Journal of Dentistry, Shiraz University of Medical Sciences
Volume:23 Issue: 2, Jun 2022

Statement of the Problem: 

Early childhood caries (ECC) is a serious public health concern in the world. Motivational interviewing (MI) has been used to prevent ECC as a scientifically tested method for advising patients.

The present study aimed to evaluate the effectiveness of MI on prevention of ECC and identify factors shaping outcomes.

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using MI as the intervention and the decay-missing-filled index (dmfs) report as result. Databases including Web of Science, PubMed, Scopus, PsycINFO and Cochrane Library were systematically searched to recognize relevant RCTs evaluating the effects of MI on prevention of ECC from the beginning of 1989 to April 2020. Mean difference and 95% confidence intervals were summarized using a fixed-effect model. Visual inspection of Egger's test was used for potential publication bias in this study.

Six studies comprising 2776 contributors showed that MI had a significant effect on preventing ECC. There was no significant publication bias in the meta-analysis. A sensitivity analysis demonstrated that deleting any of the studies could not affect the significance of pooled results. This meta-analysis showed that MI might prevent ECC.

MI will be effective at any age, whether it is a baby or a child, and more than the number of interview sessions, the quality of the sessions should be considered. Moreover, follow-up for at least 3 years will be very effective.

Statement of the Problem:

 Every effort for increasing the calcium concentration in the saliva would be beneficial for prevention of dental caries. Regarding this issue, the natural products could be considered safer and more cost effective. Sesame is rich in calcium but the data about the effect of sesame on enamel roughness is inadequate.

This study aimed to assess the effect of an experimental sesame gel on the surface roughness of human enamel by using atomic force microscopy (AFM).

In the current experimental study, fifteen enamel slices with 1mm thickness were prepared. They were polished and acid etched to produce a substantial rough surface prior to the first AFM analysis. The enamel blocks were randomly divided into three groups treated with distilled water, fluoride gel, and an experimental prepared sesame gel correspondingly. The treating agent was applied for 3minutes at 0, 8, 24, and 48h intervals and washed by distilled water after each cycles. Ultimately, the final AFM micrographs were prepared. The statistical analysis was performed using paired t-test, one-way ANOVA, and Tukey Post Hoc tests (a=0.05).

Statistical analysis revealed that the surface roughness was significantly reduced in both sesame and fluoride groups (p= 0.017 and 0.018, respectively) while the control group (distilled water) were not noticeably changed (p= 0.12). The control group had statistically significant difference with both the sesame and the fluoride groups (p= 0.007 and 0.007, respectively) while the there was no significance difference between sesame and fluoride groups (p= 0.997). 

Following demineralization by acid etched process, the sesame gel significantly reduced surface roughness of enamel and its effect was similar to fluoride gel.

Statement of the Problem:

 Resin modified glass-ionomer cement (RMGIC) shows low microleakage values. Bromelain enzyme is a deproteinizing agent with an anti-inflammatory effect in human body.Efective cavity treatment is an important factor in reduction of microleakage.

The aim of this study was to determine the effectiveness of the deproteinizing aspect of 10% bromelain enzyme on the microleakage of RMGIC and composite restorations.

In this experimental study, 40 non-carious extracted human molar teeth were categorized in eight experimental groups (n=5). Standard class V cavities were prepared on the buccal and lingual surfaces of the teeth (n=10). The specimen were classified as Group 1, in which 20% polyacrylic acid (PAA) was applied on the teeth then treated with 10% bromelain enzyme; Group 2: 10% bromelain enzyme was applied; Group 3: 10% bromelain enzyme was applied and then treated with polyacrylic acid; Group 4: 20% polyacrylic acid was applied. Groups1 to 4 were restored with RMGIC (Fuji II LC, GC, Japan). Group 5: etched by 37% phosphoric acid and then treated by 10% bromelain; Group 6: 10% bromelain enzyme was applied without etching; Group 7: teeth were deproteinized with 10% bromelain enzyme and then etched with 37% phosphoric acid; and Group 8: cavities were etched with 37% phosphoric acid. In the groups 5 to 8, Adper single bond (3M, ESPE, USA) and filled with composite resin Z350 (3M, ESPE, USA). After thermocycling, the teeth were sectioned. Microleakage scores were measured using stereomicroscope (40×). Kruskal-Wallis and Mann-Whitney tests were used for data analysis (p< 0.05).

Statistical analysis did not show any significant difference in occlusal and gingival margin microleakage in glass ionomer groups (1-4) (occlusal p= 0.218, gingival p= 0.192). Kruskal-Wallis revealed significant difference in occlusal and gingival margin microleakage of Groups 5 to 8 (occlusal p= 0.006 and gingival p= 0.00). Group 5 demonstrated the lowest occlusal microleakage (occlusal mean=0.00).

Applying bromelain or polyacrylic acid did not affect the microleakage of glass ionomer filling. Due to the antinflamatory effects of bromelain, we suggest using it instead of PAA. Pretreatment of 10% bromelain enzyme after phosphoric acid significantly decreased microleakage in the occlusal and gingival margin of composite filling.

Statement of the Problem: 

Osteoblastic differentiation of periodontal ligament stem cells (PLSCs) is essential for alveolar bone regeneration.

The purpose of this study was to compare the potential of two β-tricalcium phosphate (βTCP) products to induce osteoblastic differentiation of human PLSCs.

In this in vitro study, human PLSCs were cultured in mediums supplemented with Guidor Easy-Graft [βTCP+polylactide-co-glycolide(PLCG)+n-methyl-2-pyrrolidone(NMP)] [Sunstar Company, Swiss] or Sorbone [βTCP] [Meta Company, South Korea] as two alloplasts experimental groups, mesenchymal cells differentiated into osteoblasts without alloplast as positive control group, and mesenchymal cells without osteoblastic induction as negative control group. Osteoblastic differentiation was evaluated using Alizarine Red staining and spectrophotometry to assay calcium deposits and real-time polymerase chain reaction to examine expression of alkaline phosphatase (ALP) and osteopontin (OPN) antigens on day 21. Data were analyzed by using SPSS 22 software and one-way ANOVA and Bonferoni tests (p< 0.05).

Spectrophotometry confirmed that calcium deposits were higher in Guidor Easy-Graft group compared to Sorbone group (p< 0.001) and higher in two experimental groups than controls (p< 0.05). According to real-time polymerase chain reaction, level of ALP expression was higher in Sorbone than Guidor and the levels of Guidor, positive control and negative control were equal; OPN levels of the positive control were more than the other groups. OPN levels of Sobone, Guidor and negative control were the same.

These findings indicated that Guidor Easy-Graft and Sorbone enhanced differentiation of human PLSCs to osteoblasts, and could be employed as appropriate bone-graft materials.

Statement of the Problem:

 Orthodontic removable appliances can facilitate the accumulation of certain microorganisms and microbial plaque on tooth surfaces and appliance components. Since long-term use of chemical agents is not recommended, an alternative option would be medicinal plants for disinfection of the oral cavity.

The aim of this study was to assess the efficacy of thymus vulgaris (T. vulgaris) essential oil to decrease the count of candida albicans (C. albicans) accumulated on removal orthodontic appliances

In this 2-arm parallel controlled clinical trial, forty-four patients whose removable orthodontic appliances were contaminated with C. albicans were randomly divided into two groups by electronic random sampling. In the first group, T. vulgaris essential oil spray and in the second group, 0.2% chlorhexidine (CHX) spray was applied to the appliances. Thereafter, the C. albicans colony count was measured at baseline (T0) and at 2 (T1) and 5 (T2) days after the intervention. Microbial samples were collected by a sterile swab from 3 spots on the internal surface of orthodontic appliances. The Friedman test was used for within-group comparisons and the Mann Whitney test was employed to compare the efficacy of T. vulgaris essential oil with CHX.

The results of this study revealed that continuous use of 2%T. vulgaris essential oil or 0.2% CHX significantly decreased the colony count of C. albicans on removable orthodontic appliances; Howevere, no significant difference was noted in the efficacy of 2% T. vulgaris essential oil and 0.2% CHX in decreasing the C. albicans colony count.

T. vulgaris essential oil and CHX have favorable antimicrobial activity against C. albicans. Moreover, 2% T. vulgaris essential oil can be considered as an alternative to 0.2% CHX to eliminate fungal contamination of orthodontic appliances.

Statement of the Problem: 

Various factors have been introduced to achieve normal occlusion. One of them is anterior teeth torque that has a significant effect on orthodontic treatment outcomes.

The aim of this study was to investigate the effect of changes in anterior teeth torque on changes in the space occupied by six anterior teeth by using computer-aided three-dimensional interactive application (CATIA).

In this experimental finite element study, acrylic teeth with pre-adjusted MBT braces were aligned and three-dimensional (3D) scans were made by 3Dscaner. In the CATIA software program, upper incisors’ torque was changed to -2, -4, -6, +2, +4 and+6 degrees and in the lower incisors to -1, - 3, -5, +3 and+5 degrees; the space was measured at 3 heights of maxillary incisor crowns and at incisal edges of mandibular incisors. Then maxillary incisors were then tapered and the measurements were made again. To evaluate the effect of tooth size, these procedures were carried out on teeth with +17% and -17% magnifications

The results showed that by increasing anterior torque from 14.7 to 20.7 degrees in maxillary incisors, the space occupied by anterior teeth increased. Maximum changes were at cingulum height with 1.421mm. Reduction in anterior torque from 14.7 to 8.7 degrees resulted in a decrease in this space and maximum changes were observed in the cingulum height with 1.824mm. In the mandibular arch, a 10-degree change in anterior torque resulted in an -.752mm change in the space. Changes in the space occupied by anterior teeth was not significant in tapered and normal teeth in +6 and -6-degree torque (p Value= 0.78 and p Value=0.83).

By increasing or decreasing the incisors’ torque, the space occupied by anterior teeth increased and decreased, respectively. These changes were less in tapered teeth. Size variations had no significant effect on the results.

Statement of the Problem: 

Predictable bone regeneration is an objective in implant and periodontal treatments and barrier membranes may play a significant role in osteogenic reconstruction and differentiation.

We compared the osteoblastic differentiation level of bone marrow stem cells in the vicinity of different barrier membranes.

In this experimental in vitro study, human collagen membrane (HCM; Regen), xenogeneic collagen membrane (XCM; Jason), human acellular dermal matrix (HADM; Regen), and xenogeneic acellular dermal matrix (XADM) were used in 4 groups. No membranes were used in the control group (5th group). Bone marrow stem cells with 150,000 cells/well density were added to the culture medium. Cellular differentiation was assessed through real-time quantitative reverse transcription polymerase chain reaction (QRT-PCR) for alkaline phosphatase (ALP) and osteopontin (OPN) gene expression, and Alizarin Red staining after 21 days. Data were analyzed using Kruskal- Wallis and Mann–Whitney statistical tests on SPSS 20 software (p Value< 0.05).

ALP gene expression was significantly higher in HCM group compared to other four groups (p< 0.009) followed by XADM, control, HADM and XCM groups, respectively (p< 0.001). OPN gene expression was significantly more prominent in HCM group compared to other groups (p< 0.01) followed by XADM group in which OPN gene was expressed significantly more than XCM group. OPN gene expression was not significantly different in HADM and control groups (p= 0.52). Light absorption rate was higher in HCM group compared with other groups (p< 0.012). Light absorption rate was not significantly different among HADM, XADM, and control groups (p> 0.05), though it was higher in XCM group (p= 0.009).

Bone marrow stem cells show different levels of differentiation in the vicinity of different membranes. Generally, cell differentiation was more prominent in the vicinity of human collagen membrane.

Statement of the Problem:

 Saliva is a precious oral fluid that contributes to oral health and often goes unnoticed until its quantity is diminished. This hampers the quality of life. Individuals suffering from diabetes are often found to have a complaint of reduced salivation due to the consumption of xerogenic drugs and autonomic neuropathy.

Our study aims to evaluate the effectiveness of the Transcutaneous Electric Nerve Stimulation (TENS) device on the salivary flow rate with respect to age and gender in Jaipur population.

A descriptive type of observational study was carried out on individuals in Jaipur at the Department of Oral Medicine & Radiology at Rajasthan Dental College & Hospital during a period of 7 months (August 2019- February 2020). The study consisted of 200 individuals who were divided into two Groups. Group I consisted of 100 healthy adult subjects of age range 20-40 yrs. and Group II consisted of 100 individuals of >40 yrs. of age (50 non-diabetic and 50 Type II diabetics). Unstimulated and stimulated saliva was collected for 5 mins. in a graduated beaker. Stimulated saliva was collected after keeping the TENS unit activated at 50Hz. p value <0.05 was considered to be significant.

Kolmogorov-Smirnov and Shapiro-Wilks normality tests were used to check if the variables follow normal distribution. Mann Whitney U test was used to compare mean between groups. The TENS unit was effective in increasing the quantity of stimulated saliva and a highly statistical significance was seen in age groups. TENS was also found to be more effective in increasing saliva in diabetic individuals. The mean age for Group I was 28.36±3.1, for Group II non-diabetic individuals was 53.56±7.8 and for Group II diabetic individuals was 52.16±7.4. The mean unstimulated salivary rate was 1.64ml/5min and the mean stimulated salivary rate was 1.914ml/5min for Group I. The mean unstimulated salivary rate was 1.231ml/5min and the mean stimulated salivary rate was 1.547 ml/5 min for Group II. The p value for Group I & II for unstimulated saliva was 0.01 and for stimulated saliva was 0.03.

TENS is an effective treatment modality for stimulating saliva. Salivary values may diminish with age so TENS can be used in aged individuals and also in diabetics to increase the quantity of saliva.

Statement of the Problem:

 The risk of debonding of the orthodontic eyelets due to blood contamination from the impacted tooth is a clinical problem that orthodontists face routinely.

This study aimed to assess the effect of hemostatic agents (Viscostat clear and Astringedent X) on shear bond strength (SBS) of orthodontic eyelets bonded with conventional (Transbond XT) and universal adhesive (GC-G Premio bond) adhesives.

In this experimental study, 84 freshly extracted bovine lower incisors were randomly divided into 7 groups namely TBXT, Blood, SEP, VISCO + TBXT, VISCO + SEP, ASTX + TBXT, and ASTX + SEP groups. In the TBXT group, teeth were etched with phosphoric acid gel, and then, the Transbond XT primer was applied and eyelets were bonded with Transbond XT. In the blood group, first, contamination with blood was done followed by the same procedure as TBXT. In other groups, the teeth were etched with phosphoric acid and based on their group allocation, Transbond XT primer (in TBXT groups), GC-G Premio Bond (in SEP groups), ViscoStat Clear gel (in VISCO groups), or Astringedent X (in ASTX groups) were applied. The SBS was measured for each group and the adhesive remnant index (ARI) was determined.

The mean SBS was 20.79 MPa in VISCO+SEP group, 19.2 MPa in the TBXT group, 16.06 MPa in the SEP group, 15.43 MPa in VISCO+TBXT group, 9.39 MPa in AST-X+TBXT group, and 1.62 MPa in the blood group. The SBS of ASTX+SEP, blood and TBXT+ASTX groups had significant differences from the SBS of the control group (p< 0.05). The ARI score of 0 had the highest frequency in the blood group.

Due to the high coagulative effect of Astringedent X and acceptable SBS of Astringedent X in combination with GC-G Premio bond, this combination can be recommended for exposure of impacted teeth that are at high risk of blood contamination.

Statement of the Problem:

 The use of a new antimicrobial combination in the regenerative endodontic treatment of immature teeth pulp necrosis is a well-known method. Concerns have been raised about the destructive effect of this combination on the stem cells from the apical papilla of permanent human teeth, and there is a study gap.

The main objective of the present study was to investigate the cytotoxic effect of modified triple antibiotic paste (mTAP) on stem cells from the apical papilla (SCAPs) of permanent human teeth.

In this in vitro study, stem cells were removed from the immature teeth. After cultivation and third passage, metronidazole, ciprofloxacin, minocycline, and clindamycin were placed in the cell culture medium alone ,  paired, and in combinations as triple antibiotic paste (TAP) (metronidazole, ciprofloxacin, and minocycline) and mTAP (metronidazole, ciprofloxacin, clindamycin) with doses of 25, 50, 100, 200, 400μg/ml. After 1 and 3 days, cell viability in the culture medium was assessed using the MTT method ([4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). SPSS software version 24, descriptive statistics methods, and statistical tests such as Kruskal-Wallis and Mann-Whitney tests were adopted to analyze the data.

Analysis of MTT findings indicated that the use of mTAP at 100μg/ml and TAP at 200μg/ml had no adverse cytotoxic effect on stem cells in the first 24 hours, compared to the control group. The cell viability decreased at higher concentrations, although it was not statistically significant. After 72 hours, the toxicity of concentrations higher than 100μg/ml of mTAP and 400 μg/ml of TAP significantly mitigated the percentage of viable cells.

The obtained results demonstrated that the concentration of 100 μg/ml of mTAP could replace TAP in regenerative endodontic treatments at the studied time intervals without worrying about the toxicity.

The treatment choice in the management of odontogenic cysts in the mixed dentition period depends upon the size, location of the cyst, the bone integrity of the cystic wall, and its proximity to vital structures. Enucleation is indicated with smaller cysts, achieved by careful removal of a complete cyst without rupturing the cystic lining. Marsupializationand decompression are the treatments of choice for larger cysts as it can help to preserve the tooth bud of the successor tooth and reduce morbidity. Marsupialization is achieved by opening and deroofing the cyst, and making the cystic lining continuous with the oral cavity or surrounding structures by suturing the edges of the incised mucosa to the cystic wall. This helps in maintaining the patency of the cystic lesion. In the decompression, a cylindrical device (drain) is placed in the lesion, which maintains communication between oral cavity to cystic lesion. This decreases the intracystic pressure and results in bone formation. We present two cases of odontogenic cyst in children, where we used a modified decompression technique. We developed a modified surgical stent with the use of a Hawley’s appliance, which led to cystic decompression, and eventual eruption of the successor tooth. Notably, this modified technique also reduced both patient discomfort and the number of clinical visits, making it an effective treatment option. The unique design of the appliance also acted as a space maintainer for the eruption of successor tooth, which is very critical in mixed dentition for future prevention of space loss and eventual malocclusion. The advantage of our design was its easy removal and insertion with minimal discomfort.

Leiomyosarcoma is a malignant tumor arising from smooth muscle cells accounting for 10-20% of soft tissue sarcomas and less than 2% are located in head and neck region. We report a case of leiomyosarcoma of maxilla in a 26-year-old female patient referred to Shahid-Beheshti University of Medical Sciences, Faculty of Dentistry. Patient complained of swelling of left side of the face from 5 months ago without a history of significant illness. Clinical examination showed asymmetric swelling of left side of the face with tenderness. The lesion in the left buccal vestibule was tender to the touch and contained erythematous mucosa with a firm tissue. Results of the neck computed tomography (CT) scan indicated mucosal thickening in the left maxillary sinus. In the preoperative magnetic resonance imaging (MRI), a mass with an estimated size of 4.7×3.1×3.0cm was found, extending from the posterior wall to the posterolateral wall of the left maxillary sinus, causing impression and remodeling of the sinus wall. Incisional biopsy was preformed and immunohistochemistry suggested leiomyosarcoma. Partial maxillectomy of the posterior maxillary walls was performed, using an intraoral incision and dissection from the maxillary vestibule up to the mandibular vestibule. The tumor was excised using frozen section. Pathological examination reported the lesion compatible with leiomyosarcoma, with all surgical margins free of tumor. Post-operative MRI showed no definite mass in the region. In conclusion, according to the present results, the clinical features of leiomyosarcoma of the maxilla are clear, and diagnosis is feasible.