Journal of Dentistry, Shiraz University of Medical Sciences
Volume:16 Issue: 3, Sep 2015

Statement of the Problem: Refractory nocturnal enuresis possesses a heavy psychosocial burden for the affected child. Only a 15% spontaneous annual cure rate is reported. This patient-level meta-analysis aimed to evaluate the efficacy of rapid palatal expansion to treat nocturnal enuresis among children. A sensitive search of electronic databases of PubMed (since 1966), SCOPUS (containing EMBASE, since 1980), Cochrane Central Register of Controlled Trials, CINAHL and EBSCO till Jan 2014 was performed. A set of regular terms was used for searching in data banks except for PubMed, for which medical subject headings (MeSH) keywords were used. Children aged at least six years old at the time of recruitment of either gender who underwent rapid palatal expansion and had attempted any type of pharmacotherapy prior to orthodontic intervention were included. Six non-randomized clinical trials were found relevant, of which five studies had no control group. Eighty children were investigated with the mean age of 118 (28.12) months ranged from 74 to 185 months. The median time to become completely dry was 2.87 months [confidence interval (CI) 95% 2.07-2.93 months]. After one year, the average rate of becoming complete dry was 31%. The presence of posterior cross bite [relative risk (RR): 0.31, CI 95%: 0.12-0.79] and signs of upper respiratory obstruction during sleep (RR: 5.1, CI 95%: 1.44-18.04) significantly decreased and increased the chance of improvement, respectively. Meanwhile, the other predictors did not significantly predict the outcome after simultaneous adjustment in Cox regression model. Rapid palatal expansion may be considered when other treatment modalities have failed. The 31% rate of cure is promising when compared to the spontaneous cure rate. Though, high-level evidence from the rigorous randomized controlled trials is scarce (Level of evidence: C).

Statement of the Problem: The validity of the Index of Complexity, Outcome and Need (ICON) which is an orthodontic index developed and introduced in 2000 should be studied in different ethnic groups. The aim of this study was to perform an analysis on the ICON and to verify whether this index is valid for assessing both the need and complexity of orthodontic treatment in Iran. Five orthodontists were asked to score pre-treatment diagnostic records of 100 patients with a uniform distribution of different types of malocclusions determined by Dental Health Component of the Index of Treatment Need. A calibrated examiner also assessed the need for orthodontic treatment and complexity of the cases based on the ICON index as well as the Index of Orthodontic Treatment Need (IOTN). 10 days later, 25% of the cases were re-scored by the panel of experts and the calibrated orthodontist. The weighted kappa revealed the inter-examiner reliability of the experts to be 0.63 and 0.51 for the need and complexity components, respectively. ROC curve was used to assess the validity of the index. A new cut-off point was adjusted at 35 in lieu of 43 as the suggested cut-off point. This cut-off point showed the highest level of sensitivity and specificity in our society for orthodontic treatment need (0.77 and 0.78, respectively), but it failed to define definite ranges for the complexity of treatment. ICON is a valid index in assessing the need for treatment in Iran when the cut-off point is adjusted to 35. As for complexity of treatment, the index is not validated for our society. It seems that ICON is a well-suited substitute for the IOTN index.

Statement of the Problem: Lichen planus is a mucocutaneous disease that is relatively common in middle aged individuals. Some studies have shown that oral lichen planus has a potential to progress to squamous cell carcinoma.p21 is a cyclin-dependent kinase inhibitor that regulates the cell cycle, thus it acts as an inhibitor in cell proliferation. This study was aimed to evaluate and compare the immunostaining of p21 (as a proliferation inhibitory factor) in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). In this descriptive cross-sectional study, p21expression was investigated in 24 samples of oral lichen planus (OLP), 24 samples of oral squamous cell carcinoma (OSCC) and 24 samples of oral epithelial hyperplasia (OEH) by employing immunohistochemical staining. The mean percentage of p21-positive cells in OSCC (54.5±6.6) was significantly higher than that in OLP (32.8±6.08) and OEH (9.4±3.8). Moreover, OLP samples expressed p21 significantly higher than the OEH. Kruskal Wallis test revealed a statistically significant difference between the groups regarding the intensity of staining (p< 0.001). According to the findings of this study, the expression of p21 might be related to the potential carcinogenic transformation of lichen planus to SCC. Therefore, continuous follow-up periods for OLP are recommended for diagnosis of the malignant transformations in early stages.

Statement of the Problem: Fissure sealant therapy is among the most effective methods of preventing dental caries. However, it is lengthy and isolation of the teeth is difficult in this procedure especially in young children. Using new hydrophilic fissure sealant may reduce such problems. This study aimed to evaluate the clinical success of a hydrophilic fissure sealant on the lower permanent molar teeth in dry and wet conditions. This clinical trial assessed 31 patients (mean age 8.13±1.77 years) who needed fissure sealant therapy on their first or second mandibular permanent molar. Having performed dental prophylaxis, the teeth were etched and rinsed. Then one of the two was randomly selected and sealed with smartseal & loc in isolated and dry conditions; while, the other was wetted on the etched enamel by using a saliva-contaminated micro brush, and was then sealed with the same fissure as the first tooth. Six and 12 months later, two independent observers examined the clinical success of sealant through checking the marginal integrity, marginal discoloration, and anatomical form. Data were analyzed by using SPSS software, version 16. The bivariate Chi-square and Exact Fisher tests were used to compare the clinical success of the two treatment methods. There was a high interpersonal reliability between the two examiners (K= 0.713). After 12 months, 90.3% clinical success was observed in dry conditions and 83.9% in wet conditions for smartseal & loc; however, the difference was not statistically significant (p= 0.0707). According to the results of this study, it seems that using new hydrophilic fissure sealant can reduce technical sensitivities and consequently decreases the apprehensions on saliva contamination of etched enamel during treatment procedures.

Statement of the Problem: Mucous retention cysts (MRCs) of the maxillary sinus are lesions with undefined pathogenesis. In recent researches, geographical and climatic aspects have been related as risk factors. The purpose of this study was to determine the frequency of MRCs of the maxillary sinus using panoramic radiographs. A total of 631 panoramic radiographs were selected from a secondary database from a private radiology clinic and analyzed by two specialists in dental radiology according to gender, age, month, relative air humidity, and mean temperature. A total of 87 (6.89%) radiographic images were suggestive of MRCs. Thirty-five MRCs (40.22%) were detected on the right side, 10 (11.49%) on the left side and 42 (48.29%) on both sides. A high frequency was detected in female participants (n=45; 51, 72%), those aged 18-35 years (n=31; 35, 63%) and those from August (n=24; 27.59%) and July (n=22; 25.29%). The frequency of MRCs was low, and no statistically significant correlation was found between the prevalence of MRCs and the studied variables with the exception of the mean temperature.

Statement of the Problem: Hemostatic agents may influence the bond strength of different bonding agents. Also, chlorhexidine has shown positive effects on bond strength values and their combination effect has not been reported yet. The aim of this study was to evaluate the effect of contamination with a hemostatic agent on shear bond strength (SBS) of total- and self-etching adhesive systems and the effect of chlorhexidine application after removal of the hemostatic agent. In this experimental study, the occlusal enamel of each sixty caries-free mandibular molars was removed and their midcoronal dentin was exposed. The specimens were then mounted in auto-polymerizing resin 1mm apical to CEJ. Then, the specimens were divided into 6 groups (n=10) based on contamination with a hemostatic agent (H), application of chlorhexidine (CHX) and the adhesive system used; and then were classified as Group 1: Adper Single Bond (ASB); Group 2: H+ASB; Group 3: H+0.2% CHX+ASB; Group 4: Clearfil SE Bond (CSB); Group 5: H+CSB; Group 6: H+0.2% CHX+CSB. Then, composite resin rods (4×2 mm) were built up on the dentin surfaces and after thermocycling, the SBS (MPa) was evaluated. Statistical analysis was performed using two-way ANOVA and post hoc Tukey tests (p< 0.05). There were statistically significant differences between bond strength values of group 1 (ASB) and group 2 (H+ASB) (p< 0.001) and group 1 (ASB) and group 3 (H+CHX+ASB) (p< 0.001). Similarly, significant differences were seen between group 4 (CSB) and group 5 (H+CSB) (p< 0.001) and between group 4 (CSB) and group 6 (H+CHX+CSB) (p< 0.001). Contamination with hemostatic agent reduced the SBS of both total- and self-etching adhesive systems. In addition, application of chlorhexidine after the removal of hemostatic agent had a negative effect on SBS of total- and self-etching adhesive systems.

Statement of the Problem: Casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) increases the mineral content of tooth structure. This may enhance the chemical bonding of glass ionomer cements (GIC) and marginal sealing of their restorations. The aim of this study was to evaluate the effect of CPP-ACP paste pretreatment on the microleakage of three types of GIC. In this study, 72 Class V cavities were prepared on the buccal and lingual surfaces of molars with occlusal margins in enamel and gingival margins in root. The cavities were divided into 6 groups. Cavities in group 1 and 2 were restored with Fuji II, group 3 and 4 with Fuji II LC, and group 5 and 6 with Ketac N100 with respect to the manufacturers’ instructions. In groups 2, 4 and 6, CPP-ACP containing paste (MI paste) was placed into the cavities for 3 minutes before being filled with GIC. The teeth were thermocycled, stained with dye, sectioned, and scored for microleakage under stereomicroscope. Kruskall-Wallis and Chi-Square tests were used to analyze the data. There were no statistically significant differences between the control and the CPP-ACP pretreatment groups in enamel and dentin margins. In pairwise comparisons, there were no significant differences between the control and the experimental groups in enamel margin, and in dentin margins of G1 and 2, G5 and 6; however, a significant differences was detected in dentin margins between G3 and 4 (p= 0.041). CPP-ACP paste pretreatment did not affect the microleakage of Fuji II and Ketac N100 in enamel or dentin, but decreased the microleakage in dentine margins of Fuji II LC when cavity conditioner was applied before surface treatment.

Statement of the Problem: Insolubility is an important criterion for an ideal root-end filling material to both prevent any microleakage between the root canal and the periradicular space and provide sealing ability. Many recent studies have shown that mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) have acceptable sealing ability. The purpose of this in vitro study was to evaluate the solubility of these root-end filling materials. Forty stainless steel ring moulds with an internal diameter of 10±1 mm and a height of 2±0.1 mm were selected. Samples of MTA and CEM were mixed according to the manufacturer’s instructions and inserted into the moulds. The specimens were divided into 4 experimental groups and kept in synthetic tissue fluid (STF) for 2 different time periods (7 and 28 days). The control group contained 8 empty rings. The moulds’ weights were recorded before and after immersion in STF. The changes in the weight of the samples were measured and compared using a two- way ANOVA test at a significance level of 5%. Specimens were evaluated with scanning electron microscopy (SEM) at a magnification of 500×. There was no significant difference in weight changes between MTA and CEM samples (p> 0.05).

Statement of the Problem: The first step towards appropriately planning orthodontic treatment and prevention services is to understand the needs and demands of the target population. However, this is ignored in most developing countries. This study aims to evaluate the attitudes of patients in Fars province towards travelling to the provincial capital (Shiraz) to receive orthodontic treatments. This cross-sectional study randomly selected 420 patients referring to two public and four private orthodontic centers in Shiraz, coming from other regions of Fars province. The patients were interviewed about their demographic status, residing area and the reasons of deciding to receive orthodontic treatment in Shiraz. Data were analyzed by SPSS software, using Chi-square and ANOVA statistical tests. The response rate was 96% (N=403). Near half of the patients (176; 43.7 %) lived 100-200km, and 80 (19.9%) patients lived farther than 200km from Shiraz. Having no orthodontist (54.8%) and no dentist providing orthodontic treatment (39.2%) in their region were the most important factors bringing the patients to provincial capital for orthodontic treatments. High costs of treatment in their home county and hoping to receive treatment of higher quality were the other important motives for lower and higher socio-economic backgrounds, respectively. Friends''/relatives'' recommendation was a more important factor in patients using public clinics for choosing their therapist, while referral from dentists was more important for patients going to private clinics. The patients who lived in counties farther than 200km from Shiraz were more concerned about quality of treatment results than those who lived closer (p= 0.010). A multifactorial approach is needed to provide the desired orthodontic services for people in Fars province so that they would not need to travel to the capital for such treatments.

Statement of the Problem: During the orthodontic treatment, microbial plaques may accumulate around the brackets and cause caries, especially in high-risk patients. Finding ways to eliminate this microbial plaque seems to be essential. The aim of this study was to compare the antibacterial effects of nano copper oxide (CuO) and nano zinc oxide (ZnO) coated brackets against Streptococcus mutans (S.mutans) in order to decrease the risk of caries around the orthodontic brackets during the treatment. Sixty brackets were coated with nanoparticles of ZnO (n=20), CuO (n=20) and CuO-ZnO (n=20). Twelve uncoated brackets constituted the control group. The brackets were bonded to the crowns of extracted premolars, sterilized and prepared for antimicrobial tests (S.mutans ATCC35668). The samples taken after 0, 2, 4, 6 and 24 hours were cultured on agar plates. Colonies were counted 24 hours after incubation. One-way ANOVA and Tukey tests were used for statistical analysis. In CuO and CuO-ZnO coated brackets, no colony growth was seen after two hours. Between 0-6 hours, the mean colony counts were not significantly different between the ZnO and the control group (p>0.05). During 6-24 hours, the growth of S.mutans was significantly reduced by ZnO nanoparticles in comparison with the control group (p< 0.001). However, these bacteria were not totally eliminated. CuO and ZnO-CuO nanoparticles coated brackets have better antimicrobial effect on S.mutans than ZnO coated brackets.

Statement of the Problem: Exposure to patients’ blood and body fluids would prone the dental students to the risk of blood borne infections. Several studies have shown a high prevalence of these exposures in dental settings particularly in developing countries. However, few studies have evaluated the epidemiology of these exposures in dental students in Iran. To assess the epidemiology of occupational exposures among dental students and consequently designing the appropriate interventions in order to prevent these exposures. In this cross-sectional study performed during March to June 2011, all 191 Shiraz clinical dental students were asked to complete a self-administered questionnaire. This questionnaire included demographic information and experience of sharp injuries and mucocutaneous contaminations. Chi square and t-test were employed to evaluate the risk factors of exposure. 80%of the participants were exposed to the patients’ blood or body fluids during their clinical course. No association was found between the exposure and demographic factors. Injection needle and recapping were the most common causes of these injuries. The most common sites that were injured and caused mucocutaneous contamination were finger and face, respectively. The most frequent activity causing contamination was using high-speed rotary instruments. Only 6.4% of the exposures had been reported to the related authorities and the remains were underreported. Blood and body fluid exposure in dental setting is common and a lot of them are not reported. To reduce the hazards of these exposures, infection control authorities should design interventions especially for mentioned high-risk conditions. They should change dental students’ behavior especially regarding not recapping injection needles and using eyewear. Dental schools seem to need a management center and a standard protocol for following up the exposures.

Human T-lymphotropic virus-1 (HTLV-1) can cause adult T-cell leukemia/ lymphoma (ATL/L), which is a rare and aggressive type of blood cancer.Herein, we report a case of ATL/L in a middle-aged man with unusual jaw presentations. The patient presented with mandibular, maxillary and palatal bony hard expansion, accompanied by generalized tooth mobility six months prior to admission to the Department of Oral Medicine. The panoramic radiograph showed generalized rarefaction of jaw bones. After laboratory examinations and bone marrow aspiration, ATL/L was diagnosed in association with HTLV-1. The patient underwent chemotherapy.Although the majority of infections associated with HTLV-1 are asymptomatic, some patients may develop blood diseases such as ATL/L and neurological disorders, mainly HTLV-1 associated myelopathy and tropical spastic paraparesis. ATL/L is a rare hematological malignancy in oral cavity that should be included in the differential diagnosis of cases with jaw swelling or generalized demineralization. Serum levels of anti-HTLV-1 antibodies should be examined in suspicious patients, particularly in endemic regions.

Periodontal regeneration in a one-wall intrabony defect is a challenging and complex phenomenon. The combination therapy of commercially available bone grafts with the innovative tissue engineering strategy, the platelet rich plasma, has emerged as a promising grafting modality for two and three walled intrabony osseous defects. The application of this combination approach was attempted in a most challenging one-wall intrabony defect. Open flap debridement and placement of combination of autologous platelet rich plasma(PRP) and demineralized bone matrix was done in one-wall intrabony defect in relation to tooth #21 in a 30 year old female patient. The 6-month follow- up results showed significant improvement in clinical parameters. Radiographic evidence of bone formation was observed as early as 3 months with almost complete fill by 6 months post-operatively. The results were maintained over a period of 2 years.