Dental Research Journal
Volume:10 Issue: 5, Sep 2013

The sella turcica is a structure which can be readily seen on lateral cephalometric radiographs and sella point is routinely traced for various cephalometric analyses. The search was carried out using the following key words (sella turcica, bridging of sella, size, shape of sella turcica) and with the following search engine (Pubmed, Cochrane, Google scholar). The morphology is very important for the cephalometric position of the reference point sella, not only for evaluating craniofacial morphology, but also when growth changes and orthodontic treatment results are to be evaluated. This makes it a good source of additional diagnostic information related to pathology of the pituitary gland, or to various syndromes that affect the craniofacial region. Clinicians should be familiar with the normal radiographic anatomy and morphologic variability of this area, in order to recognize and investigate deviations that may reflect pathological situations, even before these become clinically apparent.During embryological development, the sella turcica area is the key point for the migration of the neural crest cells to the frontonasal and maxillary developmental fields. The neural crest cells are involved in the formation and development of sella turcica and teeth. The size of sella turcica ranges from 4 to 12 mm for the vertical and 5 to 16 mm for the anteroposterior dimension. There are many classification systems regarding the shape of sella turcica. Majority of the studies show that about 67% of the subjects had normal appearance and about 33% showed variations. The prevalence of sella turcica bridging is high in class III malocclusions and dental anomalies.

Oral submucous fibrosis (OSMF) is a potentially malignant oral condition effectively linked to the causative habit of chewing areca nut. Since its first description in the 1950s, numerous epidemiological, biochemical, histological, and genetic studies have been reported. While most studies point out to the cause and effect of areca nut, co-additive factors are also implicated in the progression and malignant transformation of this condition. Biochemical investigations have concentrated on outlining such changes in the blood, serum or tissues of these patients and have given insights on the possible pathogenesis of OSMF. This article attempts to compile details of biochemical investigations in OSMF and summarize and infer on the findings.

Dental abscess is a frequently occurring infectious process known to the health practice. The fate ofthe infection depends on the virulence of the bacteria, host resistance factors, and regional anatomy.Serious consequences arising from the spread of a dental abscess lead to significant morbidity andmortality. Acute dental abscess is polymicrobial, comprising of strict anaerobes, such as anaerobiccocci, Prevotella, Fusobacterium species, and facultative anaerobes, such as viridans group streptococciand the Streptococcus anginosus group. Numerous novel, uncultivable and fastidious organisms havebeen identified as potential pathogens with the use of non-culture techniques. The majority oflocalized dental abscesses respond to surgical treatment while the use of antimicrobials is limitedto severe spreading infections. There is a need for good-quality clinical trials of sufficient size toidentify the ideal treatment. The microbiology of the acute dentoalveolar abscess and its treatmentin the light of improved culture and diagnostic methods are reviewed.

Odontomas are among the most common benign odontogenic tumors, which are mostly discovered in the first and second decades of life with no clear sex predilection. The present retrospective study reviews the clinical, radiological, and the histopathological characteristics of odontomas in 19 Libyan patients seen during the last 18 years in our department. Most odontomas in our study were discovered when they obstruct a tooth from an eruption at its normal eruption time although a few cases were noticed on routine radiological examination of the region. Panoramic radiographs computed Tomography Scan of the area and the histopathological examination are helpful to elicit the diagnosis. Two cases in this series were found associating with dentigerous cyst and in another two cases the odontomas were seen erupting intraorally. Odontomas should be considered in the differential diagnosis of the mixed radioopaque radiolucent lesions, especially if they found obstructing the teeth from eruption.

Microleakage is still one of the defects of resin composites that can lead to treatment failure; and re-bonding technique is one of the effective ways to reduce it. This studyevaluated the effect of re-bonding with a surface sealant or a dentin adhesive on microleakage in class V microhybrid, nanohybrid, and packable composite restorations. In this in vitro study, class V cavities with occlusal margins in enamel and cervical margins in dentin/cementum were prepared on the buccal and lingual surfaces of 54 extracted premolars. The prepared teeth were randomly assigned to three groups (3 group’s × 18 teeth each), with each group being restored with microhybrid (Point 4); nanohybrid (Herculite XRV Ultra), and packable (Packable Premise) resin composite. Following finishing and polishing procedures, each group was randomly subdivided in to three subgroups (n = 12). The margins of two groups were both etched and re-bonded with surface sealant (Optiguard) or dentin adhesive (Opti Bond Solo Plus) and control group received no treatment. Specimens were thermocycled 1500 cycles, immersed in a methylene blue, sectioned, evaluated for microleakage using a stereomicroscope at a x 20 and scored on a scale of 0-3. Data were analyzed with Kruskal — Wallis, Mann — Whitney, and Wilcoxon tests (á = 0.05). There were no significant differences among the three resin composites tested, and also no significant differences among subgroups with the same surface treatment. Only the microhybrid and packable composite restorations sealed with Optiguard had significantly lower microleakage compared to the control subgroups at the occlusal margin. There were no significant differences between occlusal and cervical margins regarding the microleakage scores when compared to the control subgroups of microhybrid and packable composite restorations. The re-bonding technique could be considered as an advisable procedure in order to minimize microleakage and its effect might be material-dependent.

Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time. Twenty-five patients who were managed with ridge splitting technique were enrolled. Thirty-eight locations in both jaws with near equal distribution in quadrants received 82 dental fixtures. Beta Tricalcium phosphate (Cerasorb®) was used as biomaterial to fill the intercortical space. Submerged implants were used and 3 months later healing caps were placed. Direct bone measurements before and after split were done with a Collis. Patients were clinically re-evaluated at least 6 months after implant loading. All the data were analyzed by Statistical Package for Social Sciences (SPSS) software version 11.5 (SPSS Inc, Chicago Illinois, USA). Frequency of edentulous spaces and pre/post operative bone width was analyzed. Paired t-test was used for statistical analysis. Difference was considered significant if P value was less than 0.05. Mean value for presplit width was 3.2 ± 0.34 mm while post-split mean width was 5.57 ± 0.49 mm. Mean gain in crest ridge after ridge splitting was 2 ± 0.3 mm. Statistical analysis showed significant differences in width before and after operation ((P < 0.05). All implants (n = 82) survived and were in full function at follow up (at least 6 months after implant loading). Ridge splitting technique in both jaws showed the predictable outcomes, if appropriate cases selected and special attention paid to details; then the waiting time between surgery and beginning of prosthodontic treatment can be reduced to 3 month.

Geographic tongue (GT) was first reported as a wandering rash of the tongue in 1831; however, its etiopathogenesis remains unclear. Increased prevalence of GT has been documented in the pregnancy. The aim of this study was to compare the level of salivary estrogen and progesterone in pregnant women with and without GT. This analytical-descriptive study consisted of 26 pregnant women (13 with GT, 13 without GT) with an age range between 18 years and 45 years. The estrogen and progesterone level was measured during 1st, 2nd and 3rd trimester of pregnancy. Saliva sampling was performed to determine the level of sex hormones. The samples were stored at 80°C and determined by Eliza method. The results were analyzed by t-test and repeated measure ANOVA (α = 0.05). The mean level of estrogen for control and case group was 49.4and 52.33 in the 1st, 71.05 and 74.12 in the 2nd and 109.1 and 112.16 in the 3rd trimester respectively. The mean level of progesterone was 0.72 and 0.72 in the 1st, 1.14 and 1.21 in the 2nd and 1.3 and 1.28 in the 3rd trimester of pregnancy for the control and case groups respectively. Even though, there was no significant difference regarding the level of sex hormones between case and control groups (P > 0.05), but the difference between the level of these hormones during 3 trimesters of pregnancy was significant in each group (P = 0.001). The level of sex hormones is not the only etiologic factor of GT in pregnant women, but other factors such as genetic potential, human leukocyte antigen marker and stress may aggravate the incidence of this lesion.

Periodontitis and gingivitis are one of the most infectious diseases in human. Several studies have been carried out on dependence of periodontitis and stroke. The aim of this study was to investigate the gingivitis and periodontitis as a risk factor for stroke in Iranian population. A case-control study was conducted on 100 patients suffering from stroke as case group, and 100 hospitalized patients as control group. The case group included males and 58 females, and in control group there were 44 males and 56 females. Using a University of North Carolina-15 manual probe, the clinical attachment level, the distance between the cemento-enamel junction and the probed base of the periodontal pocket, were recorded by gingival and periodontal indexes. The data were analyzed by multiple logistic regressions, Chi-square test, Fisher’s test, t-test, Man Whitney, and SPSS11.5 software program. P < 0.05 was considered as significant. The case group included 42 males and 58 females, and in control group 44 males and 56 females were included. In this investigation, the average of gingival index in men and women of case group was 1.22 ± 0.55 and 1.31 ± 0.55, respectively. This study showed that the average of gingival index in case group was more than control group. Periodontal index in both groups in men was more than women. The moderate and severe periodontitis in case group were more than that of control group (P = 0.003, P = 0.001). The result of this study shows that there is a significant relation between stroke and periodontal index; however, there isn’t any significant relation between stroke and gingival index.

The most common technique to anesthetize mandibular primary teeth is inferior alveolar (I.A) nerve block injection which induces a relatively sustained anesthesia and in turn may potentially traumatize soft-tissues. Therefore, the need of having an alternative technique of anesthesia with a shorter term but the same efficacy is reasonable. The aim of this study was a comparison of the efficacy of two anesthetic techniques of mandibular primary first molar. In this randomized crossover clinical trial, 40 children with ages ranged from 5 years to 8 years whose mandibular primary first molars were eligible for pulpotomy, were selected and divided randomly into two groups. The right and left mandibular first molars of group A were anesthetized with infiltration and I. A nerve block techniques in the first and second sessions respectively. The left and right mandibular first molars of group B were anesthetized with I.A nerve block and infiltration techniques in the first and second sessions respectively. The severity of pain were measured and recorded according to sound-eye-motor scale by a certain person. Data was analyzed using Wilcoxon Signed Rank and Mann-Whitney U tests (P < 0.05). The severity of pain was lower in infiltration technique versus I.A nerve block. There were no significant differences between the severities of pain on pulpal exposure of two techniques. It seems that infiltration technique is more favorable to anesthetize the mandibular primary first molar compared to I.A nerve block.

This study compared the effect of adjunctive low dose doxycycline and licorice on gingival crevicular fluid (GCF) matrix metalloproteinase-8 (MMP-8) levels in patients with chronic periodontitis. In this in vivo, experimental study 39 patients with mild to moderate chronic periodontitis were selected. Samples of GCF were collected from three deepest pockets and MMP-8 concentration was measured. Patients were divided into three groups (n = 13). Groups were treated with doxycycline, licorice and placebo. Sampling and measurement of MMP- was repeated after 6 weeks. Data was analyzed by t-paired and ANOVA test. P < 0.001 was considered significant. The decrease in mean of MMP-8 concentration was higher in doxycycline and licorice group in comparison with the placebo group and the difference was statistically significant (P value < 0.001). The decrease in mean of MMP-8 concentration was higher in licorice group than doxycycline group, but the difference was not statistically significant. The present study showed that licorice extract can prevent the production of MMPs by host cells and can be as useful as antibiotics like doxycycline to cure periodontal and other inflammatory diseases. It must be added that no side-effects were observed in usage of licorice extract.

This randomized trial was undertaken to investigate the effect of experimentally induced allergy on orthodontic induced root resorption. A total of 30 Wistar rats were divided randomly into test and control groups. Starting from the first 3 days, the rats in the test group were injected intra peritoneally by 2 mg ovalbumin as allergen and 0.5 mg Alume as adjuvant. Afterward only allergen was injected once a week. The control group was injected by normal saline. After 21 days, Wistar immunoglobulin E was measured and peripheral matured eosinophil was counted. A total of 50 g nickel titanium closed coil spring was ligated between right incisor and first molar. All animals were sacrificed after 14 days. The mesial root of the right and left first molar was dissected in a horizontalplane. The specimens were divided into four groups considering whether force and/or ovalbumin was applied or not. Root resorption was measured and compared among these groups. Repeated measures analysis of variance (ANOVA), and Bonferoni tests were used to analyze the data. The level of significance was determined at 0.05. In general, the differences were insignificant (P > 0.05). As the only exception, the group in which both ovalbumin and force were applied had significantly more root resorption than the group in which neither force nor ovalbumin was applied (P < 0.001). Allergy may increase the susceptibility to root resorption. Application of light force, periodical monitoring of root resorption and control of allergy are advisable.

A comprehensive system of assessing orthodontic need requires the integration of normative clinical measures with patient-based indicators. This study sought to discover weather an oral health-related quality of life measure or Aesthetic Component of Index of Orthodontic Treatment Need (AC-IOTN) could be used as a predictor of orthodontic treatment need. Factors affecting the judgment of patient and dentist about this need are discussed. Oral examination on 597 Iranian students between 13 years and 18 years was done to reach the grade of Dental Health Component (DHC). The Child Oral Health Impact Profile (COHIP) and AC-IOTN were recorded. The diagnostic values of subjective tests were assessed. Multiple logistic regressions were applied to investigate the role of variables in the persons’ perceptions. Half of the 570 eligible students did not need orthodontic treatment either on professional or self-assessment; 60% of patients with definite need had a distinct impact on their quality of life. The specificity of AC to detect the healthy persons was excellent (0.99) but its sensitivity was low (0.08). COHIP score gave a better sensitivity but its specificity was 50%. Caries experience, quality of life, father’s education, and brushing habits were the factors relating to the same judgment of persons and dentists (P < 0.02). Regarding the discrepancies between two assessment methods, present instruments did not meet the predictor’s competencies. The patient-based methods could not substitute the professional assessment, but by identification, the persons with higher impacts would benefit the prioritization process.

A prolonged life of fissure sealant has always been the target for preventing caries in vulnerable newly erupted teeth. The use of preparatory techniques including bur introduction to the fissures is considered among such improving steps. The aim of this investigation was to compare the microleakage level of fissure sealants prepared by a fissurotomy bur or pumice prophylaxis prior to acid etching. Ninety freshly extracted healthy maxillary premolar teeth were randomly selected for this investigation. Teeth were then divided into three fissure sealant preparatory groups of A: Fissurotomy bur + acid etch; B: Pumice prophylaxis + acid etch and C: Acid etch alone. Sealant was applied to the occlusal fissures of all specimens using a plastic instrument. This was to avoid any air trap under the sealant. Sample teeth were first thermocycled (1000 cycles, 20 s dwell time) and then coated with two layers of nail varnish leaving 2 mm around the sealant. This was then followed by immersion in basic fuchsin 3%. Processed teeth were sectioned longitudinally and examined under a stereomicroscope for microleakage assessment using a score of 0-3. Collected data was then subjected to Kruskall-Wallis Analysis of Variance and Mann-Whitney U-test. P < 0.05 was considered as significant. Teeth in fissurotomy bur and pumice prophylaxis groups had significantly reduced level of microleakage than those in acid etch alone (P = 0.005 and P = 0.003, respectively). Use of fissurotomy bur and pumice prophylaxis accompanied with acid etching appears to have a more successful reduction of microleakage than acid etch alone.

Patients undergoing orthodontic treatment experience varying degrees of pain with separator insertion. A survey of patients’ attitude towards orthodontic treatment revealed that pain was the most discouraging factor related to their treatment. Moreover, it was the highest ranking reason for wanting to discontinue care. The purpose of this study was to determine the effect of low-level laser irradiation on dental pain induced by forces from separators in orthodontic treatment. This study was an experimental clinical trial. Twenty nine patients were recruited for this research. Low-level laser irradiation was applied on one half of the maxillary and mandibular arches for 5 days. The opposite half of the arches was considered the control group. Laser irradiation was applied for 30 seconds in the alveolar bone between the second premolars, first molars, and second molars. Pain perception was evaluated with a standardized questionnaire that was answered by patients before and after laser irradiation. Data was analyzed by Wilcoxon and Friedman test. P value ≤0.05 was considered significant. The highest pain level was reported at day 1 following separator placement and decreased gradually until day 5. At day 4 and 5, the pain intensity was lower in the laser group than in the control group; however, this finding was not statistically significant. At day 1 and 3, the pain intensity was higher in the laser group than in the control group; however, it was not statistically significant. At day 2, the pain intensity was lower in the laser group than in the control group and was statistically significant. Our findings suggest that there is no statistically significant difference in pain by using low-level laser irradiation.

The aim of this study was to investigate in vivo biocompatibility of Resilon, compared with gutta-percha, at short and long-term following implantation in a rat subcutaneous implantation model. Male Wistar rats were implanted subcutaneously with either Resilon or gutta-percha or were sham controls. Tissues were harvested at 8 days or 60 days after implantation and were evaluated histologically for inflammation and fibrous encapsulation. The severity of histologic injury, scored on a scale of 0-4 and quantitative analysis of the capsule wall thickness were determined for statistical analysis. Data were analyzed by Student t-test, one-way analysis of variance, Kruskal-Wallis or Mann-Whitney’s tests as appropriate. A value of P ≤ 0.05 was considered statistically significant. No behavioral changes or visible signs of physical impairment were observed at 8 days or 60 days post-implantation. Histopathologic observation of the implanted sites at each timepoint showed that both Resilon and gutta-percha implants induced foreign body reaction, showing minimal to mild inflammatory reactions in most cases, which diminished significantly with time. Compared with gutta-percha, the capsule wall was thinner (P > 0.05) after Resilon implantation at day 8 and significantly (P = 0.01) thicker at day 60. In addition, capsule wall thickness showed a trend to increase with time after implantation in the Resilon groups (P > 0.05), opposed to the significant decrease (P = 0.016) observed after implantation in the gutta-percha groups, suggesting lesser long-term biocompatibility of Resilon. Our findings validate Resilon as an in vivo biocompatible material. However, our data suggest that long-term biocompatibility of Resilon, despite validated, is inferior to that of guttapercha control.

The aim of this study was to assess the infant oral health (IOH) related knowledge, attitudes and practices (KAP) of parents in Udaipur, India. A cross-sectional descriptive study was conducted among 470 parents visiting the Department of Pediatrics, Rabindranath Tagore Medical College and Hospital. A 32-item questionnaire covering socio-demographic characteristics and questions pertaining to KAP regarding IOH care was used to collect the data. Descriptive statistics, Student’s t-test, one-way analysis of variance, and Scheffe’s test were used for the statistical analysis (P ≤ 0.05). Majority of the parents had good knowledge regarding tooth eruption, but had a poor knowledge of cleaning (58.7%) and development of caries (48.5%). Parents in the age group of 25-30 years showed significantly higher mean knowledge (25.90 ± 3.93), attitude (15.71 ± 2.23), and practice (20.09 ± 2.50) scores. Female parents showed a significantly higher mean knowledge (21.45 ± 4.27) and attitude scores (14.97 ± 2.15) than the male parents. Parent’s knowledge on IOH care was inadequate. Health professionals, who are the first to come into contact with expectant and new mothers, need to disseminate appropriate and accurate information about oral health-care for infants.

Corticosteroids (Cs) are used widely for their anti-inflammatory and immunosuppressive properties. They have the potential to cause dramatic improvement as well as produce equally dramatic adverse effects. The clinical misuse like over prescription of the drug should be avoided. Long-term administration may cause many adverse effects leading to impaired oral health. Oral health is usually not considered during management of patients on long term corticosteroid therapy. The aim of this study was to assess the oral health status and radiological changes in the jaw bones of the patients under long-term corticosteroid therapy. Oral health of 100 patients under long-term corticosteroid therapy with a minimum of 3 months duration was compared with sex- and age-matched 100 healthy controls. The clinical examination included complete examination of the mouth and periodontal status. Radiographic evaluation of bone with the help of intra oral periapical radiographand digital orthopantomograph and levels of serum calcium, alkaline phosphatase, and random blood sugar were assessed. ‘Chi-square test’, ‘Kolmogorov-Smirnov test’ and ‘Mann-Whitney U test’ were used for statistical analysis. P < 0.05 was considered significant. Patients on steroids exhibited significantly higher levels of candidiasis and clinical attachment loss of the periodontal ligament, probing pocket depth. Bone density was significantly lower in the study group than that in the control group. Random blood glucose was significantly higher and significant lower levels of calcium were observed in patients on steroids. Long-term use of Cs may affect oral health adversely leading to candidiasis as well as impair bone metabolism leading to a considerable decrease in the mandibular bone mineral density.

The dilated odontoma is an infrequent developmental alteration that appears in any area of the dental arches and can affect deciduous, permanent and supernumerary tooth. Dens invaginatus is a developmental anomaly resulting from invagination of a portion of crown forming within the enamel organ during odontogenesis. The most extreme form of dens invaginatus is known as dilated odontoma. The aim of this case report is to present a rare case of bilateral dilated odontoma affecting a microdontic permanent lateral incisor in a 30 year old female patient with hypodontia and peglateral teeth with its clinical, radiological and histological features, which has yet been not reported. Bilateral presence of dilated odontoma is not a common occurrence, although a single tooth involvement in each case has been reported in the literature.

Mandibular fractures are among the most common facial injuries. This case report demonstrates the efficacy of simultaneous usage of miniscrews and direct bonding techniques without open reduction in an extensive traumatized patient. A 25-year-old girl with multiple injuries in the head and facial region 1 month after a plane crash accident was referred to manage the mandibular fractures. Due to the presence of multiple injuries, a conservative treatment of symphysiseal fracture was performed. In order to keep the fractured fragments of the mandible close together, the anterior teeth of the lower arch were tied by means of the orthodontic wire. Ten miniscrews were used to improve the anchorage units and also, settling the occlusion by means of light intermaxillary elastics. Following the active treatment, clinical and radiographic analysis showed satisfactory healing without any periodontal involvement of the teeth in the fracture line.

Cystadenoma is a rare benign salivary gland tumor that chiefly originates in the minor salivary glands as a cystic growth with papillary projections into the cystic lumen without the lymphoid element. It is further classified into two histopathological variants that have been recognized by World Health Organization as the papillary and the mucinous forms of cystadenoma. Clinically, it is difficult to differentiate from other benign minor salivary tumors and mucous retention phenomenon. Diagnosis is chiefly based on characteristics histological features. It is believed that the salivary gland tumors are difficult to diagnose and interpret because there are varied patterns of presentation. The study of salivary gland disorders has increased in leaps and bounds. The authors report a case of mucinous cystadenoma of the minor salivary gland on the hard palate, which is even rarest of the rarely reported cystadenomas of the minor salivary glands.

Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR), root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.