Journal of Dental School
Volume:23 Issue: 1, 2005

Pain control before and after endodontic treatment is always a major concern in dentistry. Non-steroidal anti inflammatory drugs (NSAIDs) are the most common drugs prescribed for preventive and post operative pain control in root canal therapy. During the last decade a new generation of NSAIDs has been introduced and it seems that because of its selective inhibition of cyclooxgenase-2 activity، these drugs have less side effects than other common NSAIDs. Since no studies have been performed to compare the new NSAIDs analgesic effect with other NSAIDs in patients undergoing endodontic treatment، therefore a randomized double blind study was accomplished to compare the analgesic effect of celebrex (selective cox-2 inhibitor) and Ibuprofen on postendodontic pain. The aim of this study was to compare the analgesic effect of Celebrex vs Ibuprofen on post endodontic pain. Methods & Materials: In a randomized double blind clinical trial study 40 patients with moderate to severe endodontic pain underwent pulpectomy and received either Ibuprofen (every 6 hours) or celebrex (every 12 hours) for 3 days after endodontic treatment. Patient-reported visual analog scale rating of pain intensity were conducted upon initial clinical presentation and at 6, 24, 36, 48, and 60h after completion of pulpectomy. Also, patients were asked to record the side affects in the questionnaires. The results were obtained using the Mann Whitney, t and Chi – square tests by using the SPSS software. The results showed that there was no significant difference between analgesic effect of celebrex and Ibuprofen in controlling pain at all periods of time after endodontic treatment (P>0. 05). According to the results, Celebrex because of its high cost, no effective pain control and similar incidence of side effects in comparison to Ibuprofen is not a drug of choice for short term pain control in endodontics.

Hidden caries is a term used to describe occlusal dentine caries that is missed on a visual examination, but can be detected by bitewing radiographs. The aim of this study is the review of new studies about this lesion and presentation the ways for diagnosis, prevention and treatmen of this lesion. Review of Literature: Investigations believe that the etiology of this lesion is the morphology of occlusal fissures and also topical fluoride use. Diagnosis of hidden caries is difficult and need to use the diagnostic tools such as bitewing radiographs. Investigators have shown the prevalence of hidden caries is between 1.4% to 15% of occlusal surfaces of permanent molars that have diagnosed as sound teeth. Prevention of this lesion is taken by fissure sealing soon after eruption and treatment is taken by amalgam or composite restoration. It is suggested to investigate about the prevalence of hidden caries in our country.

The aim of this study was to determine and to evaluated the osseous healing and resorption in a unique system (Maestro) when 2 techniques of one – stage and two – stage surgeries are compared. The follow up periods were 4 and 6 months for the lower and upper jaws resepectively. Methods & Materials: Design of study was prospective. In this study, 10 one – stage and 18 two – stage implants were inserted. Clinical measurements included the distance of bone crest to implant shoulder at 4 aspect (mesial, distal, buccal and lingual) around each implants using a Williams periodontal probe. These measurements were taken at baseline and at the re-entry visit. Radiographic evaluation included the observation of crestal bone resorption around implant at baseline and at the re-entry visit using a panoramic radiography. The mean bone changes showed no statistical differences in terms of surgical procedure, implant diameter, implant length, as well bone type, and location (anterior or posterior) and jaw (mandible or maxilla), when two sample t test were used for comparison. However, Logistic regression revealed that of the above mentioned parameters, two factors, ie. Surgical procedure and implant diameter showed significant roles in bone loss around implants. Radiographic evaluation proved unsatisfactory for precise measurements of bone changes, therefore, the x–rays were not analyzed for our purpose. The results of this study demonstrated that at least during the first healing period after the first surgical visit, two – stage surgical technique is superior to one – stage technique. Moreover implants with greater diameter are less prone to early bone loss during this healing period.

Osteopetrosis is a bone disorder which is identified as an increase in bone density. Lack of blood supply and bone brittleness may predispose to pathologic fracture and osteomyelitis. The only effective way is bone marrow transplantation. The aim of this report is to introduce a patient with mandibular osteomyelitis who has not been treated efficiently in spite of several approaches. Case Report: Patient was a 4 – year old boy complained about mandibular pain, swelling and pus secretion. He had toxic appearance, pale conjective and deformity of extremities. Radiographic features showed diffused sclerosis, thickening and increased opacity of some parts of mandible – Malignant infantile osteopretrosis was diagnosed via inspection, radiography and bone marrow aspiration. Aggressive acute mandibular infection, led to incision and drainage (I & D) and décortication. Finally, long period of hospitalization caused psychological depression and he was discharged with psychological recommendations, drug and hygiene instruction. 8 months later infection recurred and the patient had no cooperation tendency and could bo longer been followed. Due to nature of osteopetrosis and infection predisposition, specially jaw osteomyelitis, oral hygiene instructions, regular appointments, early diagnosis and treatment of jaw infections is suggested.

The prevalence of class II malocclusion is reported 1. 7٪ to 63٪ in the orthodontic literature. It has been pointed out by many investigators that a dental class II division 1 malocclusion occurs in a variety of skeletal and dental configurations. The purpose of this study is identification of the craniofacial features of patients with class II division 1 malocclusion. Methods & Materials: In this descriptive study lateral cephalograms of 63 samples with normal occlusion as control group and 41 samples with class II division 1 malocclusion as case group between the ages of 11 to 14 years were selected according to Angle`s criteria. Then craniofacial features of case and control groups were compared by paired t test. Since there were no significant differences between the boys and girls in any groups, the total results of case and control groups compared. Results indicate that except maxillary skeletal position, lower incisor position and vertical dentofacial components, all of the selected linear and angular measurments showed significant differences between the class II division 1 malocclusion and with normal occlusion. The findings of this study suggest a difinite skeletal and dentoalveolar pattern with the following characteristics for class II division 1 malocclusion: 1) Orthognathic maxilla, 2) Retrognathic mandible 3) Class II intermaxillary relationship 4) Upper incisors are proclined and lower incisors are in normal position, 5) Vertical components are similar to samples with normal occlusion.

On the basis of current data, the correlation between symptomatic pulpitis of deciduous teeth and presence or concentration of different immunoglobulins was not studied up to now. So the aim of this study was to investigate the correlation between presence or concentration of IgG, IgA, IgM and IgE and symptomatic pulpitis in deciduous teeth. Methods & Materials: For this purpose, in this analytical (case-control) study, 22 pulpal samples with irreversible symptomatic inflammation from 11 deciduous teeth and 11 permanent teeth were collected. After culturing them for 3 days, SRID method was used for detecting the amount of IgG, IgA and IgM and ELISA was used for measuring the amount of IgE in supernatant fluids. Mann – whitney U, Exact Fisher and Spearman correlation test were used to show the difference. The presence of IgG, IgA, IgM and IgE in the deciduous samples was 27.3%, 0%, 0% and 54.5%, respectively, with mean concentration of 1721.41± 3384.46 mg/100ml, 0, 0 and 0.36± 0.56 IU/ml. The presence of IgG, IgA, IgM and IgE in permanent samples was 54.5%, 18.2%, 9.1% and 54.5% respectively with mean concentration of 2688.96± 2631.39, 38.84± 87.93, 47.15± 156.38 mg/100ml and 0.27± 0.38 IU/ml. Statistical analysis did not show any significant difference between deciduous and permanent teeth regarding to presence or concentration of immunoglobulins. It is suggested that in symptomatic pulpitis in both types of dentition, humoral immune response is involved. Of course further study is needed in order to prove this hypothesis.

The effect of periodontal disease on blood cells and hematopoises mechanisms has been focused during recent years, and based on researches on this field, leukocyte and platelete production are changed by the periodontal disease which in turn is believed to be an etiologic factor for thromboembolic phenomenom and cardiovascular disease. Due to lack of information about the possible changes by periodontal disease and blood indices in our country, this study was done on the patients referred to the oral medicine and periodontic wards of Azad Islamic dental faculty during 1381-82. This study was a historical cohort study. The patients with moderate to severe chronic periodontits (Bone loss & CAL > 3 at more than 30% sites) without systemic diseases and infection and history of using any drugs and/or antibiotics, surgery, recent trauma or tooth extraction selected as test group, meanwhile, among the patients reffered to the oral medicine ward who were periodontally healthy (CAL < 1) samples were selected as control group. The interventional variables, (age, gender, education, smoking habit and remained teeth) were matched between two groups. After describing the procedure of research to all of the participants, consent forms were signed. Base line data, consisted of “CAL” and “PI” in the both groups were recorded. Samples of 2ml venous blood were collected in standard tubes containing EDTA, send immediately to the laboratory for analysis of blood cells with automatic cell counter (Sysmex K1000). The smear blood sample was taken from each patient, and evaluated by pathologist, to determine differential counting of WBC. The study was done on 60 participants (test=30, control=30). There was no significant difference between the test and control group in interventional variables. Laboratory tests showed significant differences in some of blood indices, leukocytes were elevated in periodontal patient compare to healthy controls (P<0.001). This finding was primarily explained by higher numbers of neutrophils in periodontitis (P<0.001). Periodontal patient had a higher number of platelet compared to control group (P<0.01). There were no significant differences in other indices. (RBC, HGB, MCV, MCH, MCHC) between two groups (P<0.05). This study showed that periodontal diseases due to its influence on hematopoises mechanisms and blood cell production, may cause increased WBC count, neutrophil and platelets, without alteration on RBC, HGB and other blood indices.

Castability of Ni-Cr alloy as an alternative to gold, has an important role in the success of metal – ceramic restorations. This research evaluates the importance of adding Berilium (Be) to Ni – Cr alloy to compare the castability of two Ni – Cr and Ni – Cr – Be alloys in reproducing different lengths of bevel finish line. Methods & Materials: Using Replica method, 30 wax-up with three different lengths of bevel were casted with Rexillium III and Wiron 99. After completing the necessary procedures, the bevel lengths were evaluated, and compared by t - test. There was no significant difference between the castability of these two alloys. The best castabilty in both alloys was seen in the range of 0.5 mm. It seems that Be is not necessary for a good castability. Although an increase in volume/surface of wax- ups in a significant range can improve the castability, the farther the margin of restoration located to the sprue, the more the possibility of incomplete castings. It seems the best castablity occurs in bevels of 0.5 mm.

One of the major factors responsible for failure in treatment is perforation and different studies have shown that furcal perforation will result in destruction of tooth supporting tissues and if not treated, may result in tooth loss. Different materials have been introduced for perforation treatment, such as Cavit, Zinc Oxide Eugenol, Calcium Hydroxide, Amalgam and MTA. Today, MTA (first introduced by Torabinejad in 1993 as a root end filling material) is the first choice for treating perforations, due to its excellent sealing ability and biocompatibility. In this report, we describe the treatment with MTA performed for a patient with perforation due to massive dental caries and the results of the treatment. Case Report: The patient was a 19 year old girl with no medical records which came to clinic for treatment of her lower left first molar tooth. The clinical and radiographic investigations showed massive decay in the crown and forcal region of the molar tooth. First, the crown and furcal caries were completely removed. After root treatment with Guta-Percha and AH26 sealer, the perforation was sealed with MTA and temporarily filled and in the next session, the tooth was restored. 6 months later, radiographic investigation was performed to confirm the success of treatment. Perforation in the furcal region, even if it is produced by caries, can be treated using MTA and this material is thought to be the first choice for treating perforations.

Mineral trioxide aggregare (MTA) is one of the new materials that was introduced for apicectomy at first but today is used for many purposes in endodontics. This study is done due to the importance of economical points in dental materials and decreasing the dental fees and to use new products. The aim of this study was to compare tissue reaction of foreign MTA (proroot)and Iranian MTA(Root) by subcutaneous implanted tube in rat. Methods & Materials: Fifty four rats were divided into four groups of experiments (40 rat) and 2 groups of control (14 rat). In experimental groups two isolated regions were incised to implant two polyethylene tubes filled with Root and ProRoot, and in control groups two empty tubes were implanted. Animals were sacrificed after 7 and 30 days. After histopathologic preparation, H&E staining, samples were evaluated for the thickness of capsule, intensity, type and extention of inflammation and necrosis. The results were analysed by chi-square. There was no statistical difference in the tissue reaction between Root and pro Root. Root is a biocompatible material as ProRoot.

It's obvious that periodontal health for long term prognosis of the teeth and restorations is critical, specially so when considering a subgingival restoration. This article explains about biologic width and reviews the crown lengthening procedures and conditions and it's indications and contraindications. Biologic width in definition is the region that junctional epithelium and connective tissue fibers attach to the tooth, and may include sulcular depth. If for any reasons, we have to insert the margins of restorations in subgingival regions, biologic width consideration and not to violate to its dimension is critical. So, if exposure of excess tooth structure is necessary, we should do crown lengthening procedures to achieve the objectives of restorative procedures and not to invade to BW.

There are many different ideas for second molar periodontal problems after extraction of wisdom tooth. Bone resorption, food impaction, deepening of pocket and loss of attachment is some of them. The aim of this study was to assess the periodontal status of second molar after third molar extraction. Methods & Materials: This study was done on 18 – 25 years old patients with extracted third molars, the presence of pocket, bone loss and bleeding were studied. For analysing the data, Chi – square and Fisher exact tests were used. The presence of pocket at the distal surface of second molar was 56.9%. Osseous defect was seen 31.2% and inflammation and attachment loss in 67.7% of the cases. Presence of pockets distal to the second molar is in accordance but bone resorption in this area was contradictory to the findings of other researchers. Problems like pocket, osseous defect, inflammation and attachment loss at distal of second molars adjacent to the extracted wisdom tooth in patients younger than 25 years old, make us to extract the third molars even in younger people.

Treatment of patients with class III malocclusion is one of the most challenging problems in orthodontic practice. This problem which causes functional and esthetic problems can result from prognathism of mandible or deficiency of nasomaxillary complex or a combination of both. It has been estimated that the incidence of this type of malocclusion in Iranian population is between 7.22 – 19.5 percent. The importance of early identification and treatment of this malocclusion is significant. The aim of this study was to determine the cephalometric changes following combined use of rapid maxillary expansion and facemask therapy in class III malocclusion. Methods & Materials: In this quasi experimental prospective clinical trial, 15 Iranian patients (6 males and 9 females with a mean age of 8.6 years) were selected. They were first treated with rapid maxillary expansion for 14 days prior to facemask delivery. Then facemask therapy was initiated untill normal canines and molars relationship and a normal overjet were achieved. Cephalometric means (consist of 11 angular and 8 linear measure) before and after treatment were calculated and compared with paired t-test to determine significant differences. Cephalometric analysis showed following changes: SNA=1.3±1.6, SNB=-0.5±1.6,ANB=1.7±2.3,Gonial Angle=-1.4±4.1,Articular Angle=-6±27.5, SNPog=-0.7±1.7, Inclination Angle=2.3±7.3, Y axis Angle=1.5±3.4, Mandibular Plan Angle=2.3±3.3, Occlusal Plan to SN=1±5.4, NSAr=0.8±2.3,PFH/AFH=0.8±1.9,N┴FH to A=1.1mm±1.9, N┴FH to Pog=1mm±4.6, Maxilla length=2.3mm±2.9, Mandible length=0.4mm±0.8, Overjet=3.8±2.7,Overbite=-0.8mm±1.5, Wit’s appraisal=2.4±2.5. This results indicate that facemask and rapid maxillary expansion improve class III malocclusion by increase in maxillary growth in anterioposterior dimension and a slight limitation of mandibular growth.

localized aggressive peridontitis is a destructive periodontal disease affecting first molars and/or incisors in young adults. The aim of this study was to determine the prevalence of this disease in 14-16 years old students in Tabriz. Methods & Materials: A two stage diagnostic procedure was used in this cross-sectional study where 1482 school students (14-16 years old) were screened initially by assessment of probing depth around the incisors and first molars and by assessment of plaque index (PI), gingival indx (GI) and calculus surface severity index (CSSI). Positive subjects were then diagnosed definitively by full clinical examination including depth, and assessment of CSSI, PI and GI and bitewing radiographic examination. The difference in gender was evaluated by chi – square test. Localized aggressive peridontitis exists among the 14-16 years old students. The total prevalance of localized aggressive peridontitis in 14-16 years old is 0.5% 0.6% for boys and 0.45% for girls. Chi-square test showed no difference in gender. Localized aggressive peridontitis is an early- onset type of periodontitis and the prevalence of localized aggressive peridontitis in this study corresponds to other studies in general. Further studies recommend for clarifying the causes of disease and evaluation of younger childern.

A successful endodontic surgery is due to adequate apical seal. Amalgam is used as a retrofill material but in long term the prognosis is not known. Amalgam bonding systems that provide bonding of Amalgam to dentin and MTA (mineral trioxide aggregate) are recently introduced. The aim of this study was to evaluate sealing ability of MTA, Amalgam and Amalgam with scotch bond M.P as retrofilling materials. Methods & Materials: In this experimental study 70 human single root extracted teeth were used, the teeth were divided randomly in to three experimental groupes: MTA, Amalgam, Amalgam with scotch bond M.P and two positive and negative control groups. Retrofilling materials were used in experimental groups then dye penetration by %2 methylen blue was performed for evaluation of leakage. Kruskal – Wallis and Mann – Whitney tests were used for statistical analysis. Amalgam+amalgam bond had better sealing than MTA and Amalgam in dry and wet condition (P<0.001). Amalgam leakage was approximately equal to MTA in dry condition but in wet condition amalgam had better seal (P<0.05). In comparison of each material in dry and wet condition no significance was found (P>0.05). This study recommends the use of amalgam + dentin bond as retrofills.

Bleaching technique is known to be an effective method for elimination of tooth discoloration but residual Oxygen after bleaching inhibits polymerization of resin based materials. The aim of this study was to evaluate the shear bond strength of composite to Sodium Ascorbate applied on bleached enamel. Methods & Materials: The study was carried out experimentally. Materials used were: Composite Z100 (3M), Single Bond (3M), Carbamide Peroxide 35% (Opalescence), Sodium Ascorbate 10%. The flattened labial surface of 75 maxillary premolars were subjected to 5 different treatments as follows:(1): No treatment, (2): Bleaching for 30 minutes, (3), (4), (5): Immersion in Sodium Ascorbate for 2, 10, 30 minutes, respectively, after bleaching. After bonding procedure, specimens were subjected to shear bond test after 24 hours. Data were analyzed by ANOVA and LSD post hoc tests. Shear bond strength of composite on enamel bleached with Carbamide Peroxide 35% was reduced significantly while it was increased by using Sodium Ascorbate 10% after bleaching with Carbamide Peroxide 35% although this increase was less than that occurred in control group (bonding to enamel without bleaching with Sodium Ascorbate 35%). Shear bond strength values in different groups were: (1) 29.06± 3.99, (2) 14.41± 3.31, (3) 24.46± 4.51, (4) 25.81±3.97, (5) 23.19± 4.27. ANOVA revealed no significant difference in shear bond strength when different times used to apply Sodium Ascorbate 35%. Stereomicroscopic evaluations showed most fractures in group 1 to be enamel cohesive, group 2, adhesive between tooth and composite, and other three groups to show all three fracture types (adhesive, enamel cohesive, composite cohesive). Although bonding to bleached enamel was improved by Sodium Ascorbate but duration of application had no significant effect on the shear bond strength of composite to bleached enamel.

During the month of Ramadan, oral hygienic habits, dietary, repetition of food receipt and the amount of received food change. It seems the factors effect on composition and quantity of dental plaque, dental caries and periodontal condition. Therefore, this study assessed the Ramadan effect of bacterial colonization on teeth surface. Methods & Materials: In this study thirty student of Shahid Beheshti University, aged between 18 and 24 (the same of both sex) that kept the fast at least for 20 first day of the month of Ramadan, were selected on special condition in 2001. The mandibular first molar of selected cases was sampled with strilled paper point 20 days before Ramadan and paper points were cultivated initially in the Trypticase Soy Broth and then in the special media of streptococcus mutans and actinomyces viscosis. These steps were repeated 10 days and one day before Ramadan and on first, 10th and 20th days of Ramadan. In this manner, dietary examination was done three times before and in the month of Ramadan. The differences were assessed by Paired t – test. In the comparision between streptococcus.m and actinomyces.v colony count on first, 10th and 20th days of Ramadan with basic colony count (mean of three sampling before Ramadan), no significant difference was seen by Paired t - test statistically. The amount of sucrose, mono, di and poly saccharides indicated increased significantly in diet and the amount of fibers decreased. In the streptococcus.m and actinomyces.v colony count no difference was seen. The amount of carbohydrate consumption increased in Ramadan.

Iatrogenic perforation has been known as one of the most important factors in endodontic failure. Nowadays, the immediate restorative material is considered as the key of long term success. The purpose of this study was to compare the sealing ability of Amalgam, MTA, Geristore which place in furcation perforation.Methods & Materials: In this experimental study, Fifty-five extracted human molar teeth were allocated randomly to three groups (n=15). Furcal perforations were made in teeth using an ISO 012 round bur in a slow – speed handpiece. Three different dental materials including Amalgam (group 1), MTA (group 2), Geristore (group 3) were used to repair the perforation areas. The microleakage at the repaired sites was then tested by dye penetration and cleaning method and evaluated under stereomicroscope at x20 magnification. The all data were statistically analyzed with ANOVA & Mann – Whiteny tests. The findings have shown that the perforation repaired with MTA and Geristore leaked significantly less to the tracer dye than those repaired with Amalgam (P=0.000), however, there was no statistical difference between MTA and Geristore (P=1.000). The results of this study support usage of Geristore and MTA with high seal ability for perforation repair.

The role of genetic factors in etiology of dental caries is not clear. It seems that twins studies provide valuable material. Thus the aim of the present study was comparison of the total caries experience (DMF and dmf) of 21 pairs of monozygotic twins with that of 29 pairs of dizigotic twins. Methods & Materials: In this descriptive and analytical study, twenty on pairs of monozygotic twins and 29 pairs of dizigotic twins were examined. Determination of zygosity blood group, similarity of a physical features was done. DMF, dmf and Debri Index were determined. T and Spearman correlation tests were used to compare the differences. Results revealed no significant differences in intra and inter pair between the groups. Although, resemblance in DMFT between monozygous twins was greater on the other hand. Debri index and consumption of cariogenic food had highly significant differences in subjects. It can be concluded that environmental factors are major one’s in the etiology of dental caries.

Recognizing canal configuration is necessary for a correct endodontic therapy and having no information about canal configuration causes failure in therapy. Since one of the most effective factors in canal configuration is race، we decided to have a laboratory and clinical research in Isfahan. The aim is to recognize canal configuration of the mandibular first premolar and compare the clinical and laboratory results. Methods & Materials: 1- Laboratory study (Invitro): At first we selected 127 mandibular first premolar، then we disinfected them in CLONA 5. 25%. We made a correct access cavity on the teeth. In order to vacate pulp tissue in chamber and canals, we placed them in H2O2 35% for 15 days. Then we placed them in HNO3 5% for 3 days to be decalcified. Then we used 70%, 90%, 100% isopropyl alchole to dehidrate the teeth. After the above proccesses we injected India ink in -1. 8 P, in canals and sealed access cavity by Zonaline cement, we used the teeth in Metyle Salicylate to make clear. Then, we studied canal configuration. 2- Clinical study (Invivo): In this study we selected 125 mandibular first premolar treated in post graduate and under graduate departments of Isfahan University school of Dentistry. Then we studied every radiograph using a negatoscope, and the data were analysed. 1-Laboratory (invitro) Out of 112 mandibular first premolar (researchable), 75 type I (67%), 5 type II (4. 5%), 13 type III (11. 6%), 16 type IV (14. 2%) and 3 (2. 7%) were out of Weine classification. 2-Clinical (invivo) Out of 125 mandibular first premolar, 103 type I (82. 4%), 3 type II (2. 24%), 12 type III (9. 66%), 5 type IV (4%) and 2 (1. 66%) were out of Weine classification. The out coming results of this study are different from other researches. Perhaps the differences are caused by some factors such as race and method. Also the clinical results are too different from laboratory results which could be due to method. The labratory study is more exact.