Journal of Clinical and Experimental Dentistry. 2020. Vol. 12, no. 3

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    Comparison between different surface treatment methods on shear bond strength of zirconia (in vitro study)
    (2020) Joukhadar, Christelle; Ossman, Essam; Rayyan, Mohammad; Shrebaty, Mohammed
    To compare the effect of Er:YAG Laser and Air particle abrasion (APA) surface treatments on shear bond strength of Y-TZP to composite resin cuboids in the presence and absence of primer application and salivary contamination. Seventy-two cuboidal shaped specimens 7x7x3 were prepared from Y-TZP using CADCAM, cleaned and sintered. Specimens were divided into 2 main groups (n=36) according to surface treatment method; Air particle abrasion (A) and laser (L). Each group was subdivided into 2 subgroups (N = 18) according to surface modification using primer; each subgroup was further divided into 2 subdivisions (N=9) according to the presence of salivary contamination; APC (Air particle abrasion, primer, contamination), AP (Air particle abrasion, primer), AC (Air particle abrasion, contamination), A (Air particle abrasion), LPC (Laser, primer, contamination), LP (Laser, primer), LC (Laser, contamination), L (Laser). Composite cuboids having dimensions of 6x6x3 were also fabricated using custom made plexi plates. Composite cuboids were cemented centrally to zirconia cuboids and light cured under 5 kg weight for 6 mins. Shear bond strength of specimens was measured utilizing universal testing machine at a crosshead speed of 0.5 mm/min. Failure loads were recorded in Newton. SBS was calculated according to equation: SBS (MPa) = load (N)/area(mm2). Viewing shear bond strength between studied groups, group APNC (484.02±85.02) showed higher mean value compared to ANPNC (122.09±55.80), also LNPNC (120.87±65.10) showed higher mean value in comparison to LPNC (170.78±53.22). APNC (484.02±85.02) and APC (592.22±189.65) showed higher mean values than LPNC (170.78±53.22) and LPC (3227.66±108.28) in sequence. APA showed higher SBS values than Er:YAG surface treatment. Primer showed better results than no primer coating. Artificial saliva contamination did not affect the SBS of zirconia compared with no contamination results.
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    Bond strength of cemented fiber posts to teeth with simulated internal root resorption
    (2020) Abreu, Ricardo-Toledo; Monteiro, Jaiane-Bandoli; Abu-Hasna, Amjad; Santos, Thaís-da Silva-Alves; Dal Piva, Amanda-Maria-de Oliveira; Pucci, Cesar-Rogerio; Torres, Carlos-Rocha-Gomes; Carvalho, Cláudio-Antonio-Talge
    Teeth with internal root resorption (IRR) have guarded prognosis, considering that IRR defect could influence on the post bond strength. The aim of this study was to evaluate the bond strength and the bond interface between different glass fiber-reinforced posts (FRP) after cementation in teeth with simulated internal root resorption (IRR). Forty-five (45) human premolar roots with simulated IRR were embedded in acrylic resin blocks and cross-sectioned into two segments, enabling them to be re-approximated by screws. Intracanal medication was inserted for 15-days, removed by passive ultrasonic irrigation (PUI) and examined by stereomicroscopy. The push-out bond strength of two fiber reinforced composite posts (Rebilda Post - RP) and Rebilda Post GT ? GT, (VOCO) were evaluated at the cervical and IRR regions (n = 20). And, the bonded interface between resin cement and root dentine was analysed by scanning electron microscopy (SEM). 62.5% of IRR were not completely cleaned by PUI. Bond strength values at the cervical region (9.8 and 14.6 MPa) were higher than the IRR region (6.3 and 4.2 MPa). Micrographies showed bubbles in the cement and spaces in the bonded interface. RP post showed better bond strength at the cervical region while GT had better bond strength at the IRR region.
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    Comparative evaluation of bioactive cements on biomimetic remineralization of dentin
    (2020) Daneshpoor, Nazanin; Pishevar, Leila
    This study was designed to quantitatively compare the presence of apatite peaks on demineralized dentin to induced bio-mimetically by bioactive commercial materials. Dentin slice specimens (n=6) were prepared and demineralized by by17% EDTA for 2 hours. Each disks materials (Theracal, Biodentine, CPP-ACP) were freshly prepared and was maintained in close contact with a demineralized dentin specimen immersed in PBS solution during one week. To evaluation of bioactivity, cements disks (n=6) were prepared from each material and immersed in PBS solution for one week. The bioactivity and remineralization ability was evaluated using FTIR spectroscopy and Scanning Electron Microscopy. The Ca/P ratio of the surface of dentin and cements disks were compared with one -way ANOVA, independent T test and Duncan test (?=0.05). Ca/P weight ratio of Biodentine (187.5) was significantly higher than Theracal (10.10) and Theracal higher than CPP-ACP (0.37) (P=0.008). Demineralized dentin in contact with Test materials, indicated Ca and P peak after 7 days, but not showed statistically differences between the groups (P=0.08). The outcome revealed that bioactive cements and CPP-ACP had bioactivity capability during one week. Biodentine had higher bioactivity between others. Demineralized dentin could be remineralized with bioactive materials.
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    Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis
    (2020) Simpione, Guilherme; Caldas, Rogério J.; Soares, Mariana Quirino Silveira; Rubira Bullen, Izabel Regina Fischer; Santos, Paulo Sergio da Silva
    Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP. All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions. The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change. In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs.
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    Hot air stream reduces cytotoxicity of light-cured calcium hydroxide based cements
    (2020) Klein-Júnior, Celso-Afonso; Zimmer, Roberto; Borghetti, Diana-Lina-Bronca; Portella, Fernando-Freitas; Abich, Flávia-Carolina; Marinovic, Daniel Rodrigo; Hosaka, Keiichi; Reston, Eduardo-Galia
    The light-cured calcium hydroxide based cements have incomplete polymerization and unconverted monomers can cause pulp cell damage. The aim of this study was to evaluate the influence of a warm and hot air stream on the cytotoxicity of light-cured calcium hydroxide based cements. The materials Dycal (conventional cement), Biocal, Hidrox-Cal, and Ultra-Blend Plus (light-cured calcium hydroxide cements) were submitted to cytotoxicity analysis after polymerization, without vs. with previous heat treatment with a warm (37°C) and a hot (60°C) air stream. Following polymerization, cements were maintained in culture medium for 24 hours and 7 days, and subjected to the MTT test. Data were analyzed using analysis of variance (ANOVA) followed by post-hoc Student-Newman-Keuls (<0.05). The results indicated significant differences between the materials according to their composition, i.e., light-cured cements treated with a jet of warm air showed similar cytotoxicity levels to those observed for conventional cement, suggesting that they may be considered alternatives in cases requiring pulp-capping treatment. Application of a hot air stream reduced cytotoxicity of materials tested.
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    Full mouth functional and aesthetic rehabilitation of a patient affected with hypoplastic type of amelogenesis imperfecta
    (2020) Nazeer, Muhammad-Rizwan; Ghafoor, Robia; Zafar, Kamil; Khan, Farhan-Raza
    The management of Amelogenesis imperfecta often poses a challenge for the dentists. It not only includes aesthetic and functional rehabilitation of the patient, but also requires a positive rapport building with the patient due to psychosocial issues. The treatment plan is driven by patient demands, age, cost-affordability, severity of the disease and the presenting condition. The present case report elucidates step by step management of a 20 year-old female who presented with generalized hypersensitivity, intermittent pain associated with multiple decayed posterior teeth, poor dental aesthetics and anterior deep bite. The management consisted of endodontic treatments in all teeth, crown lengthening to gain ferrule in some teeth, provision of provisional bridges at an increased vertical dimension for six weeks followed by full mouth all ceramic crowns on all teeth. The prosthetic management aimed at reorganized occlusal scheme. There was a significant improvement in the aesthetics, deep bite, and along with correction of the vertical dimension of occlusion.
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    Influence of cortical bone and implant design in the primary stability of dental implants measured by two different devices of resonance frequency analysis : an in vitro study
    (2020) Chávarri Prado, David; Brizuela Velasco, Aritza; Diéguez Pereira, Markel; Pérez Pevida, Esteban; Jiménez-Garrudo, Antonio; Viteri Agustín, Iratxe; Estrada-Martínez, Alejandro; Montalbán Vadillo, Oier
    This study aimed to evaluate the effect of the implant design and the presence of cortical bone in the primary stability, as well as analyze the differences between the stability measurements obtained by two different resonance frequency analysis (RFA) devices. A total of 80 Klockner implants of two different models [40 Essential Cone implants (group A) and 40 Vega implants (group B)] were used. The implants were placed in two polyurethane blocks that simulated the mechanical properties of the maxillary bone. One block featured a layer of cortical bone that was absent from the other block. The primary stability of all implants was measured by insertion torque and RFA using two different devices: Penguin RFA and Osstell IDX. Primary stability was superior in the cortical bone in both torque and RFA. In the block containing cortical bone, group A implants obtained a greater insertion torque than did group B. The insertion torque was lesser in the bone lacking cortex. Regarding the ISQ of the implants, group A presented higher values in the block with cortical bone, but the values were lower in the block without cortical bone. There were no significant differences between the values obtained from the Osstell IDX and Penguin RFA. The presence of cortical bone positively influences the primary stability of dental implants. The design of the implant also has a statistically significant influence on implant primary stability, although the impact depends on whether there is coronal cerclage or not. There were no statistically significant differences in the implant stability measurements obtained by two different devices.
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    Evaluation of dentifrices of complementary and alternative medicinal systems on plaque formation and gingivitis : a randomized controlled clinical trial
    (2020) Ramesh, Manumanthu-Venkata; Kumar, Puvvadi-Gopala-Krishna-Naveen; Allamaprabhu, C.R; Kumar, Nerella-Narendra; Yasmeen, Syed-Amtu; Praveen, Gadde; Lakshmi, Thorreti-Venkata-Sandhya
    Bio-film formation is a natural process in the oral environment, but needs to be controlled through regular brushing in order to prevent the development of caries and periodontal diseases. A wide variety of dentifrices of complementary and alternative medicinal systems are available in the market which claims superior plaque control. A randomized controlled double-blinded concurrent parallel clinical trial was conducted with the objective to evaluate and compare the clinical effectiveness of three commercially available dentifrices of complementary and alternative medicine systems with that of a placebo dentifrice on Gingival Index (GI) and Plaque Index (PI) scores after 15, 30, 45 and 60 days of usage among 80 adults aged 35-44 years. The mean GI scores reduced by 29.19 %, 22.28 %, 32.43 % and 10.33 % in the herbal dentifrice, homeopathic dentifrice, conventional dentifrice, and placebo dentifrice groups by the end of the study period. Highest reduction of 33.5% and 34.87 % in PI scores were seen in the herbal and conventional dentifrice. This reduction was statistically significant (p=0.001). The herbal dentifrice tested in the present study has demonstrated anti-gingivitis and anti-plaque efficiency equivocal to the conventional dentifrice. The homeopathic dentifrice was as good as a placebo.
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    Effects of timing of adjunctive systemic antibiotics on the clinical outcome of periodontal therapy : a systematic review
    (2020) Abdallaoui-Maan, Lamiaa; Bouziane, Amal
    Many systematic reviews and meta-analysis have indicated beneficial effects of adjunctive systemic antibiotics in periodontal therapy in specific situations. However, some essential issues such as the ideal time of their administration during periodontal therapy remain unanswered. This systematic review aimed to determine at which phase of periodontal treatment would adjunctive systemic antibiotics lead to the best clinical outcomes, during the active phase or in the reevaluation phase. Searches in the databases Medline, Scopus and Cochrane Library were conducted. The randomized clinical trials and retrospective cohort studies comparing the clinical benefits of adjunctive systemic antibiotic administration in the active phase of periodontal treatment versus their administration in the reevaluation phase were included. The primary outcomes assessed were differences in clinical changes in periodontal pocket depth and clinical attachment loss at all post-treatment phases. Of the 6209 records identified, two randomized clinical trials and two retrospective cohort studies were eligible according to inclusion criteria. Two studies suggested there were greater clinical benefits when systemic antibiotics were prescribed during the active phase of periodontal therapy than in the reevaluation phase while two other studies showed no significant difference in clinical outcomes at 6 months between these two different timing of administration. The evidence available and evaluated in this systematic review is of heterogeneous quality and limited by the restricted number of studies and their dissimilarities in their study design and outcome reporting. Despite insufficient evidence to determine the ideal time to the adjunctive systemic antibiotic administration in the periodontal therapy, it seems that prescription of systemic antibiotic at the active phase of periodontal therapy leads to better clinical outcomes.
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    A high salivary calcium concentration is a protective factor for caries development during orthodontic treatment
    (2020) Cardoso, Andreia-Alves; Tavares-de-Sousa, Emerson; Steiner-Oliveira, Carolina; Parisotto, Thaís; Nobre dos Santos, Marines
    This research aimed to evaluate the salivary concentrations of fluoride (F-), calcium (Ca2+), and phosphate (Pi) after brackets bonding, and to identify the role of [F-], [Ca2+], and [Pi] on the development of active caries lesion (ACL) in individuals under fixed orthodontic treatment. A longitudinal investigation with twenty-two individuals from 11 to 22 years of age was performed in four phases (baseline and after 1, 3, and 6 months). Analyses were carried out considering the salivary concentration of [F-], [Ca2+], and [Pi], as well as the caries index. Data were analyzed using the Friedman test, followed by the Wilcoxon test and the multivariate Cox model (p?0.05). 1 and 3 months after appliance bonding, the [Ca2+] was statistically lower than after 6 months (p<0.0083). On the other hand, salivary [F-] and [Pi] did not show any significant difference during the follow-up. The Cox model demonstrated that the increase of 1 µg/mL in Ca2+ decreased the risk of ACL development by 27%. In conclusion, the levels of Ca2+ changed during orthodontic treatment. A high Ca2+ level in the saliva is a protective factor for ACL development over time.
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    Effect of proanthocyanidin mediated immediate and delayed dentin sealing on the strength of premolars restored with composite resin inlay
    (2020) Shafiei, Fereshteh; Aghaei, Tayebeh; Jowkar, Zahra
    Immediate dentin sealing (IDS) with proanthocyanidin (PA) could be used before cementation with a self-adhesive (SA) cement. The aim of this study was to assess the effect of PA treatment on acid-etched dentin before adhesive application, in IDS and delayed dentin sealing (DDS), on the strengthening property of SA-cemented composite resin inlay in premolars. Eighty-four maxillary premolars were divided into 7 groups (n=12): 1) (Intact) Sound teeth served as controls; groups 2-7) After cavity preparation and fabrication of composite resin inlay, temporary inlays were made and cemented. After one week, the inlays were removed and composite inlays were luted with a self-adhesive resin cement as follows: 2) (SA) Without dentin- pretreatment; 3) (DDS) Etch-and-rinse adhesive before the cementation; 4) (DDS/PA) PA treatment of acid-etched dentin before the adhesive, followed by the cementation; 5) (Etch/PA) PA treatment of acid-etched dentin before the cementation; 6 and 7) (IDS and IDS/PA) Application of IDS without or with PA treatment, respectively, one week before the cementation. After thermo-mechanical aging, fracture resistance (FR) was tested. Data were analyzed using one-way ANOVA and Tamhane tests (?=0.05). There was a significant difference between the study groups (P<0.001). The IDS and IDS/PA groups yielded significantly higher FR compared to the SA group (P ? 0.003), but the DDS, DDS/PA and Etch/PA groups did not differ from the SA group (P>0.05). The effect of PA on FR in the IDS and DDS techniques was not significant. IDS with or without PA treatment considerably improved the strength of premolars with self-adhesive-cemented inlay, while the value of only IDS with PA treatment reached the level of the sound teeth.
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    The effect of silver nanoparticles, zinc oxide nanoparticles, and titanium dioxide nanoparticles on the push-out bond strength of fiber posts
    (2020) Jowkar, Zahra; Omidi, Yekta; Shafiei, Fereshteh
    This study was undertaken to investigate the effect of intraradicular dentin pretreatment with silver nanoparticles (SNPs), zinc oxide nanoparticles (ZNPs), and titanium oxide nanoparticles (TNPs) on the push-out bond strength (PBS) of fiber posts to root dentin using two types of resin cements. Eighty single-rooted human premolar roots were randomly divided into eight groups after endodontic treatment and post space preparation, according to the type of intraradicular dentin pretreatment with different nanoparticle solutions (n=20). The groups included no pretreatment (control) and pretreatments with SNPs, ZNPs, and TNPs. Each group was divided into 2 subgroups (n=10) according to cementation: Excite DSC/Variolink II and ED Primer II/Panavia F2.0. The PBS values were measured in different areas of the post space. The data were subjected to the three-way analysis of variance and Tukey tests (p=0.05). The SNP-pretreated groups showed significantly higher PBS values than the other groups. No significant differences in PBS were noted among the control, ZNP-pretreated, and TNP-pretreated groups. There was no significant difference in the PBS of the fiber posts with respect to cement type. The PBS was significantly lower in the apical region than in the other two regions. There was no statistically significant difference between the PBSs of the cervical and middle thirds. Intraradicular dentin pretreatment with SNPs, TNPs, and ZNPs did not interfere with the PBS of the fiber posts. The best result was obtained for the SNP-pretreated groups for both types of cement. Also, the lowest PBS was found in the apical third of the root canal spaces.
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    Assessment of shear bond strength and microleakage of fissure sealant following enamel deproteinization : an in vitro study
    (2020) Bayrak, Gokcen-Deniz; Gurdogan-Guler, Elif-Beril; Yildirim, Yagmur; Ozturk, Dilek; Selvi-Kuvvetli, Senem
    To evaluate the effect of two different deproteinizing agents (5.25% sodium hypochlorite and Papacarie®) prior to acid etching on the shear bond strength and microleakage of a fissure sealant material. A total of 123 extracted noncarious human third molar teeth were randomly divided into three groups for each test: acid etching alone (control) (C), sodium hypochlorite (NaOCl), and Papacarie Duo® (PC). The shear bond strength tests were performed using a universal testing machine, and microleakage was evaluated using a dye penetration method. The mean shear bond strength values obtained in Group C were significantly lower than those of Group NaOCl and Group PC (p=0.0001). There were no significant differences between Group NaOCl and Group PC (p>0.05). No statistically significant difference was observed among the groups in terms of microleakage (p>0.05). Papacarie Duo® and 5.25% sodium hypochlorite treatments before etching increased the shear bond strength of the fissure sealant. However, pre-treatment with these agents did not decrease the microleakage between teeth and sealant.
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    Evaluation of diode laser application on chemical analysis and surface microhardness of white spots enamel lesions with two remineralizing agents
    (2020) Moharam, Lamiaa M.; Sadony, Doaa-Mohamed; Nagi, Shaymaa M.
    To investigate the effect of diode laser application and two commercial remineralizing agents on the remineralization and surface microhardness of white spot enamel lesions. Sixty specimens were prepared then equally divided into six groups (n=10/group), according to the diode laser and the two commercial remineralizing agents applied to demineralized enamel surfaces (APF gel and sodium fluoride NaF mousse) with or without diode Laser application as follows; Group A; control, Group B; diode Laser application, Group C; APF gel application, Group D; NaF mousse application, Group E; APF gel application + diode Laser, Group F; NaF mousse application+ diode Laser. Then the teeth were investigated for their Ca, P & F ions content and surface microhardness. One-way ANOVA followed by Tukey?s (HSD) post hoc test were used for statistical analysis. Ca ion wt% showed no statistically significant difference between tested groups, with the highest mean value recorded with Group C. P ion wt%, showed a statistically significant difference between Groups A and C, and the highest mean value was recorded for Group A. The highest F ion wt% was recorded for Group C, while the lowest was recorded for both A and B groups. The highest significant microhardness mean values was recorded for Group E, while the lowest was recorded for Group A. Diode Laser treatment of the demineralized enamel surface had a positive influence on the chemistry and surface microhardness and it may represent a promising adjunct for enamel surface remineralization.
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    Influence of resin cement shade on the color and translucency of zirconia crowns
    (2020) Ayash, Ghada M.; Ossman, Essam; Segaan, Lucette G.; Rayyan, Mohammad; Joukhadar, Christelle
    Zirconia crowns are highly attractive for clinicians, although have poor translucency when used as single restorations, in addition to unknown effect of resin cement shade on final cemented crown shade. This study aimed to assess effect of resin cement opacity on color replication potential of different zirconia frameworks with target tooth color, in addition to different zirconia crowns translucency evaluation. Twenty-four zirconia crown restorations were fabricated to restore single central maxillary incisor for 8 patients, divided into 3 groups according to color and type of zirconia used (white Zr core, colored Zr core and monolithic HT Zrcowns). Each group was further subdivided into 2 subgroups according to resin cement shade. Using Easyshade spectrophotometer, Delta E color difference was calculated between each crown parameters using 2 different resin luting cement shades and adjacent target tooth. Translucency parameters (TP) were tested for finished crowns. ?Es obtained were assessed based on ?Eof 1.6 which represented color difference that could not be detected by human eye and considered clinically acceptable. No statistically significant values were found between subgroups related to different resin cement shade. Translucency parameters showed statistically significant different values. Monolithic crowns showed highest translucency parameters followed by Zr crowns on white cores then Zr crowns on colored cores. Resin cement shade didn?t affect final color perception. Monolithic high translucency crowns usage gained advantages of high translucency and delamination prevention. Zirconia crowns could be cemented by opaque or transparent cement without affecting final color.