Frontiers in Dentistry
Volume:10 Issue: 3, May 2013

This study was conducted to compare the mandibular bone density between postmenopausal women with normal skeletal bone mass density (BMD) and those with low skeletal BMD using digital panoramic radiographs. One hundred fifteen postmenopausal women were divided into normal and osteoporotic/osteopenic groups. Digital panoramic radiographs were prepared using Digora PCT Sorodex equipment and Promax panoramic X-ray unit (Planmeca, Helsinki, Finland, Kvp=68 and mA=9). The mandibular bone density of an area (approximately 4×4 mm), exactly near the distal edge of the right mental foramen was determined in digital panoramic radiographs using Digora for Windows (DfW) Software. There was no statistically significant difference in mandibular bone density between the normal and osteoporotic/osteopenic participants (P >0.05). Mandibular bone density was not statistically different in normal and osteoporotic individuals with SBMD or FBMD T-score -2.5 (P >0.05). Density of the region of interest differed significantly between the normal and the osteoporotic group with SBMD and FBMD T-score -2.5 (P <0.05). The same results also gained in women who were osteoporotic only in the femoral region (P <0.05). Mandibular bone density in subjects with low BMD was related to FBMD. So, digital panoramic radiographs could be beneficial in the diagnosis of postmenopausal women who are at risk of osteoporosis.

The facial esthetics after orthodontic treatment and orthognathic surgery may be affected by the patient’s natural head position. The purpose of this study was to evaluate the natural head position for the three skeletal classes of malocclusion. Our sample consisted of 102 lateral cephalometric radiographs of patients aged 15 to 18 years; class I (n=32), class II (n=40) and class III (n=30). Nine landmarks of the craniofacial skeleton and three landmarks of the cervical vertebrae were determined. Variables consisted of two angles for cervical posture (OPT/Hor and CVT/Hor), three angles for craniofacial posture (SN/Ver, PNS-ANS/Ver, and ML/Ver) and five for craniofacial angulation (SN/OPT, SN/CVT, PNS-ANS/OPT, PNS-ANS/CVT, ML/CVT). The data were analyzed statistically using ANOVA and post hoc tests. PNS-ANS/Ver and SN/Ver differed significantly (p<0.05) among the three groups. There were no significant differences between class I and class II malocclusions for the indicator angles of cranial posture except for ML/Ver. The SN/CVT was significantly different for class I compared to class III patients. A head posture camouflaging the underlying skeletal class III was observed in our population. A more forward head posture was observed in skeletal class III participants compared to skeletal class I and II and that class III patients tended to incline their head more ventral compared to class I participants. These findings may have implications for the amount of jaw movements during surgery particularly in patients with a class III malocclusion.

Intra-oral appliances such as transpalatal arch and Nance appliance fail to resist against forces that tend to loosen the anchorage. The infirmity arises due to the long lever arm and the mesial force that is perpendicular to the long axis of the appliance. The butterfly arch is presented here as an intra-oral appliance that withstands the mesially directed forces with a mechanism that puts strain on a stiff wire along its long axis. The unique shape of the butterfly arch is advantageous in maximum anchorage cases, cases in which arch width preservation is critical and cases with a vertical growth pattern. With the aid of the butterfly arch, clinical concerns such as patient cooperation, wearing extra-oral appliances, complicated mechanics in extraction cases and control of the arch length, arch width and vertical dimension would be greatly diminished.

The efficacy of correctly applied fissure sealants has been revealed in the prevention of caries. Saliva and moisture contamination of the etched enamel surface before sealant placement can decrease the bonding strength of the sealant to the enamel. The aim of this study was to test the new bonding agents containing nano-fillers in order to reduce the negative effect of saliva contamination on the sealant micro leakage. Seventy five sound human premolars were randomly assigned to five equal groups as follows: Group A: etching, sealant; Group B: etching, saliva contamination, sealant; Group C: etching, saliva contamination, Single bond, sealant; Group D: etching, saliva contamination, Adper Single bond 2, sealant; Group E: etching, saliva contamination, N Bond, sealant. The samples were thermo-cycled and immersed in basic fuchsine 0.5% by weight. Then, the teeth were sectioned bucco-lingually and parallel to the long axis into two segments. Finally, the length of dye penetration at the sealant-tooth interface was scored according to a four-point scale. Micro-leakage was higher in group B compared to the other groups, while there were no differences among the evaluated dentin adhesives. The use of nano-filled bonding agents as an intermediate layer between the etched enamel and the sealant can reduce sealant micro-leakage after saliva contamination at the level of the uncontaminated enamel.

Certain conditions limit the independence of deprived people. However, those conditions do not limit the right of these people to receive dental care. Portable dental units may make it possible for the deprived and elderly to receive the care they deserve in more areas. This study aimed to explore dentists’ perceptions of the use of portable dental units in community outreach programs as a precursor to our quantitative study in the future. Qualitative semi-structured interviews were conducted by one interviewer, seven dentists, two specialists, and 11 final-year dental students who had experience with portable dental units in Isfahan, Iran. The qualitative research method was chosen first due to the rarity of information readily available about the units and second due to their specialist application; with which only certain members of the dental community have experience. Participants described a range of observations they had made whilst using the portable dental units in different locations. The qualitative data were primarily concerned with the range of ideas the interviewers distinguished as relevant when describing the portable dental units. The predominant view most noted within interviews was that the portable units are very useful for the community outreach programs, with two subcategories of serviceability and access to oral health. Other factors mentioned were the competence of the portable dental unit and the factors affecting each individual patient. Our findings illustrate a number of features that may enhance the reputation of portable dental units, due to their useful nature.

The aim of this study was to assess the amount of interdental bone in posterior areas of the mandible for placing orthodontic mini-implants to provide and control anchorage in orthodontic treatment. The amount of interdental bone in areas between the second premolars and first molars, first and second molars on the right and left sides of the mandible were determined in fifty patients by RVG using periapical radiographs. The images were assessed using Cygnus Media Software to determine the mesio-distal width of the interdental bone, starting at the crest of the alveolar bone (2 mm below the CEJ) every one millimeter up to 12 mm from the CEJ. The actual amount of interdental bone and the effect of related factors were assessed using chi-square test at a 95% confidence interval. The minimum desired interdental bone width for placing mini-implants, 3 mm from the CEJ, between the second premolar and first molar and the first and second molars of the mandible on both sides were significantly different (p<0.01): 1.8 mm (31%) more apical in the area between the second premolar and the first molar. There was also a statistically significant difference between the areas under study on the right side (p<0.002), which was 2.2 mm (44%) more apical in the area of the second premolar and the first molar. The most secure site for placing orthodontic mini-implants in the mandible is between the first and second molars at the height of 5.8 mm from the CEJ.

One-stage full-mouth disinfection technique (FMD) has been introduced to avoid cross-contamination between the treated and untreated regions between treatment sessions. Considering the role of inflammatory mediators in periodontitis, the aim of the present study was to compare the effects of FMD with the quadrant-wise scaling and root planing (Q-SRP) on serum levels of IL-17 and IL-1β in patients with moderate-to-severe chronic periodontitis. Twenty patients with chronic periodontitis were selected randomly and based on inclusion criteria in each group. In order to evaluate the periodontal status, the clinical parameters of bleeding on probing (BOP), clinical attachment level (CAL), probing depth (PD) and modified gingival index (MGI) were measured and recorded before treatment and at 2- and 4-month intervals after treatment. Immunologic parameters of the study such as IL-17 and IL-1β serum levels were determined by special laboratory kits at the same intervals. Data were analyzed by SPSS 15 statistical software. Statistical significance was defined at p<0.05. The results showed a decrease in the means of IL-17 and IL-1β serum levels in both treatment modalities, with no statistically significant differences between the two study groups at the two time intervals (p>0.05). In the evaluation of periodontal parameters, all parameters exhibited clinical improvements in both groups, with no statistically significant differences between the two study groups (p>0.05). Based on the results of the present study it was concluded that both FMD and Q-SRP techniques result in improvements in periodontal indexes and decreases in the serum levels of IL-17 and IL-1β inflammatory mediators.

Despite the recent developments in peri-implant surgical regenerative procedures, re-establishing the hard and soft tissue contour is still a challenge in cases with severe ridge deficiency. It becomes more difficult when incorrectly placed implants cause screw connections to come out onto the labial surfaces of the teeth. A two-part maxillary implant supported fixed restoration was constructed. The first part was consisted of a screw retained sub-structure that replaced gingival portions of the deficient maxilla and the second part was a cement retained super-structure that reconstructed the anatomical crowns of the lost teeth. In this way awkwardly placed implants did not interfere with the desired esthetic result. Another great advantage was that the alterations or repairs on cemented crowns can easily be carried out without compromising the entire construction.

Increased duration of fixed orthodontic treatments leads to increased tooth root degeneration, gum inflammation and tooth caries. To decrease the time period of orthodontic treatment, it is essential to facilitate tooth movement or in other words increase the speed of bone remodeling. Use of low level laser therapy is a method for achieving this goal.

This evidence-based article reviews risk indicators and management of unknown-origin xerostomia. Xerostomia and hyposalivation refer to different aspects of dry mouth. Xerostomia is a subjective sensation of dry mouth, whilst hyposalivation is defined as an objective assessment of reduced salivary flow rate. About 30% of the elderly (65 years and older) experience xerostomia and hyposalivation. Structural and functional factors, or both may lead to salivary gland dysfunction.Study Selection: The EBM literature search was conducted by using the medical literature database MEDLINE via PubMed and OvidMedline search engines. Results were limited to English language articles (1965 to present) including clinical trials (CT), randomized controlled trials (RCT), systematic reviews and review articles. Case control or cohort studies were included for the etiology. Neuropathic etiology such as localized oral alteration of thermal sensations, saliva composition change (for example higher levels of K, Cl, Ca, IgA, amylase, calcium, PTH and cortisol), lower levels of estrogen and progesterone, smaller salivary gland size, and illnesses such as lichen planus, are risk indicators for unknown-origin xerostomia. The management is palliative and preventative. Management of symptoms includes drug administration (systemic secretogogues, saliva substitutes and bile secretion-stimulator), night guard, diet and habit modifications. Other managements may be indicated to treat adverse effects. Neuropathic etiology, saliva composition change, smaller salivary gland size, and illnesses such as oral lichen planus can be suggestive causes for unknown-origin xerostomia. However, longitudinal studies will be important to elucidate the causes of unknown-origin xerostomia.

Full mouth rehabilitation in patients with ectodermal dysplasia (ED) is difficult to manage, especially because the afflicted individuals are quite young when they are evaluated for treatment; therefore, esthetics is an important concern. This clinical report describes the rehabilitation of a 19-year-old girl diagnosed with ectodermal dysplasia. Eleven implants were placed in the maxilla and mandible along with bone grafting to the upper jaw and both arches were constructed by metal-ceramic implant-supported fixed prostheses. This treatment plan seems to be favorable for ED patients.Key Words:

Invasive cervical resorption is a condition that affects the root surface area below the epithelial attachment. Multiple treatment modalities are advocated, involving exposure of the invasive defect, removal of the granulation tissue and sealing with various restorative materials. This report demonstrates conservative treatment of a patient presenting with peri-apical periodontitis in upper right central and lateral incisors, along with Class II invasive resorption defect cervically on the mesial aspect of the central incisor, as a result of trauma. As the patient was not willing for any surgical intervention, only ortho-grade root canal treatment was carried out in both teeth, with Calcium hydroxide as intra-canal medicament. At three year follow-up, the patient remains asymptomatic demonstrating radiographic evidence of infilling of defect with bone-like tissue.Within the limitations of this report, it was seen that this conservative method for halting the progression of invasive cervical resorption could be under taken in patients who are un-willing for surgical intervention or in whom surgery is contra-indicated.