Dental Research Journal
Volume:13 Issue: 1, Jan 2016

Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the effi cacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age. In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test. The BIS value was signifi cantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was signifi cantly shorter in remifentanil group (P = 0.008 and P = 0.003). It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures.

Obtaining optimal marginal adaption with prefabricated stainless steel crowns (SSCs) is diffi cult, especially after removing dental caries or defects in cervical areas. This situation requires the use of an SSC after tooth reconstruction. This study evaluated microleakage and material loss with fi ve restorative materials at SSC margins. One hundred and twenty primary molar teeth were randomly divided into six groups (n = 20). Class V cavities were prepared on the buccal surfaces of the teeth in groups 1-5. Cavities were restored with amalgam, resin-based composite, glass ionomer (GI), zinc phosphate, or reinforced zinc oxide eugenol (Zonalin). Group 6 without cavity preparation was used as a control. Restorations with SSCs were prepared according to standard methods. Then, SSCs were fi tted so that the crown margins overlaid the restorative materials and cemented with GI. After thermocycling, the specimens were placed in 0.5% fuchsin and sectioned. The proportions of mircoleakage and material loss were evaluated with a digital microscope. Statistical analysis was performed with Kruskal–Wallis and Mann–Whitney tests. The groups differed signifi cantly (P < 0.001). Amalgam and GI showed the least microleakage. Amalgam restorations had signifi cantly less microleakage than the other materials (P < 0.05). Microleakage was greatest with resin-based composite, followed by Zonalin. Material loss was greater in samples restored with Zonalin and zinc phosphate. When SSC margins overlaid the restoration materials, cavity restoration with amalgam or GI before SSC placement led to less microleakage and material loss. Regarding microleakage and material loss, resin-based composite, zinc phosphate, and Zonalin were not suitable options.

The aim of this study was to evaluate apical transportation and centering ability of single-fi le instruments, WaveOne primary, with full rotation versus reciprocation movement using cone-beam computed tomography (CBCT) analysis in curved mesiobuccal (MB) root canal of human mandibular molars. Thirty MB canals of mandibular molars were randomly divided into two groups according to the instrument motion (n = 15): Group 1, reciprocation/WaveOne primary; Group 2, continuous rotation/WaveOne primary. After preparation, the amount of apical transportation and centering ability were assessed by evaluating pre- and post instrumentation CBCT scans in three section (1, 3, and 5 mm from apical foramen). Statistical analysis of the data was performed using Mann-Whitney U-test and Friedman test (α = 0.05). There was no statistically signifi cant difference between two experimental groups in terms of apical transportation and centering ratio at 1, 3, and 5 mm from apical foramen (P > 0.05). Apical transportation and centering ability of WaveOne primary reciprocating instrument did not signifi cantly differ between two motion patterns.

To determine plasma concentrations of bone resorption marker cross-linked N-terminal telopeptide (NTx) of Type I collagen in periodontal health, disease and after nonsurgical periodontal therapy in chronic periodontitis group.In addition, to know the association between plasma NTx levels and the different clinical parameters. Thirty subjects were divided on the basis of their periodontal status and were categorized as Group I: Healthy, Group II: Gingivitis, and Group III: Chronic periodontitis. Group III subjects were treated with scaling and root planing, 6-8 weeks later blood samples were analyzed, and they constituted Group IV. NTx levels in plasma were analyzed by competitive - enzyme-linked immunosorbent assay. All data were analyzed using statistical software (SPSS) (α = 0.05). All the samples tested positive for the presence of NTx. The mean NTx concentration was highest in Group III (18.77 nanomole Bone Collagen Equivalent [nm BCE]) and the lowest in Group IV (16.02 nm BCE). The values of Group I and Group II fell between the highest and the lowest values (16.23 nm BCE and 16.70 nm BCE, respectively).The difference in mean NTx levels in Group III and Group IV were statistically signifi cant. NTx levels in all the groups positively correlated with the clinical parameters. All data were analyzed using statistical software (SPSS) (α = 0.05). Within the limits of this study, it may be suggested that plasma NTx levels may provide distinguishing data between periodontally healthy diseased sites and after nonsurgical therapy of diseased sites.

The effectiveness of low power lasers on incisional wound healing, because of confl icting results of previous studies, is uncertain. Therefore, the aim of this study was to evaluate the effects of low-level helium-neon (He-Ne) laser irradiation on wound healing in rat’s oral mucosa. Sixty-four standardized incisions were carried out on the buccal mucosa of 32 male Wistar divided into four groups of eight animals each. Each rat received two incisions on the opposite sides of the buccal mucosa by a steel scalpel. On the right side (test side), a He- Ne laser (632 nm) was employed on the incision for 40 s. Laser radiation was used just in 1st day, 1st and 2nd day, 1st and 3rd day, and continuous 3 days in groups of A, B, C, and D of rats, respectively. The left side (control side) did not receive any laser. Histological processing and hematoxylin and eosin staining were done on tissue samples after 5 days. Wilcoxon and Kruskal-Wallis tests were used for statistical analysis. Histological analysis showed that the tissue healing after continuous 3 days on the laser irradiated side was better than the control side, but there was no difference between the two sides in each groups (P > 0.05). This study showed that He-Ne laser had no benefi cial effects on incisional oral wound healing particularly in 5 days after laser therapy. Future research in the fi eld of laser effects on oral wound healing in human is recommended.

The management of deep carious lesions can be done by various techniques but residual caries dilemma still persists and bacterial reduction in cavities treated by either partial or complete caries removal techniques is debatable. So the objective of the present randomized clinical trial was to compare microbial counts in cavities submitted to complete caries removal and partial caries removal using either hand instruments or burs before and after 3 weeks of restoration. Primary molars with acute carious lesions in inner half of dentine and vital pulp were randomly divided into three groups of 14 each: Group A: Partial caries removal using hand instruments atraumatic restorative treatment (ART) only; Group B: Partial caries removal using bur; Group C: Complete caries removal using bur and caries detector dye. Dentine sample obtained after caries removal and 3 weeks after restoration, were subjected to microbial culture and counting (colony-forming units [CFU]/mg of dentine) for total viable bacterial count, Streptococcus spp., mutans streptococci, Lactobacillus spp. Three techniques of caries removal showed signifi cant (P < 0.05) reduction in all microorganisms studied after 3 weeks of evaluation, but there was no statistically signifi cant difference in percentage reduction of microbial count among three groups. Results suggest the use of partial caries removal in a single session as compared to complete caries removal as a part of treatment of deep lesions in deciduous teeth in order to reduce the risk of pulp exposure. Partial caries removal using ART can be preferred for community settings as public health procedure for caries management.

This was a retrospective cephalometric study to develop a more precise estimation of soft tissue changes related to underlying tooth movment than simple relatioship betweenhard and soft tissues. The lateral cephalograms of 61 adult patients undergoing orthodontic treatment (31 = premolar extraction, 31 = nonextraction) were obtained, scanned and digitized before and immediately after the end of treatment. Hard and soft tissues, angular and linear measures were calculated by Viewbox 4.0 software. The changes of the values were analyzed using paired t-test. The accuracy of predictions of soft tissue changes were compared with two (1) Use of ratios of the means of soft tissue to hard tissue changes (Viewbox 4.0 Software), (2) use of stepwise multivariable regression analysis to create prediction equations for soft tissue changes at superior labial sulcus, labrale superius, stomion superius, inferior labial sulcus, labrale inferius, stomion inferius (all on a horizontal plane). Stepwise multiple regressions to predict lip movements showed strong relations for the upper lip (adjusted R2 = 0.92) and the lower lip (adjusted R2 = 0.91) in the extraction group. Regression analysis showed slightly weaker relations in the nonextraction group. Within the limitation of this study, multiple regression technique was slightly more accurate than the ratio of mean prediction (Viewbox4.0 software) and appears to be useful in the prediction of soft tissue changes. As the variability of the predicted individual outcome seems to be relatively high, caution should be taken in predicting hard and soft tissue positional changes.

Dental caries is one of the most prevalent infectious diseases affecting humans of all ages. Streptococcus mutans has an important role in the development of dental caries by acid production. The purpose of this study was to evaluate the antibacterial and biofi lm disinfective effects of the oak tree Quercus infectoria galls against S. mutans. The bacterial strain used in this study was S. mutans (ATCC: 35668). Two kinds of galls, Mazouj and Ghalghaf were examined. Galls were extracted by methanol, ethanol and acetone by Soxhlet apparatus, separately. Extracts were dissolved in sterile distilled water to a fi nal concentration of 10.00, 5.00, 2.50, 1.25, 0.63, 0.31, and 0.16 mg/ml. Microdilution determined antibacterial activities. The biofi lm removal activities of the extracts were examined using crystal violet-stained microtiter plate method. One-way ANOVA was used to compare biofi lm formation in the presence or absence of the extracts. The methanolic, ethanolic, and acetonic extracts of Q. infectoria galls showed the strong inhibitory effects on S. mutans (P < 0.05). The minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values for the Mazouj and Ghalghaf gall extracts against S. mutans were identical. The MIC values ranged from 160 μg/ml to 320 μg/ml, whereas the MBC values ranged from 320 μg/ml to 640 μg/ml. All extracts of Q. infectoria galls signifi cantly (P < 0.05) reduced biofi lm biomass of S. mutans at the concentrations higher than 9.8 μg/ml. Three different extracts of Q. infectoria galls were similar in their antibacterial activity against S. mutans. These extracts had the highest biofi lm removal activities at 312.5 μg/ml concentration. The galls of Q. infectoria are potentially good sources of antibacterial and biofi lm disinfection agent.

In order to compensate the adverse consequences of bleaching agents, the use of fl uoride-containing remineralizing agents has been suggested by many researchers. The aim of this study was to compare the effect of applying two remineralizing materials on bleached enamel hardness and in comparison to natural saliva. In this experimental study, 30 enamel samples of sound human permanent molars were prepared for this study. Microhardness (MH) of all specimens was measured and 35% hydrogen peroxide was applied 3 times to the specimens. After completion of the bleaching process, MH of samples was measured and then enamel specimens were divided into three groups each of 10, specimens of groups 1 and 2 were subjected to daily application of hydroxyl apatite (Remin Pro) and casein phosphopeptide amorphous calcium phosphate fl uoride (CPP-ACPF) (MI Paste Plus) pastes, respectively, for 15 days. In group 3, the specimens were stored in the operators’ natural saliva at room temperature in this period of time. Final MH of all groups was measured. The data were analyzed using repeated measures ANOVA (α = 0.05). The hardness signifi cantly decreased in all groups following bleaching. Application of either Remin Pro, CPP-ACPF or natural saliva increased the hardness signifi cantly. The hardness of the three test groups after 15 days were statistically similar to each other. The hardness of enamel increases eventually after exposure to either MI Paste Plus, Remin Pro or natural saliva.

This study was conducted to assess the effect of thickness and hydration condition on the surface microhardness of Endosequence Root Repair Material putty (ERRM; Brasseler USA, Savannah, GA), a premixed bioceramic material. Polymethyl methacrylate cylindrical molds with an internal diameter of 4 mm and three heights of 2, 4, and 6 mm were fabricated. In Group 1 (dry condition), the molds with heights of 2, 4, and 6 mm (10 molds of each) were fi lled with ERRM. In Groups 2 and 3 (wet condition), a distilled water- or phosphate-buffered saline (PBS)-moistened cotton pellet was placed directly on the upper surface of ERRM, respectively. The lower surface of ERRM was in contact with fl oral foams soaked with human blood. After 4 days, Vickers microhardness of the upper surface of ERRM was tested. The data were analyzed using two-way analysis of variance. Signifi cance level was set at P < 0.05. No signifi cant difference was found between the microhardness of three thicknesses of ERRM (2, 4, and 6 mm) with or without placing a distilled water- or PBS-moistened cotton pellet over the material (P > 0.05). Based on the results of this study, it could be concluded that placing a moistened cotton pellet on ERRM putty up to 6 mm thick might be unnecessary to improve its surface microhardness and hydration characteristics.

This study was planned to determine the relationship between bispectoral index (BIS) during dental treatment and recovery conditions in children undergoing two regimes of anesthesia of propofol and isofl urane. In this single-blind clinical trial study, 57 4-7-year-old healthy children who had been referred for dental treatment under general anesthesia between 60 and 90 min were selected by convenience sampling and assigned to two groups, after obtaining their parents’ written consent. The anesthesia was induced by inhalation. For the fi rst group, the anesthesia was preserved by a mixture of oxygen (50%), nitrous oxide (50%), and isofl urane (1%). For the second group, the anesthesia was preserved by a mixture of oxygen (50%), nitrous oxide (50%), and propofol was administered intravenously at a dose of 100 Ng/kg/min. The patients’ vital signs, BIS, and agitation scores were recorded every 10 min. The data were analyzed by repeated measure ANOVA and t-tests at a signifi cance level of α = 0.05 using SPSS version 20. The results of independent t-test for anesthesia time showed no statistically signifi cant difference between isofl urane and propofol (P = 0.87). Controlling age, the BIS difference between the two anesthetic agents was not signifi cant (P > 0.05); however, it was negatively correlated with the duration of anesthesia and the discharge time (P = 0.001, r = –0.308) and (P < 0.001, r = –0.55). The same depth of anesthesia is produced by propofol and isofl urane, but lower recovery complications from anesthesia are observed with isofl urane.

Infl ammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are elevated in end-stage renal disease (ESRD). IL-6 and TNF-α are toxins which deteriorate renal function, and their pathogenic role has been confi rmed in cardiovascular and oral diseases. This study was designed to investigate the salivary levels of IL-6 and TNF-α in patients with ESRD undergoing hemodialysis (HD). Twenty patients with ESRD who were treated with 4 h HD sessions, with low fl ux membrane were included in this cross-sectional study. Average Kt/V index in patients was 1.19 ± 0.1. Twenty age-sex-matched healthy controls with no infectious diseases during 1 month before saliva sampling were selected. Unstimulated whole saliva was collected and TNF-α and IL-6, concentrations were measured using human IL-6 and TNF-α ELISA kits. Independent t test was used to analyze the data using SPSS (α = 0.05). There was a signifi cant difference between dialysis and control groups regarding the salivary levels of TNF-α (P = 0.034) and IL-6 (P = 0.001). Considering the results of this study and reported role of infl ammatory cytokines in the pathogenesis of cardiovascular and oral diseases, measurement of salivary IL-6 and TNF-α in HD patients may help in risk stratifi cation of HD patients and in planning pertinent preventive strategies.

The eventual sequel of dental caries is determined by the dynamic equilibrium between pathological factors which lead to demineralization and protective elements, which in turn leads to remineralization. Remineralization is the natural process for noncavitated demineralized lesions and relies on calcium and phosphate ions assisted by fl uoride to rebuild a new surface on existing crystal remnants in subsurface lesions remaining after demineralization. Hence, the present study was designed to evaluate the effi cacy of fl uoride dentifrices in remineralizing artifi cial caries-like lesions in situ. A double-blind, randomized study with an initial washout period of 7 days was carried out for 3 weeks. Twenty volunteers were enrolled, who wore the intraoral cariogenicity test appliance having enamel slabs incorporated into them, for 3 weeks. 10 participants were instructed to use Group A dentifrice (fl uoride) and the other 10 Group B dentifrice (nonfl uoride) for brushing their teeth. The enamel slabs were analyzed by surface microhardness testing and scanning electron microscopy (SEM) at 3 intervals. No signifi cant differences was seen in the microhardness values recorded for Group A and Group B at baseline and after demineralization (P > 0.05); however Group B exhibited lesser microhardness compared to Group A, after intra-oral exposure (P < 0.05). In the SEM analysis, the Group A enamel surfaces had more regular and longer crystallites to those of the Group B. Fluoride dentifrices avert the decrease in enamel hardness and loss of minerals from the enamel surface to a large extent as compared to the nonfl uoride dentifrices.

The purpose of this report is to present a rare case of a fused mandibular lateral incisor with supernumerary tooth with a follow-up for 18-months. A 35-year-old female patient was referred to our clinic with an extraoral sinus tract in the chin. The intraoral diagnosis revealed the fusion of her mandibular lateral incisors. Vitality pulp tests were negative for mandibular right central and lateral incisors. Radiographic examinations showed a fused tooth with two separate pulp chambers, two distinct roots, and two separate root canals. There were also periapical lesion of fused teeth and mandibular right central incisor, so endodontic treatment was carried out the related teeth. Radiographic examination revealed a complete healing of the lesion postoperatively at the end of 18-months. This paper reports the successful endodontic and restorative treatment of unilateral fused incisors. Because of the abnormal morphology of the crown and the complexity of the root canal system in fused teeth, treatment protocols require special attention.

Surgical procedure for removal of impacted teeth is a challenge for clinicians as it involves accuracy in the diagnosis and localization of the dental elements. The cone-beam computed tomography (CBCT), compared to the conventional radiography, has a greater potential to provide complementary information because of its three-dimensional (3D) images, reducing the possibility of failures in surgical procedures. Two 10-year-old boys presented with aesthetic issues associated with the juxtaposition of ectopic teeth with the permanent ones. Both two-dimensional and 3D preoperative radiographic diagnostic sets were produced. The occlusal and panoramic radiographs were not enough for proper localization of impacted incisors. Thus, the CBCT was used as a surgical guide. After 2 years of longitudinal following, no lesion was recorded, and the orthodontic treatment has proven successful. In all cases, CBCT contributed to both diagnosis and correct localization of supernumerary teeth, aiding the professional in the treatment planning, and consequently in the clinical success. The surgeries were completely safe, avoiding damage in noble structures, and providing a better recovering of the patients.