial genes involved in sucrose metabolism, reduced the overall number of dental caries, and served as a suitable matrix for subgingival air-polishing to replace traditional root scaling. Conclusions. Important differences were reported in the effect of individual polyols on oral health. The current review provides evidence demonstrating better efficacy of erythritol compared to sorbitol and xylitol to maintain and improve oral health. Peter de Cock, Kauko Mäkinen, Eino Honkala, Mare Saag, Elke Kennepohl, and Alex Eapen Copyright © 2016 Peter de Cock et al. All rights reserved. “Digitally Oriented Materials”: Focus on Lithium Disilicate Ceramics Thu, 18 Aug 2016 14:14:02 +0000 The present paper was aimed at reporting the state of the art about lithium disilicate ceramics. The physical, mechanical, and optical properties of this material were reviewed as well as the manufacturing processes, the results of in vitro and in vivo investigations related to survival and success rates over time, and hints for the clinical indications in the light of the latest literature data. Due to excellent optical properties, high mechanical resistance, restorative versatility, and different manufacturing techniques, lithium disilicate can be considered to date one of the most promising dental materials in Digital Dentistry. Fernando Zarone, Marco Ferrari, Francesco Guido Mangano, Renato Leone, and Roberto Sorrentino Copyright © 2016 Fernando Zarone et al. All rights reserved. Comparison of Piezosurgery and Conventional Rotary Instruments for Removal of Impacted Mandibular Third Molars: A Randomized Controlled Clinical and Radiographic Trial Sun, 14 Aug 2016 13:42:50 +0000 The purpose of this study was to test the effect of the surgical removal of impacted mandibular third molars using piezosurgery versus the conventional surgical technique on postoperative sequelae and bone healing. Material and Methods. This study was carried out as a randomized controlled clinical trial: split mouth design. Twenty patients with bilateral mandibular third molar mesioangular impaction class II position B indicated for surgical extraction were treated randomly using either the piezosurgery or the conventional bur technique on each site. Duration of the procedure, postoperative edema, trismus, pain, healing, and bone density and quantity were evaluated up to 6 months postoperatively. Results. Test and control sites were compared using paired t-test. There was statistical significance in reduction of pain and swelling in test sites, where the time of the procedure was statistically increased in test site. For bone quantity and quality, statistical difference was found where test site showed better results. Conclusion. Piezosurgery technique improves quality of patient’s life in form of decrease of postoperative pain, trismus, and swelling. Furthermore, it enhances bone quality within the extraction socket and bone quantity along the distal aspect of the mandibular second molar. Hani Arakji, Mohamed Shokry, and Nayer Aboelsaad Copyright © 2016 Hani Arakji et al. All rights reserved. Frequency and Influencing Factors of Rubber Dam Usage in Tianjin: A Questionnaire Survey Sun, 31 Jul 2016 06:30:09 +0000 Objective. To investigate the frequency and influencing factors of rubber dam usage for endodontic procedures among general dentistry practitioners and specialized practitioners (endodontist) in Tianjin. Methods. Three hundred questionnaires were distributed among practitioners from 3 different types of medical institutions in Tianjin. Data were collected and analysed using Chi-square tests. Results. There were 63.3% of respondents who have used rubber dam (response rate 82.7%, valid response rate 76.3%). However, only 0.4% and 3.1% of them recognized using rubber dam “every time” during caries direct restoration and root canal therapy, respectively. There was no significant difference in rubber dam usage between male and female practitioners. Among the respondents, practitioners with working experience between 5 and 10 years showed the highest usage rate (76.3%), while practitioners working more than 20 years showed the lowest (53.2%). The endodontists gained the highest and the most frequent usage rate and the best rubber dam technique mastering skills. Practitioners working in those stomatological departments of general hospitals showed the lowest rubber dam usage rate. Conclusions. The prevalence of rubber dam usage in Tianjin city is still low. The practitioner’s gender, years of professional experience, general or specialized field, and the type of dental setting they work for are the factors that need to be considered during making policy and executing training. Huiru Zou, Yanni Li, Xiaoli Lian, Yan Yan, Xiaohua Dai, and Guanhua Wang Copyright © 2016 Huiru Zou et al. All rights reserved. Estimate of Impact on the Oral Health-Related Quality of Life of Older Thai People by the Provision of Dentures through the Royal Project Tue, 26 Jul 2016 14:16:52 +0000 Purpose. To estimate the impact of the provision of dentures to Thai older people by the Royal Project on their oral health-related quality of life. Methods. A purposive cross-sectional study of a sample of 812 subjects was conducted. The Oral Impacts on Daily Performances (OIDP) measure was used to assess the oral health-related quality of life. Results. Four groups of older people with different tooth types were studied. 216 (26.6%) had natural teeth (NT). 189 (23.3%) had natural and replaced teeth (NRT). 167 (20.6%) had below the minimum number of teeth but had no dentures (Edent) and 240 were edentate with complete dentures provided by the Royal Project (ECD) (29.6%). Overall, 36.5% had at least one oral impact. Eating was the most affected oral impact. When compared to the group with natural teeth (NT), the Edent group was significantly more likely to report having impacts on eating OR = 6.5 (3.9–10.9), speaking clearly OR = 43.7 (12.7–15.07), emotional stability OR = 16.5 (6.0–45.6), and social contacts OR = 4.6 (2.2–9.5) (). Conclusion. Those who are edentulous are much more likely to have an oral impact on their daily performances than those provided dentures. Provision of dentures may lead to improvement of considerable oral impacts. Patcharawan Srisilapanan, Narumanas Korwanich, Sutha Jienmaneechotchai, Supranee Dalodom, Nontalee Veerachai, Warangkana Vejvitee, and Jeffrey Roseman Copyright © 2016 Patcharawan Srisilapanan et al. All rights reserved. Prevalence of Dental Caries in Kosovar Adult Population Tue, 19 Jul 2016 12:42:37 +0000 Objectives. The aim of this study was to assess the prevalence of dental caries in the Kosovar adult population. Materials and Methods. A cross-sectional study in Kosovo was conducted examining 9387 patients, aged 18 upwards, between January 2010 and December 2011. Clinical evaluation was done using WHO criteria for evaluation of dental health status and data collection. Results. The prevalence of caries for the whole study was 72.80%. The mean DMFT index was 9.61 (±5.12) in the 18–34-year age group, 11.6 (±6.42) in the 35–44-year age group, 13.68 (±8.12) among the 45–64-year age group, 17.98 (±9.81) in the 65–74-year age group, and 23.19 (±9.41) in the age group of 75+ years, respectively. A significant difference of mean DMFT and its each component was observed between the ages (). Conclusion. This study comes out with the significant levels of dental caries among young Kosovar population (18–34 years old). Blerim Kamberi, Ferit Koçani, Agim Begzati, Jeta Kelmendi, Donika Ilijazi, Nora Berisha, and Lumnije Kqiku Copyright © 2016 Blerim Kamberi et al. All rights reserved. Bacterial Adhesion and Surface Roughness for Different Clinical Techniques for Acrylic Polymethyl Methacrylate Tue, 19 Jul 2016 08:59:46 +0000 This study sought to assess the effect of different surface finishing and polishing protocols on the surface roughness and bacterial adhesion (S. sanguinis) to polymethyl methacrylates (PMMA). Fifty specimens were divided into 5 groups () according to their fabrication method and surface finishing protocol: LP (3 : 1 ratio and laboratory polishing), NF (Nealon technique and finishing), NP (Nealon technique and manual polishing), MF (3 : 1 ratio and manual finishing), and MP (3 : 1 ratio and manual polishing). For each group, five specimens were submitted to bacterial adhesion tests and analyzed by scanning electron microscopy (SEM). Two additional specimens were subjected to surface topography analysis by SEM and the remaining three specimens were subjected to surface roughness measurements. Data were compared by one-way ANOVA. The mean bacterial counts were as follows: NF, ; MP, ; NP, ; MF, ; and LP, (CFU). The mean surface roughness values were as follows: NF, ; MP, ; NP, ; MF, ; and LP, (m). A reduction in the surface roughness was observed to be directly related to a decrease in bacterial adhesion. It was verified that the laboratory processing of PMMA might decrease the surface roughness and consequently the adhesion of S. sanguinis to this material. Lucas Costa de Medeiros Dantas, João Paulo da Silva-Neto, Talita Souza Dantas, Lucas Zago Naves, Flávio Domingues das Neves, and Adérito Soares da Mota Copyright © 2016 Lucas Costa de Medeiros Dantas et al. All rights reserved. From Guided Surgery to Final Prosthesis with a Fully Digital Procedure: A Prospective Clinical Study on 15 Partially Edentulous Patients Thu, 14 Jul 2016 16:15:13 +0000 Scope. To demonstrate guided implant placement and the application of fixed, implant-supported prosthetic restorations with a fully digital workflow. Methods. Over a 2-year period, all patients with partial edentulism of the posterior maxilla, in need of fixed implant-supported prostheses, were considered for inclusion in this study. The protocol required intraoral scanning and cone beam computed tomography (CBCT), the superimposition of dental-gingival information on bone anatomy, surgical planning, 3D-printed teeth-supported surgical templates, and modelling and milling of polymethylmethacrylate (PMMA) temporaries for immediate loading. After 3 months, final optical impression was taken and milled zirconia frameworks and 3D-printed models were fabricated. The frameworks were veneered with ceramic and delivered to the patients. Results. Fifteen patients were selected for this study. The surgical templates were stable. Thirty implants were placed (BTK Safe®, BTK, Vicenza, Italy) and immediately loaded with PMMA temporaries. After 3 months, the temporaries were replaced by the final restorations in zirconia-ceramic, fabricated with a fully digital process. At 6 months, none of the patients reported any biological or functional problems with the implant-supported prostheses. Conclusions. The present procedure for fully digital planning of implants and short-span fixed implant-supported restorations has been shown to be reliable. Further studies are needed to validate these results. Giorgio Andrea Dolcini, Marco Colombo, and Carlo Mangano Copyright © 2016 Giorgio Andrea Dolcini et al. All rights reserved. A New Total Digital Smile Planning Technique (3D-DSP) to Fabricate CAD-CAM Mockups for Esthetic Crowns and Veneers Sun, 10 Jul 2016 10:20:19 +0000 Purpose. Recently, the request of patients is changed in terms of not only esthetic but also previsualization therapy planning. The aim of this study is to evaluate a new 3D-CAD-CAM digital planning technique that uses a total digital smile process. Materials and Methods. Study participants included 28 adult dental patients, aged 19 to 53 years, with no oral, periodontal, or systemic diseases. For each patient, 3 intra- and extraoral pictures and intraoral digital impressions were taken. The digital images improved from the 2D Digital Smile System software and the scanner stereolithographic (STL) file was matched into the 3D-Digital Smile System to obtain a virtual previsualization of teeth and smile design. Then, the mockups were milled using a CAM system. Minimally invasive preparation was carried out on the enamel surface with the mockups as position guides. Results. The patients found both the digital smile design previsualization (64.3%) and the milling mockup test (85.7%) very effective. Conclusions. The new total 3D digital planning technique is a predictably and minimally invasive technique, allows easy diagnosis, and improves the communication with the patient and helps to reduce the working time and the errors usually associated with the classical prosthodontic manual step. F. Cattoni, F. Mastrangelo, E. F. Gherlone, and G. Gastaldi Copyright © 2016 F. Cattoni et al. All rights reserved. Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton Mon, 04 Jul 2016 09:44:56 +0000 Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions. Sevin Barghan, Mehrnaz Tahmasbi Arashlow, and Madhu K. Nair Copyright © 2016 Sevin Barghan et al. 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.